Psychopathology 8

WEEK 8 VIDEO # 115

VIDEO # 115

VIDEO #115

Search transcript

00:00:15>> I see in your chart that you asked 

00:00:15your family physician to 

00:00:20prescribe oxycodone for your elbow pain, 

00:00:20and that your family physician 

00:00:25is worried that some of other medications, 

00:00:30drugs you may use may interact with the oxycodone? 

00:00:35>> Oxycodone is that’s the same as OxyContin? 

00:00:35>> Yeah. Oxycodone is the generic name. 

00:00:40>> Yeah, I did ask for OxyContin, 

00:00:45but I don’t take any other medications or drugs. 

00:00:50I’m opposed to putting anything unhealthy in my body. 

00:00:55>> Okay. What else have you tried? 

00:01:00>> Nothing else works. 

00:01:00>> Ibuprofen, acetaminophen? 

00:01:00>> Not even close. 

00:01:05>> No? 

00:01:05>> Yeah. I mean, 

00:01:05I’m allergic to codeine. 

00:01:05>> Allergic? 

00:01:05>> Yeah, like in Tylenol three. 

00:01:10A little while back, my friend 

00:01:10was in a motorcycle accident and had some leftover, 

00:01:15and I tried one of those, 

00:01:15and I was way allergic. 

00:01:20>> What was the allergic response you had? 

00:01:25>> My face flushed like real bad, 

00:01:25besides it didn’t work. 

00:01:30>> Have you tried morphine? 

00:01:30>> Well, that’s addictive, isn’t it? 

00:01:35>> Yeah, well all the pain medications 

00:01:35or most of them are addictive. 

00:01:35Anti-inflammatory medications are not usually addictive. 

00:01:45>> Yeah, I tried morphine and the codeine, didn’t work. 

00:01:50>> Okay. 

00:01:50>> Yeah, I get headaches too, 

00:01:55so ideally I need something that works for both. 

00:02:00I’d rather not take two medications if I don’t have to. 

00:02:05Less medications the better, 

00:02:05that’s what grandma always said. 

00:02:05>> Grandma? Okay. 

00:02:05>> Yeah. 

00:02:10>> Have you ever tried Dilaudid? 

00:02:10>> Yeah. They gave that to me in the ER once, 

00:02:15but just made me dizzy and constipated. 

00:02:20Constipated for like a month. 

00:02:25>> Oh, wow. 

00:02:25>> I almost had to go back to 

00:02:25the hospital for constipation. 

00:02:25Can you imagine having to go to 

00:02:25the hospital for constipation? 

00:02:30>> Oh my goodness. 

00:02:30>> Yeah, that’s how bad it was. 

00:02:30>> Have you tried Demerol? 

00:02:35>> Yeah, it kind of worked for my headache. 

00:02:40It comes in a shot, right? 

00:02:40>> Yeah. An injection. 

00:02:45>> Yeah, they gave that to me at the hospital. 

00:02:45But that’s the thing, you 

00:02:50can only get it at the hospital, 

00:02:50so it’s not like it’s going to work for me everyday. 

00:02:55It didn’t do anything for my elbow. 

00:02:55OxyContin it’s the only thing that works for both. 

00:03:00The only thing that works for both. 

00:03:00>> You do seem set on the oxycodone? 

00:03:00>> Because it works. 

00:03:05>> What else have you tried other than medications? 

00:03:10>> Other than medications? 

00:03:10>> Yeah. 

00:03:10>> Yoga. 

00:03:10>> Okay. 

00:03:10>> Yeah. Tried that. Other kinds of meditation. 

00:03:20I mean, that’s the thing with meditation is, 

00:03:20it works while you’re doing it, 

00:03:25but then as soon as you stop, zilch. Biofeedback. 

00:03:30>> Good. 

00:03:30>> One doc tried that, same thing. 

00:03:30Works while you’re doing it, 

00:03:35but then when you stop doesn’t help at all. What else? 

00:03:40Like warm, hot compresses, 

00:03:45candles, long walks on the beach, massages. 

00:03:50>> Wow. 

00:03:50>> My boyfriend is really good at massages actually. 

00:03:55He’s studied with this guru in India. 

00:03:55>> Oh, wow. 

00:03:55>> Yeah, swear to God 

00:04:00>> You have tried a lot of solutions. 

00:04:00Let me ask you more about your medication history. 

00:04:05>> I only take stuff for my headache and my elbow. 

00:04:10>> Okay. 

00:04:15>> Like I said, I don’t like 

00:04:15putting unhealthy things in my body. 

00:04:15Vitamins, I take vitamins. 

00:04:20>> Yeah? Okay. 

