GROUP 8: INNA, PUJA, MONIKA, BONIKA

CASES:3,8
Question 3:Case Analysis and Underlying Psychiatry Symptoms
G.E.'s presentation with multiple psychiatric symptoms that span several diagnostic
categories indeed indicates the need for a comprehensive psychiatric assessment.
To reach a proper diagnosis and create an effective treatment plan, a detailed
history and clinical evaluation should include an exploration of his symptoms in
relation to OCD(obsessive-compulsive Disorder), GAD(Generalized Anxiety
Disorder), MDD(Major Deprssion Disorder), and Social Anxiety Disorder.
For OCD, specific attention should be paid to G.E.'s compulsive behaviors such as
checking, and whether they are related to intrusive, uncontrollable thoughts. His
difficulty making decisions and intrusive thoughts may be features of this
condition. It is also noted that individuals with obsessional problems like OCD
may experience a worsening of symptoms when feeling stressed, low, or
tired (MANAGING OBSESSIVE-COMPULSIVE DISORDER, n.d).
In examining GAD, the focus would be on G.E.'s persistent insomnia, excessive
worrying, and difficulty making decisions, which are often characteristic signs of
this anxiety disorder.For MDD, the clinician should explore the sadness G.E. is
experiencing, any changes in appetite or weight, sleep disturbances, and loss of
interest or pleasure in previously enjoyed activities, which could be indicative of
depression.Social anxiety would be considered in the context of G.E.'s reported
discomfort and avoidance of social interactions.
Behavioral observations, psychometric testing, and discussions about personal and
family history of mental health issues may also assist in distinguishing between
these disorders. After diagnosis, a treatment plan possibly involving medication,
therapy, or a combination thereof, would be tailored to address G.E.'s specific
needs. It's crucial to emphasize the importance of seeking help from a medical
professional who can provide an accurate diagnosis and appropriate treatment.

Question 8 Case Analysis and Underlying Psychiatry Symptoms

T.M., a 50-year-old accountant and widower, is facing several complex psychiatric
symptoms that require careful consideration. His presentation suggests a primary
diagnosis of Post-Traumatic Stress Disorder, as evidenced by his recurrent
nightmares, hypervigilance, avoidance of reminders of the traumatic accident, and
intrusive flashbacks. These symptoms fulfill the criteria for PTSD, which includes
intrusive recollections, avoidance, negative alterations in mood and cognition, and
increased arousal and reactivity.
In addition to PTSD, T.M. is also experiencing sleep disorders and restlessness,
which are common in individuals with PTSD and can significantly disrupt daily
living. The superficial sleep and restlessness at night further indicate the
pervasiveness of the trauma's impact on his life.T.M.'s avoidance of situations that
might evoke memories of the accident and his difficulty in discussing or recalling
details about the event hint at emotional numbing, a symptom often related to
PTSD. This avoidance behavior is essential in distinguishing PTSD from other
conditions.
Furthermore, T.M.'s increased use of alcohol to cope with his symptoms and the
decline in his work performance raise concerns about potential alcohol misuse,
which may be functioning as a maladaptive coping strategy.While PTSD seems to
be the most accurate diagnosis, it is important to consider differential diagnoses,
such as an Adjustment Disorder with prolonged depressive reaction, particularly
given the severity and persistence of T.M.'s symptoms after the traumatic incident.
This disorder is characterized by emotional and behavioral symptoms that develop
in response to an identifiable stressor, and T.M.'s avoidance and emotional
numbing, coupled with a decline in work performance, align with such a
diagnosis.Another consideration is Major Depressive Disorder with Mixed Anxiety
and Depressive Features, as T.M.'s disturbed sleep, avoidance of triggers, and
impaired work performance could be indicative of MDD, especially in the
aftermath of a traumatic loss, which can bring about such symptoms.
Given these possibilities, a thorough evaluation of T.M.'s trauma history, coping
strategies, and overall functioning is essential in establishing an accurate diagnosis
and devising a suitable treatment plan. The complexity and overlap of the
symptoms mean that professional assessment is necessary to ensure T.M. receives
the appropriate care and support to address his specific mental health needs.
DRUG TREATMENT FOR G.E.
In the case of G.E., if a definitive diagnosis of OCD, GAD, MDD, or Social
Anxiety Disorder is identified, pharmacologic treatment could be considered as
part of a comprehensive treatment plan.
For OCD, selective serotonin reuptake inhibitors (SSRIs) are often the first-line
pharmacological treatment. SSRIs can help reduce obsessive thoughts and
compulsive behaviors. Examples include fluoxetine, sertraline, and fluvoxamine.
For GAD, SSRIs and serotonin-norepinephrine reuptake inhibitors (SNRIs) are
commonly used. These medications can help manage the chronic worry and
physical anxiety symptoms. Buspirone, an anti-anxiety medication, may also be
used, and for acute anxiety episodes, benzodiazepines may be prescribed with
caution due to their potential for dependency.
For MDD, SSRIs and SNRIs are also typically prescribed to help alleviate
depressive symptoms. Atypical antidepressants, tricyclic antidepressants, and
monoamine oxidase inhibitors can be considered for treatment-resistant cases.
In cases of Social Anxiety Disorder, SSRIs are often used, and in certain situations,
SNRIs or benzodiazepines might be appropriate.

DRUG TREATMENT FOR T.M.

