Depression, PTSD, substance use disorder
The case study focuses on a 42-year-old female with depression, PTSD, substance use disorder, and interpersonal stress. She has been sober for ten years and attend alcohol and narcotic anonymous meeting. The patient has a past medical history of diabetes, COPD, coronary artery disease, gastroesophageal reflux disease, hypertension, and glaucoma, all well controlled with medication. In addition, the client is overweight and on ten different medications for her comorbidities. The client is at increased risk of polypharmacy due to all these medications she is on and comorbidities. The client reports that she was severely abused as a child and used alcohol and illicit drugs to cope with the aftereffects and currently attends alcohol and narcotics anonymous. The client also reports PTSD symptoms such as flashbacks, nightmares, and panic attacks, which has impaired her school and work. The client reports episodes of dysthymia with intermittent full major depressive episodes. The psychiatric review reports mood lability symptoms, empty depression, lack of control, and dissociative events consistent with a mild borderline personality disorder. The client has no history of inpatient psychiatric admission and denies any hallucination, delusions, suicidal thoughts, or ideation. The client reports financial strain and a history of legal trouble for reacting to social retaliation due to past abuse triggers
(1) The purpose of this discussion is to explain three questions that will be asked to the patient and people in client’s life, appropriate physical exams and diagnostic tests, differential diagnoses, pharmacologic agents, therapeutic changes, and lessons learned from the case study.