00:04:20>> Like fish oils, some supplements, 

00:04:20but nothing corporate, nothing pharmaceutical. 

00:04:25I don’t want to put that in me. 

00:04:30Even coming here today, 

00:04:35asking for this, it goes against my values. 

00:04:35>> I see. Okay. 

00:04:35>> But I got to function. 

00:04:40>> Do you drink alcohol? 

00:04:40>> On special occasions 

00:04:45like weddings, funerals, birthdays. 

00:04:50I got a ton of friends, so 

00:04:50whenever we have a birthday we’re going to drink. 

00:04:55Let me think, like holidays, 

00:04:55New Years, and Christmases. 

00:05:00There’s Christmas and then we also celebrate 

00:05:05Russian Orthodox Christmas on January 7th. 

00:05:10>> How often on the average? 

00:05:15>> When you add it all up, 

00:05:15once, maybe twice a week, I guess. 

00:05:20>> Will you drink enough to get intoxicated? 

00:05:20>> Depends on who I’m drinking with. 

00:05:25As Zane, that’s my boyfriend, 

00:05:30he drinks a lot, so 

00:05:30I drink a little more when I’m with him. 

00:05:30>> Any legal problems from the drinking? 

00:05:35>> Once. So dumb. 

00:05:40Yeah, just one little charge for drinking. 

00:05:45I was the tiniest little bit over the limit. 

00:05:45So yeah, I got that and I had to take that course, 

00:05:50that stupid, boring course. 

00:05:50But I learned my lesson. If you’re 

00:05:55a little bit over the limit, 

00:05:55stick to the back roads. 

00:05:55>> So you will still drive? 

00:06:00>> Well, yeah, but I’m super careful. 

00:06:00>> You think after you’ve been drinking, 

00:06:05that’s an okay idea to drive? 

00:06:05>> It’s better than letting Zano drive. 

00:06:10>> Zano? 

00:06:10>> Zane, Zano, same person. 

00:06:15Yeah. He doesn’t even have his license anymore. 

00:06:15Not that it stops him. 

00:06:20>> What about marijuana? 

00:06:20>> Do I use it? 

00:06:25>> Yeah. 

00:06:25>> Marijuana medically helps with my headaches, 

00:06:30so yeah, I use it. 

00:06:35It’s my right. Yeah, it’s 

00:06:35your right. It’s everybody’s right. 

00:06:40>> How often? 

00:06:40>> Not often. 

00:06:45Two, four times a week, sometimes none. 

00:06:50It’s expensive. Then when you do get some, 

00:06:55suddenly everybody is your best friend and you 

00:06:55got to share, you know how it is. 

00:06:55>> Do you ever grow marijuana? 

00:07:00>> I used to. But then we 

00:07:05moved and it’s not legal in this backward state. 

00:07:05Where we live it’s pretty public, 

00:07:10its not really private. 

00:07:10>> Do you ever have any side effects 

00:07:15from using marijuana like memory problems? 

00:07:15>> I was born with memory problems, 

00:07:20Doc, I don’t think it’s from the marijuana. 

00:07:20>> Any legal trouble with the marijuana? 

00:07:25>> Once. I mean, I’m super careful. 

00:07:30But Zano, he went away for 

00:07:30a year for selling 

00:07:35the tiniest little bit to an undercover cop, 

00:07:35which is total entrapment, 

00:07:40which is how I lost custody of Camper. 

00:07:40>> Camper? 

00:07:45>> My son. 

00:07:45>> Oh. 

00:07:45>> Yeah. He’s staying with 

00:07:45my ex husband’s parents right now. 

00:07:50They take good care of him. 

00:07:50>> How long have you been divorced? 

00:07:55>> Oh no, I never married that guy. 

00:07:55>> Oh. 

00:07:55>> No way I would marry that jerk. 

00:08:00No, I don’t know. 

00:08:00It’s been like four years since I’ve even seen him. 

00:08:05Something like that, four years. 

00:08:05>> What happened? 

00:08:10>> Lucas, my ex, 

00:08:10he freaked out because he caught 

00:08:15me doing just a few lines of coke, 

00:08:15but everybody was doing it back then. 

00:08:20Anyway, his mom found the mirror, 

00:08:25and the razors, and Lucas said I had to quit. 

00:08:30For whatever I lied, 

00:08:35and when he caught me, 

00:08:35I know it was bad to lie about that, 

00:08:40but I don’t know it’s in the past. 

00:08:45Water under the bridge. You live, you learn, you move on. 

00:08:45>> Right. Do you use cocaine now? 

00:08:50>> No, hardly ever. 

00:08:55I don’t know, it’s been like a month maybe, 

00:08:55or two months or something since I have. 

