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To prepare:
Review this weeks Learning Resources and reflect on the insights they provide.
Read the case study I am Feeling Like Im Going Crazy
For guidance on assessing the client, refer to pages 137-142 of the Wheeler text in this weeks Learning Resources.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues postings. Begin by clicking on the Post to Discussion Question link and then select Create Thread to complete your initial post. Remember, once you click submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking Submit!
By Day
1-Post an Explanation of the most likely DSM-5 diagnosis for the client in the case study.
2- Be sure to link those behaviors to the criteria in the DSM-5. Then,
3- Explain Group Therapeutic Approaches you might use with this patient.
4-Explain expected Outcomes for the client based on these therapeutic approaches.
5-Finally consider Legal and Ethical implications of counseling children and adolescent clients with psychiatric disorders.
6-Support your approach with evidence-based literature.
2020, Walden University
NRNP 6650: Psychiatric Mental Health Nurse Practitioner Role I:
Child and Adolescent
Case Study: I am Feeling Like Im Going Crazy
IDENTIFICATION: The patient is a 15-year-old male of Native American descent who resides at home
with his mother and 6-year-old brother.
He is seen for the psychiatric evaluation on an inpatient crisis unit. Collateral information was obtained
from the patients mother.
CHIEF COMPLAINT: I am feeling like Im going crazy
HISTORY OF CHIEF COMPLAINT: Patient reports that he intentionally cut his leg at school yesterday
before gym class. He realized that he would not be able to participate in class because he could not
control the bleeding of the cuts. He went to the nurse and she referred him to the ER for admission. The
ER provider admitted him to the acute psychiatric unit as he was at risk of harming himself due to
suicidal ideation. He reports that he harmed himself by cutting as he was feeling abandoned by his
boyfriend. He states that he is not emotionally supportive. He reports that self-injurious behavior began
10 months ago, and he uses a disposable razor to cut his upper arm or forearm. He reports problems
with sleep onset. He reports low self-esteem and low energy level. He endorsed a history of two prior
suicide attempts by taking a palm-full of acetaminophen; the most recent attempt was 2 months ago.
He did not report his attempt denies serious adverse effects. His last suicidal ideation due to pressure of
getting good grades and low self-esteem. He used to participate in the school band but stopped
attending rehearsals about 2 months ago because he was no longer interested.
Patients mother expressed frustration and difficulty understanding why the patient treats her
disrespectfully when she gives the patient everything the patient wants, such as clothing and money to
go out with friends. The patients mother acknowledged that she works a lot and is infrequently at
home, but stated that when she tries to spend time with the patient and express interest in his life, the
patient shuts her out or states that he does not have time to spend with her because she needs to finish
his homework. Patients mother additionally expresses confusion about why the patient behaves so
differently than she did at that age, reporting that he was expected to be respectful and comply with her
mothers requests.
PAST PSYCHIATRIC HISTORY: No prior psychotherapy or trials of psychiatric medication.
MEDICAL HISTORY: Multiple wounds noted on patients right upper arm, which appear to be healing. No
known allergies. No acute or chronic medication conditions. Review of systems is negative. Patient
appears to be average height and weight. He denies any recent changes in weight.
HISTORY OF DRUG OR ALCOHOL ABUSE: No alcohol use. States that he tried marijuana once 3 months
ago. Denies use of any other illicit substances.
2020, Walden University
FAMILY HISTORY: Patients parents were both born in the US. The patient was born in the United States.
Patient reports that her parents got divorced when she was 5 years old. His father currently lives in Los
Angeles and he has minimal contact with him. Family history of mental illness denied.
Personal History
Perinatal: No known perinatal complications.
Childhood/Adolescence: The patient attends the local private high school where he used to get good
grades in her classes, mostly As and Bs; however, he states her grades have declined recently and she is
in danger of failing several classes. He reports recent loss of close friends due to interpersonal conflict.
He identifies as pansexual and is currently dating a male peer. They have been dating for the past 2
months. He states that she would like to have sex with him, but he is not ready yet.
TRAUMA/ABUSE HISTORY: Patient denies trauma or abuse history.
Mental Status Examination
Appearance: Good grooming and hygiene. Cooperative.
Behavior and psychomotor activity: no increased or decreased psychomotor agitation. Sits quietly in
chair.
Consciousness: Alert.
Orientation: To person, place, time.
Memory: Not formally assessed but appears to be intact based on patients ability to relate details from
the past.
Concentration and attention: Not formally assessed, but no indication of abnormalities.
Visuospatial ability: Not formally assessed.
Abstract thought: Intact.
Intellectual functioning: Appears to be above average.
Speech and language: Quiet volume, regular rate and rhythm.
Perceptions: No evidence of perceptual disturbance. Patient denies auditory and visual hallucinations.
Thought processes: Coherent and goal directed.
Thought content: Distressed about peer relationships.
Suicidality or homicidality:
Denies current suicidal or homicidal ideation; however, reports suicidal thoughts yesterday on the way
to the hospital.
Mood: Depressed
Affect: Constricted.
2020, Walden University
Impulse control: Limited as evidenced by impulsive self-injurious behavior.
Judgment/Insight/Reliability: Poor/Poor/Fair Learning Resources
Required Readings
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
McGillivray, J. A., & Evert, H. T. (2014). Group cognitive behavioural therapy program shows potential in reducing symptoms of depression and stress among young people with ASD. Journal of Autism and Developmental Disorders, 44(8), 2041-2051. doi:10.1007/s10803-014-2087-9
Restek-Petrovi, B., Bogovi, A., Mihanovi, M., Grah, M., Mayer, N., & Ivezi, E. (2014). Changes in aspects of cognitive functioning in young patients with schizophrenia during group psychodynamic psychotherapy: A preliminary study. Nordic Journal of Psychiatry, 68(5), 333-340. doi:10.3109/08039488.2013.839738
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. New York, NY: Springer.
Chapter 17, Psychotherapy with Children (pp. 597624)
Chapter 20, Termination and Outcome Evaluation (pp. 693712)
Document:I am Feeling Like I’m Going Crazy