 In the case of T.M., the primary diagnosis indicated is PTSD, alongside concerns
of alcohol misuse. There are psychotherapeutic approaches that are frequently
recommended for PTSD, such as cognitive behavioral therapy, which includes
trauma-focused interventions like prolonged exposure therapy and cognitive
processing therapy. Alongside therapy, several classes of medication can be used:
• Antidepressant medication, specifically SSRIs and SNRIs, are first-line treatments

for PTSD. They can help to relieve symptoms such as sadness, worry, anger, and
feelings of numbness.
• The antipsychotic medication Prazosin is sometimes used off-label for treating

nightmares and sleep disturbances in PTSD.

• Benzodiazepines should be used with caution, if at all, as they can elicit dependency

and are generally not recommended for PTSD or for individuals with a substance
use disorder, like T.M.'s alcohol misuse.
Given the symptom of nightmares in T.M.’s case, which is not uncommon with
PTSD, treatments specifically addressing this aspect could include image rehearsal
therapy or prazosin, an alpha-1 adrenergic receptor antagonist that has been shown
to help reduce or suppress nightmares in some patients with PTSD (Nappi et al.,
2012) (El-Solh, 2018).
NURSING CARE PLAN:
As we can see from the case number 3, the patient is suffering from OCD, which
got deteriorated with overload on the work and hyper anxiety, that was developed
due to his grandmother upbringing.
The nursing problem:
 Patient is suffering from recurring anxious thoughts
 Patient looses weight
 Patient experiencing insomnia
 Patient cannot relax
 Patient feeling suicidal and depressed
 Patient overworks
The nursing diagnosis:
Patient is diagnosed with OCD, which got deteriorated due to overwork and
anxiety thoughts. As patient was brought up by strict parent, is reflected on
his attitude toward himself’s esteem. The perfectionism lead to constant in
satisfaction and suffering over it.
Nursing goals:
 Exposure therapy (give the patient understanding that he is okay/does have
cancer, etc.)
 Help patient to realise his responsibilities and no need for stress over
somebody’s clutter
 Give to patient understanding of his own dreams and wishes
 Work on OCD symptoms
  Help patient with sleep/gaining weight
 Prevent suicidal thoughts and attempts
Nursing interventions:
 Exposure therapy
 Promotions of self-care activities
 Activity and exercise
 Sleep interventions
 Nutritional interventions
 Relaxation interventions
 Encourage patient in the participation of treatment
Evaluation is done, when the patient is noticed to have changes in his life, such as
not over stressing because of the job, positive feedback.
In case number 8, the patient is suspected to have PTSD. Due to the car accident
and not properly lived trauma, patient faced with difficulties to live with the
burden. Trauma lead to alcoholism and attempts to forget the accident.
Nursing problem:
 Insomnia
 Alcoholism
 Poor concentration
 Triggers
 Trauma, which was not lived
 Inability to perform basic tasks (work/driving car)
Nursing diagnoses:
Due to patient past, we can assume that patient is suffering from PTSD.
Nursing goals:
 Encourage patient to vent emotions and give time and space to burst them
out
 Help patient with sleep
 Find the care taker for the daughter until the patient is able to continue
parental duties
 Prevent alcoholism
 Work on triggers
Nursing interventions:
 Speaking therapy with patient
 Group therapy
 Family members are encouraged to take part in the treatment
 Cognitive behavioural therapy
 Normalising periwigs emotions
 Help the client re-experience the trauma and its consequences, and gain
control over the memories.
  Control addictive behaviour
Nursing diagnosis:
The patient should be evaluated when he will go though emotional and acceptance
phases.
1. evaluations of patients at the beginning of the process:

First, mental health examinations are performed to determine the extent to

which the patient is experiencing symptoms and issues associated with post-
traumatic stress disorder (PTSD). Secondly, these tests are performed to
eliminate the likelihood of co-occurring diseases, such as anxiety, depression, or
substance abuse.
It is necessary to conduct an evaluation of the present status of the patient's
health problems as well as any additional medical challenges.

2. Immediately take the necessary steps to ensure that the T.M. is safe and does
not pose a threat to themselves or other employees.
For your safety, you should put together a plan that is both secure and
comprehensive. This plan should include information on who to contact in the
event of an emergency and connections to extra crisis intervention tools.
In order to reduce the patient's feelings of guilt and loneliness, it is vital to
educate T.M. on post-traumatic stress disorder (PTSD) and how other people
react to different forms of trauma. Additionally, it is necessary to normalize the
patient's previous experiences.

3. Specify the areas in which specialized treatment is required: • Patients were

sent to a psychologist or psychiatrist for ongoing treatment, which may include
cognitive behavioral therapy.
It would be beneficial for him to consult with a substance abuse counselor in
order to analyze his drinking habits and devise an efficient treatment strategy.

4. Strategies for Restoring Individual Health:

Sessions of psychotherapy that are routinely scheduled for T.M. will have an
emphasis on the maintenance of trauma, the development of coping strategies,
and the avoidance of exceptionally destructive situations.
Education on proper sleep hygiene should be provided, and if necessary, a
referral to a sleep specialist should be made.

5. Taking measurements, remaining vigilant, and following up: • It is necessary

to provide both practical practices and emotional support, not to mention the
participation of friends and family.
Patients who are suffering from post-traumatic stress disorder (PSTD) should be
encouraged to participate in support groups and individual experience groups.
Physical exercises and other forms of relaxation training, in addition to
techniques for stress management, are included in this category.
Make it a point to check in with T.M. at predetermined intervals to determine
how she is doing, provide her with unwavering support, and make any required
modifications to the treatment plan that she has been following.
• This standardized evaluation instrument can be utilized as a checklist for post-
traumatic stress disorder (PTSD) in order to assess the progression of symptoms
over time.
• To meticulously document in a notebook his symptoms, triggers, and coping
techniques concerning his condition. In order to provide support for T.M., this
information will be checked during follow-up appointments.