00:08:55>> Any legal problems from using cocaine? 

00:09:05>> No, we hardly ever do it. 

00:09:10>> Have you thought about stopping altogether? 

00:09:15>> I hardly ever do it. 

00:09:15Hardly even counts. 

00:09:20I don’t know, when I do it, 

00:09:20it’s just to relieve tension 

00:09:20or it’s this thing Zano 

00:09:25and I do to bring each other closer together, 

00:09:30but I could quit anytime I wanted, easy. 

00:09:35>> Does your boyfriend have children? 

00:09:35>> Yeah, he’s got two kids. 

00:09:40Yeah, but we don’t see them much. 

00:09:45His other with his ex. 

00:09:45>> Oh? 

00:09:50>> She’s a real snobby type. You know the type? 

00:09:50It is a freaking tragedy 

00:09:55because I see his two kids 

00:09:55just going down that same path. 

00:10:00They’re just two little snobs. 

00:10:00It’s a real shame. 

00:10:05We’re not allowed to see them anymore though, 

00:10:10so I guess like what’s the difference? 

00:10:10She went to court and said we were unsuitable. 

00:10:15Not suitable. 

00:10:20Says it all real nice in court, 

00:10:20and then not so nice over the phone, 

00:10:20if you know what I mean? 

00:10:25She’s a real bitch. 

00:10:25>> Any other drugs? 

00:10:25Ecstasy? LSD? 

00:10:35>> This is going to make me sound like I’m 

00:10:35some 1970s hippy, druggo person. 

00:10:40I’ve tried ecstasy twice, 

00:10:45just twice, and LSD once, last year. 

00:10:50That was a bad trip. I am not doing that again. 

00:10:55>> Anything else? 

00:10:55>> Like what? 

00:11:00>> Stimulants? 

00:11:00>> Like power drinks if I need to stay up? 

00:11:05>> Sure 

00:11:05>> Caffeine, I drink a lot of coffee. 

00:11:10I don’t know if cigarettes, 

00:11:10do they count as stimulants? 

00:11:10>> Yeah. 

00:11:10>> Yeah, I’m trying to cut back. 

00:11:15Two packs a day. 

00:11:15>> Ritalin, Dexedrine? 

00:11:20>> Oh, stimulants? 

00:11:20>> Right 

00:11:20>> Oh, yeah. Not a lot. 

00:11:25Like hardly ever. 

00:11:25I mean, if Zano and I are down for whatever reason, 

00:11:30or sluggish from smoking pot, 

00:11:35or just like if I need to get back up again. 

00:11:35Yeah, Adderall, just 20 helps. 

00:11:40>> Do you ever take prescription medications 

00:11:40that are not prescribed for you? 

00:11:45>> Well, are you kidding me? 

00:11:45Why would I do that? 

00:11:50I told you I don’t like medications in the first place. 

00:11:50>> Klonopin, Ativan, Xanax? 

00:11:55>> Those? 

00:11:55>> Yeah. 

00:12:00>> Yeah, if my anxiety is acting up, 

00:12:05if my meditation isn’t working? 

00:12:10Yeah, a couple Xana bars, 

00:12:10but not a lot. 

00:12:10>> How often would you estimate that is? 

00:12:15>> I don’t know. 

00:12:20Two? I don’t know. 

00:12:20I need like a freaking calendar to keep up with 

00:12:25all your questions, Doc, God. 

00:12:25>> So in the past, 

00:12:30who prescribed the oxycodone for you? 

00:12:30>> No one yet. Zano he 

00:12:35takes them because he’s got shoulder and back problems, 

00:12:40and I tried one and it really works. 

00:12:45To be honest it works fantastic. 

00:12:45This transcript was automatically generated using speech recognition technology. Because this method relies on machine learning algorithms, the quality of transcripts may vary. To request this transcript be improved with enhanced accuracy, please email [email protected] 

Title 151 Name: Daniela Petrov Gender: female Age:47 years old T- 98.8 P- 84 R 20 B/P 132/90 Ht 5’8 Wt 128lbs Background: Moved to Everett, Washington from Russia with her parents when she was 16 years old. Currently lives in Boise, Idaho. She has younger 1 brother, 3 older sisters. Denied family mental health or substance use issues. No history of inpatient detox or rehab denied self-harm hx; Menses regular. uses condoms for birth control Has fibromyalgia. She works part time cashier at Save A Lot Grocery Store. Dropped out of high school in 10th grade. Sleeps 5-6 hours on average, appetite good. Symptom Media. (Producer). (2018). Training title 151 [Vid

______________________________________________________________________________ 

WEEK 8 VIDEO #114

VIDEO #114

_____________________________________________________________________ 

00:00:00BEGIN TRANSCRIPT: 

