St Thomas University Mental

J.T.  is a 20-year-old who reports to you that he feels depressed and is experiencing a significant amount of stress about school, noting that he’ll “probably flunk out.” He spends much of his day in his dorm room playing video games and has a hard time identifying what, if anything, is enjoyable in a typical day. He rarely attends class and has avoided reaching out to his professors to try to salvage his grades this semester. J.T. has always been a self-described shy person and has had a very small and cohesive group of friends from elementary through high school. Notably, his level of stress significantly amplified when he began college.

You learn that when meeting new people, he has a hard time concentrating on the interaction because he is busy worrying about what they will think of him – he assumes they will find him “dumb,” “boring,” or a “loser.” When he loses his concentration, he stutters, is at a loss for words, and starts to sweat, which only serves to make him feel more uneasy. After the interaction, he replays the conversation over and over again, focusing on the “stupid” things he said. Similarly, he has a long-standing history of being uncomfortable with authority figures and has had a hard time raising his hand in class and approaching teachers. Since starting college, he has been isolating more, turning down invitations from his roommate to go eat or hang out, ignoring his cell phone when it rings, and habitually skipping class. His concerns about how others view him are what drives him to engage in these avoidance behaviors.

After conducting your assessment, you give the patient feedback that you believe he has a social anxiety disorder, which should be the primary treatment target. You explain that you see his fear of negative evaluation, and his thoughts and behaviors surrounding social situations, as driving his increasing sense of hopelessness, isolation, and worthlessness.

Questions: 

Remember to answer these questions from your textbooks and NP guidelines. At all times, explain your answers. 

Generate a primary and differential diagnosis using the DSM-5 criteria.

Develop a biopsychosocial plan of care for this client.

Compare and contrast fear, worry, anxiety, and panic.

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St. Thomas University Mental

To analyze and apply critical thinking skills in the psychopathology of mental health patients and provide treatment and health promotion while applying evidence-based research.

Chapter 6, Case 1Trisha is a 28-year-old, unemployed white female. She is no stranger to therapy, having seen counselors for most of her teen and adult years. Her friends would describe her as a “wild woman” who takes no crap from anyone. She has held various part-time jobs for the last few years because she usually gets angry at her boss or coworkers and quits. While she has had a string of boyfriends over the years, she has been seeing one man for the last year or so. He too is unemployed and has both an alcohol and methamphetamine problem. She describes the relationship as “addictive and dysfunctional, yet exciting and hot.” Trisha is back in treatment at the urging of her parents, who describe her behavior as erratic and unpredictable. They also claim that she has periods where she “sleeps little and parties lots.” There were also several occasions in the last five years when she was so depressed she didn’t eat or want to leave the house. Her father also admits to periods of depression, and Trisha’s grandfather was diagnosed with manic depression, resulting in numerous hospitalizations in the 1950s and 1960s. Trisha’s only brother died in a car accident several years ago. He was drunk at the time, but she claims he had a long history of depression. Recently Trisha was arrested for disorderly conduct at a friend’s party. She had not slept for nearly 24 hours and was drunk and combative. When she was first approached by police, she solicited them for sex. They report that she was rather hyperverbal and hyperactive. They later had to investigate a complaint from local storeowners for bad checks she wrote in excess of $7,000.Questions:Remember to answer these questions from your textbooks and clinical guidelines to create your evidence-based treatment plan. At all times, explain your answers. 

  1. Summarize the clinical case.
  2. Create a list of the patient’s problems and prioritize them.
  3. Which pharmacological treatment would you prescribe? Include the rationale for this treatment.
  4. Which non-pharmacological treatment would you prescribe? Include the rationale for this treatment.
  5. Include an assessment of treatment’s appropriateness, cost, effectiveness, safety, and potential for patient adherence.

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