00:00:00DISCLAIMER 

00:00:00THE INFORMATION CONTAINED HEREIN IS OF A GENERAL NATURE AND CANNOT SUBSTITUTE FOR THE ADVICE OF A MEDICAL PROFESSIONAL. THE CONTENT PROVIDED MAY NOT APPLY TO YOU OR YOUR SYMPTOMS. YOU SHOULD NOT RELY ON THIS INFORMATION AS A SUBSTITUTE FOR, NOR DO THEY REPLACE, PROFESSIONAL MEDICAL ADVICE, DIAGNOSIS OR TREATMENT. IF YOU HAVE ANY CONCERNS OR QUESTIONS ABOUT YOUR HEALTH OR THE CONTENT. YOU SHOULD ALWAYS CONSULT WITH A PHYSICIAN OR OTHER HEALTH-CARE PROFESSIONAL. DO NOT DISREGARD. AVOID OR DELAY OBTAINING MEDICAL OR HEALTH RELATED ADVICE FROM YOUR HEALTH-CARE PROFESSIONAL. THE CONTENT SHOULD NOT BE USED IN PLACE OF A CALL OR VISIT TO A MEDICAL, HEALTH OR OTHER COMPETENT PROFESSIONAL, WHO SHOULD BE CONSULTED BEFORE ADOPTING ANY OF THE SUGGESTIONS IN THE CONTENT OR DRAWING INFERENCES FROM IT. 

00:00:00SYMPTOM MEDIA, LLC DISCLAIMS ALL RESPONSIBILITY FOR ANY LIABILITY LOSS OR RISK, PERSONAL OR OTHERWISE, WHICH IS INCURRED AS A CONSEQUENCE, DIRECTLY OR INDIRECTLY, OF THE USE AND APPLICATION OF ANY OF THE CONTENT CONTAINED HEREIN. 

00:00:15ALLY (ph) Really, come on. I’m missing first period. And now you want me to be late for my second class. Can we do this during my third period break? 

00:00:25UNKNOWN I… I’m sorry, Ally(ph) but principal Michaels requested that you and I take some time this morning and talk. I… I know we worked together before right now, I’m going to have to put on my professional app. 

00:00:35ALLY (ph) That’s ridiculous. Why? 

00:00:35UNKNOWN Well, maybe you can tell me why. 

00:00:40ALLY (ph) I have a class waiting for me. 

00:00:45UNKNOWN Well, you been frequently late for your classes. In fact, let’s say uh… 22 days so far this year? 

00:00:50ALLY (ph) It has not been 22 days. 

00:00:55UNKNOWN Yes, it has, something not right here at school or something not right at home. 

00:01:00ALLY (ph) My personal life is fine. And personal. 

00:01:05UNKNOWN I know you haven’t changed addresses so it can’t be the traffic. 

00:01:10ALLY (ph) Jesus. The History Department had a party last night a Darrel’s(ph). Why don’t you bring him in here and question him? 

00:01:20UNKNOWN So are you saying the Darrel’s(ph) party is the reason that you were late? That was last night? I don’t understand. 

00:01:25ALLY (ph) Okay. Alcohol was served. We had a bit much to drink. Not just me. We’re adults here. And I mean, the… the school host of social hour on campus every month. 

00:01:40UNKNOWN So what are you saying? Are you saying that you were drunk? 

00:01:45ALLY (ph) I drank, but no. 

00:01:45UNKNOWN Were you intoxicated enough that you passed out? 

00:01:50UNKNOWN I woke up and Darrel’s(ph) cash responding. And, and fuck him for not waking me. He came to school on time but let’s be there lying on the couch. 

00:02:00UNKNOWN Have you passed out other times? 

00:02:05ALLY (ph) We have all passed out at times. I’m sure I’ve seen you drunk at those parties. 

00:02:10UNKNOWN Are you still feeling intoxicated this morning? 

00:02:15ALLY (ph) No, Course not. 

00:02:15UNKNOWN Have you ever been drunk? While you were here teaching? 

00:02:20ALLY (ph) No. 

00:02:20UNKNOWN I’m asking that because we’ve had complaints. 

00:02:25ALLY (ph) Complaints from who? 

00:02:25UNKNOWN Students, parents. 

00:02:30ALLY (ph) Well, bring him in. Let them tell that to my face because it’s totally not true. 

00:02:35UNKNOWN They’ve complained that at different times you came into class and then you ordered the kids to read from their textbook or you ordered the kids to copy notes from the board while you were sleeping with your head on the desk. 

00:02:45ALLY (ph) You have to be kidding me. 

00:02:50UNKNOWN Several students and several parents have complained. 

00:02:55ALLY (ph) Exactly who, Alexis? Do you know how many problems she’s created for the teachers at the school. 

00:03:00UNKNOWN But you were drinking last night. And it sounds like you drank enough that you passed out and had to sleep on Darrel’s(ph) couch? 

00:03:10ALLY (ph) Yes. I mean, I did. 

00:03:15UNKNOWN So, is there something going on in your personal life? 

00:03:20ALLY (ph) No. 

00:03:20UNKNOWN How’s Ryan? 

00:03:25ALLY (ph) Ryan? First time I’ve known you to travel slow here. We split up before the school year started. Last summer. 

00:03:35UNKNOWN What happened? 

00:03:35ALLY (ph) I’m really, really uncomfortable sharing anything about my relationships with you. 

00:03:45UNKNOWN Okay, that’s fair. That is your personal life. 

00:03:50ALLY (ph) Is there any reason I just can’t walk out of this office right now? 

00:03:50UNKNOWN Well, I don’t know the specifics of what the Board of Education would decide if you don’t cooperate, but I’m guessing at something pretty serious. 

00:04:00ALLY (ph) This is unbelievable. 

00:04:05UNKNOWN Wait, wait. Wait a minute. The administration asked me to speak with you. The school wants to work with you if you’ll cooperate. And as someone who really likes you. I am warning to understand. I’m hoping to help you. So just, okay, thank you. Good. Now, what’s going on? 

00:04:30ALLY (ph) I don’t know. 

00:04:30UNKNOWN Okay. How much did you drink last night? 

00:04:35ALLY (ph) Too much. 

00:04:35UNKNOWN How often do you drink too much? 

00:04:40ALLY (ph) I don’t know. 

00:04:45UNKNOWN How much would you estimate that you drink in a typical week? 

00:04:50ALLY (ph) Every night. 

00:04:50UNKNOWN Do you drink with friends, family, by yourself? 

00:04:55ALLY (ph) Alone. Once in a while I’ll go to a bar with my friends or drink at school functions. Where I might add they do supply alcohol liberally. 

00:05:05UNKNOWN Yes. 

00:05:10ALLY (ph) They’re removing our social hours to downtown. 

00:05:10UNKNOWN Do you go out and drink other than with friends? 

00:05:15ALLY (ph) Occasionally. 

00:05:15UNKNOWN Do you drink alone at home? 

00:05:20ALLY (ph) Few glasses of wine while a grade takes the edge off the day. 

00:05:25UNKNOWN Takes the edge off. 

00:05:30ALLY (ph) Yes. The kids here are getting worse by the year. The teachers talk about it. We all know what’s going on. They become they just become more… more vicious, more mean. I’m talking about kids who have no hint of remorse, no empathy, no thoughtfulness for others. When was the last time you try teaching them? 

00:05:45UNKNOWN I have to admit it has been a while. 

00:05:50ALLY (ph) Just last week, I caught Alexis filming me on her phone. I was bent over picking up trash a student through on the floor. It was not flattering. And you know what she did? 

00:06:00UNKNOWN No. 

00:06:05ALLY (ph) Send it out to the whole grade adding a really obscene title. 

00:06:05UNKNOWN Was she punished? 

00:06:10ALLY (ph) Do the kids here ever get punished? All she caught was a bucking set down with their neuter principal. And then her mom comes threaten Sue again and naturally our fearless leader backs down. Michaels humiliated me. Did the administration tell you that? 

00:06:25UNKNOWN No. 

00:06:30ALLY (ph) Humiliated me. I work for a place that has no backbone, no spine. Who runs this place here? The students or the teachers. 

00:06:40UNKNOWN Sounds horrible. 

00:06:45ALLY (ph) And it goes on day after day. Rich kids who have no respect while you struggle to teach. I’m trying to pay bills here. Pay uh… pay the gas, driving shitty car, pay off student loans. 

00:06:55UNKNOWN That does sound like a lot of stress. 

00:07:00ALLY (ph) Sounds like. 

00:07:00UNKNOWN Do you like teaching? 

00:07:05ALLY (ph) Once upon a time when it had meaning. 

00:07:05UNKNOWN What about now? 

00:07:10ALLY (ph) We aren’t supported. 

00:07:15UNKNOWN Do you think all of this stress is contributing to your drinking? 

00:07:15ALLY (ph) Of course it is. 

00:07:20UNKNOWN Do you drink during the day? 

00:07:20ALLY (ph) No, no, absolutely not. 

00:07:25UNKNOWN When you do drink, how much do you drink? 

00:07:25ALLY (ph) Enough. 

00:07:30UNKNOWN Enough to pass out? 

00:07:30ALLY (ph) If I’m lucky. 

00:07:35UNKNOWN How much do you have to drink to get that feeling of being intoxicated? 

00:07:40ALLY (ph) Five or six glasses of wine, a couple of mixed drinks. 

00:07:45UNKNOWN Do you think that’s more than it takes most people to get intoxicated? 

00:07:50ALLY (ph) I don’t know, but… but I can. 

00:07:50UNKNOWN So, so do you think alcohol affects your body differently than it affects your friends? 

00:07:55ALLY (ph) Yes, alcohol affects. Yes. 

00:08:00UNKNOWN Do you drink more than your friends and the other teachers? 

00:08:05ALLY (ph) I… I drink, but… but you’re not understanding it, it affects me differently. 

00:08:15UNKNOWN Has it prevented you from doing things or interfered with relationships? 

00:08:25ALLY (ph) Are you specifically talking about Ryan here? 

00:08:25UNKNOWN Yeah. 

00:08:30ALLY (ph) Okay, Ryan did not leave me because I drink. 

00:08:30UNKNOWN Okay. 

00:08:35ALLY (ph) I’m seeing someone new. We weren’t even together for a year. 

00:08:35UNKNOWN Is drinking wine, beer, other alcoholic drinks in the evenings. Is that something new for you? Or was that something typical than your past? 

00:08:50ALLY (ph) No. Look, my father was an alcoholic growing up. When I was really little he drank. He got into AA and got sober. Mom was very supportive of him, but extremely strict with us in drinking. 

00:09:10UNKNOWN How did you feel about her being so strict with alcohol? 

00:09:15ALLY (ph) As a teenager it sucked. I went out with my friends I got drunk. And then freshman year was a huge vendor. Eventually I just I mellowed out. 

00:09:25UNKNOWN And after college? 

00:09:25ALLY (ph) In grad school I drank here and there but not much. 

00:09:30UNKNOWN Do you think your alcohol intake is less that when you were in college or is it gone the other way? Has it increased recently? 

00:09:40[sil.] 

00:09:50ALLY (ph) More. 

00:09:55END TRANSCRIPT

Training Title 114 Name: Ally Chen Gender: female Age: 44 years old Background: Only child, raised by parents in Philadelphia, PA. Has PhD in biology and master’s degree in high school education (8–12). Her supervisor has asked the school EAP counselor to intervene with concerns regarding potential substance use in effort to facilitate getting her help and be able to retain her. She is divorced, has a 4-year-old son who lives with his father. Appetite healthy, sleeping 9 hours/24 hrs., wakes 2-3 times during the night. Denied drug use. had DUI when she was age 21. Symptom Media. (Producer). (2018). Training title 114-2 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-114-2 Training

Week 8: Substance-Related and Addictive Disorders

Many individuals seeking treatment meet the criteria for both mental health and substance-related disorders. Regardless of whether you specialize in substance-related disorders, all advanced practice nurses should know their signs and symptoms and how to assess and diagnose them. There are assessment and screening tools available to clinicians, and a plethora of information can be obtained through the diagnostic interview. It takes time and experience to know what types of questions to ask to gain the most information, in addition to a basic knowledge of the substances and behaviors you are trying to assess. It can be complicated to sort out substance use disorders from other mental health disorders, but most clients seeking treatment have comorbidities. 

This week, you apply 
DSM-5-TR substance use and addictive criteria as you formulate a diagnosis for a patient in a case study.

For this Assignment, you will practice assessing and diagnosing a patient in a case study who is experiencing a substance-related or addictive disorder. With this and all cases, remember to consider the patient’s cultural background.

To Prepare:

· Review this week’s Learning Resources and consider the insights they provide.

· Review the Comprehensive Psychiatric Evaluation template, which you will use to complete this Assignment.

· select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.

· Consider what history would be necessary to collect from this patient.

· Consider what interview questions you would need to ask this patient.

· Identify at least three possible differential diagnoses for the patient.

Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis.

Incorporate the following into your responses in the template:

·
Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life? 

·
Objective: What observations did you make during the psychiatric assessment?  

·
Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.

·
Reflection notes: What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

Learning Objectives

https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x16_Substance_Related_Disorders

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015).
Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

· Chapter 20, Substance Use and Addictive Disorders

· Chapter 31.16, Adolescent Substance Abuse

00:00:00BEGIN TRANSCRIPT: 

00:00:00[sil.] 

00:00:20LISA Well I had to be here in this hospital if that answers your question. 

00:00:25OFF CAMERA Yes, thank you. Can I get you a drink of water or something else to drink? Anything? 

00:00:35LISA A drink isn’t going to convince me, right? You’re going to have to convince me. 

00:00:40OFF CAMERA What is you want me to persuade you to do? 

00:00:45LISA Going to rehab. 

00:00:50OFF CAMERA What worries you about going to rehab? 

00:00:55[sil.] 

00:01:00LISA Everything. 

00:01:00OFF CAMERA Okay. I tell you what let’s go back a little bit and tell me about how you’re feeling today. 

00:01:10LISA Scared. 

00:01:15OFF CAMERA Can you tell me more about that feeling of being scared? 

00:01:20LISA Well, I don’t want to be. I don’t want to be what people say I am because if I say it and I’m not going to say it because I ain’t going to change. I can’t. 

00:01:35OFF CAMERA What do people say you are? 

00:01:40LISA And I’m not. 

00:01:45OFF CAMERA What don’t you want to be? 

00:01:45LISA An addict. 

00:01:50OFF CAMERA Do you use drugs and alcohol? 

00:01:50LISA Yeah sometimes I have a drink. You know with friends [inaudible] but it doesn’t matter. I’m in control. 

00:02:00OFF CAMERA Do you feel in control now? 

00:02:05LISA Maybe I could just get that drink [inaudible]. 

00:02:10OFF CAMERA Sure. Sure. Here you go. 

00:02:15LISA Thank you. 

00:02:20[sil.] 

00:02:30LISA You know what I just think I should leave. 

00:02:30OFF CAMERA You keep saying you should leave. You said that earlier but do you really want to leave? 

00:02:40LISA No. 

00:02:45OFF CAMERA Okay. Tell me why you are here. 

00:02:45LISA Because I’m scared. 

00:02:50OFF CAMERA You said that earlier. You think if you could — then I could figure out together why you’re scared and maybe we can come up to a plan. Up with a plan and if we do that, then maybe your fears will disappear. 

00:03:05LISA No not these fears [inaudible] because it’s over. 

00:03:10OFF CAMERA What’s over? 

00:03:10LISA Everything. The business. 

00:03:15OFF CAMERA What do you mean? 

00:03:20LISA Jeremy. 

00:03:25OFF CAMERA Who is Jeremy? 

00:03:25LISA He’s my boyfriend. I saw him naked with Alisa [assumed spelling] with the same fucking name as me. We now have the same fucking boyfriend. In my office, he was screwing that fucking cunk. 

00:03:45OFF CAMERA So you’re the one who caught Jeremy cheating? 

00:03:55LISA Yeah. Cheating? Yeah that’s a clever word shrinks use. 

00:04:05OFF CAMERA So you and Jeremy share an office? 

00:04:05LISA Yeah we do commercials for local businesses, you know, build websites, that kind of stuff. We started a business together. He moved in with me. 

00:04:15OFF CAMERA How long ago was that? 

00:04:20LISA Nine months. 

00:04:20OFF CAMERA Do you have any children? 

00:04:20LISA Not with that fucking asshole. 

00:04:25[sil.] 

00:04:30LISA I have a daughter, Sarah. Gosh, she’s beautiful. She stays with some friends. She’s not related to Jeremy, thank God. 

00:04:45OFF CAMERA And where are you staying? 

00:04:45LISA I’m renting a place far away from here. You know I ran down to the bank to empty both our bank accounts. 

00:04:55OFF CAMERA Business accounts? 

00:04:55LISA Yeah. And do you know that asshole has been draining them for 4 months? I swear. 

00:05:05OFF CAMERA Taking money out of your account without your knowledge. 

00:05:05LISA Yeah. For his buys. 

00:05:10OFF CAMERA Buys? 

00:05:10LISA Yeah, to payoff his debts with my money. 

00:05:20OFF CAMERA Or crack cocaine? 

00:05:25LISA Yeah for crack. 

00:05:25OFF CAMERA How long have you know he’s been smoking crack? 

00:05:30LISA Ever since I saw him with that — every since I saw with her naked. The both of them naked. 

00:05:40OFF CAMERA What was that like seeing Jeremy and Alisa naked and smoking crack? 

00:05:40LISA Well have you ever seen someone you love naked smoking crack? 

00:05:45OFF CAMERA No. 

00:05:50LISA Yeah no I didn’t think so. 

00:05:50OFF CAMERA So what has that been like for you knowing Jeremy’s smoking crack? 

00:05:55LISA Well, I’ve never seen him do drugs before. You know he drinks a lot, smokes weed, but crack cocaine. I mean God have mercy. 

00:06:15OFF CAMERA What are you thinking about? 

00:06:20LISA Everyone’s going to know. 

00:06:25OFF CAMERA Know what? 

00:06:30LISA That I was getting high to stay in this hospital and get cleaned up. 

00:06:35OFF CAMERA You mean rather than go to rehab. 

00:06:40LISA Rehab, man they’re fucking dirty places and I’m sick and tired of dirty places. 

00:06:45OFF CAMERA No, no, no this rehab place is very clean. I’ve seen it. There are a lot of nice people there. People who feel like they get much better help than here in the hospital. In fact, I can call someone for you and let you talk with them. 

00:06:55LISA No, no, no, no, no, no, no, no, don’t do that. 

00:07:00OFF CAMERA You’re really fearful of going to rehab. 

00:07:05LISA Well if everyone finds out that I’ve been to rehab, I won’t get a job. I won’t be hired anyway. 

00:07:10OFF CAMERA Plus if people are fearful of the stigma and fearful of what people will think of them. 

00:07:20LISA Yeah, but he says that I’m not addicted. It’s just — you know something wrong with my personality. 

00:07:25OFF CAMERA Who says there’s something wrong with your personality? 

00:07:30LISA Jeremy. 

00:07:30OFF CAMERA When did he tell you that? 

00:07:35LISA Lots of times. 

00:07:35OFF CAMERA I thought you said you and Jeremy split up after you caught him cheating. 

00:07:40LISA I — 

00:07:45OFF CAMERA It’s okay. Take your time. 

00:07:50LISA Well yeah he moved back in. 

00:07:50OFF CAMERA Into your new home? 

00:07:55LISA Yeah. What changed that you two decided to get back together? 

00:08:00OFF CAMERA Well he said he was sorry and he begged me. He’s done it before so I took him back. 

00:08:10LISA And how has that been being back with Jeremy? 

00:08:15OFF CAMERA Well I love Jeremy. I do and don’t want to go out and find another boyfriend. I mean we lost 80,000 dollars on that business. And he promised me that he would make it all back. 

00:08:30LISA So is that why you took him back? Has Jeremy continued smoking crack? 

00:08:45OFF CAMERA Yeah a little but he’s not addicted. He says that it calms him down. Me too. 

00:09:05LISA You too? 

00:09:05OFF CAMERA So do you smoke crack with Jeremy? 

00:09:15LISA Yeah we — he made me try it. 

00:09:25[sil.] 

00:09:30[ Crying ] 

00:09:40LISA And then he tried just once. We did it together. [Inaudible] I could. 

00:09:55[ Crying ] 

00:10:00LISA Hit me like a bullet. And it felt so good. I felt so good. And real fast. 

00:10:20[sil.] 

00:10:25LISA Have you ever felt like you were dancing with butterflies? 

00:10:30OFF CAMERA Dancing with butterflies? No I have not. 

00:10:40[sil.] 

00:10:45LISA But he says it’s not addictive, Jeremy. 

00:10:50OFF CAMERA What do you think? 

00:10:55LISA Well I know I can’t get enough. 

00:11:00[ Crying ] 

00:11:10LISA And I know I don’t want to go back to feeling horrible again because when I don’t smoke it I get worse. And when I have it, I feel good. And then it’s gone. And then I know that I’m going to be needing another hit. 

00:11:45OFF CAMERA That sounds a lot like addiction. 

00:11:55LISA Yeah but I know I don’t want it to be. 

00:12:00OFF CAMERA It sounds like you are very scared of getting help and yet at the same very time, it sounds like you know you need that help. 

00:12:15LISA I know I don’t need help. I don’t need anything. Jeremy promised me that everything is going to be okay. And when you love someone like I do, you got to believe him. Right? 

00:12:45[sil.] 

00:12:45END TRANSCRIPT

Training Title 82 Name: Lisa Tremblay Gender: female Age: 33 years old T- 100.0 P- 108 R 20 180/110 Ht 5’6 Wt 146lbs Background: Lisa is in a Naples, FL detox facility thinking about long term rehab. She is considering treatment for her Hep C+ but needs to get clean first. She has been abusing opiates, approximately $100 daily. She admits to cannabis 1–2 times weekly (“I have a medical card”), and 1/2 gallon of vodka daily. She has past drug paraphernalia possession arrest. Her admission labs. abnormal for ALT 168 AST 200 ALK 250; bilirubin 2.5, albumin 3.0; her GGT is 59; UDS positive for opiates, THC. Positive for alcohol or other drugs. BAL .308; other labs within normal ranges. She reports sexual abuse as child ages 6-9 perpetrator being her father who went to prison for the abuse and drug charges. She is estranged from him. Mother lives in Maine, hx of agoraphobia and benzodiazepine abuse. Older brother has not contact with family in last 10 years, hx of opioid use. Sleeps 5-6 hrs., appetite decreased, prefers to get high instead of eating. Allergies: azithromycin Symptom Media. (Producer). (2017). Training title 82 [Video].
https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-82