CASE STUDY TWO – 26-year-old BIPOC Female
The patient is a 26-year-old BIPOC female who has been diagnosed with borderline personality disorder and bipolar disorder, and also experiences depression, anxiety, panic, and anorexia. She has a history of self-harm and four psychiatric hospitalizations, and is currently prescribed lamotrigine and clonazepam. She has a history of emotional abuse by her parents, a parental divorce as a teenager, and a history of anorexia and cutting. She reports difficulty sleeping and nightmares, and has a history of childhood sleep disruption. She is currently in a stable relationship and has a job as a sales representative. She reports fair appetite and weight within low to normal limits, and denies any significant medical or substance use history. She is seeking a new psychiatric provider to prescribe her medications.
CASE STUDY TWO – 26-yr-old female
The patient is a 26-year-old, single, BIPOC female who lives with her boyfriend. She has moved recently and needs a new psychiatric provider to prescribe her medications. She is scheduled to see a new dialectical behavioral therapist in a few days.
Chief Complaint: “Need a new psychiatrist.”
History of Presenting Problem/History of Present Illness:
The patient says that she has been diagnosed with borderline personality disorder and bipolar disorder. Has depression and anxiety, panic and anorexia. While out with her boyfriend in a restaurant, she became upset at comment he made that she now thinks was not inflammatory but at the time she thought it was meant to be hostile toward her. She went to the restroom and used a fork to scratch herself until she broke her skin. Then when she went home, she went to the bathroom again and started cutting her arm with a knife. Shortly after, she told her boyfriend. The wounds have since closed and healed. Now, she thinks there was really no reason for her to react the way she did, but at the time she interpreted his comments as a statement against her.
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She is currently prescribed lamotrigine 200 mg daily and clonazepam 0.5 mg Q 12 hours.
Past Psychiatric History: The patient has had four psychiatric hospitalizations. The first hospitalization was when she was 13 years old after taking an overdose. The most recent hospitalization was three years ago. Denies any manic or psychotic symptoms. History of anorexia and cutting.
Medication history includes sertraline, fluoxetine, trazadone, quetiapine, lorazepam, gabapentin, and citalopram.
Substance Use: Only drank occasionally and has not drunk at all for several years. Uses nicotine vape. Denies caffeine.
Trauma/Abuse History: Patient made vague comments about emotional abuse by her parents but was unable to describe any specific traumatic incident. Parental divorce as a teenager.
Medical history: No acute or chronic medical conditions.
Birth/Developmental: Denies in-utero exposure, no complications at birth, met developmental milestones. Childhood sleep disruption-delayed onset, frequent nightmares.
Family History: Biological father-“had a problem with drinking”
Personal/Social History:
The patient was raised by both her parents until they divorced when she was a teen and then lived with her mother and stepfather. Angry at her mother but adores her stepfather. Will talk to him on the phone but not her mother. Her father had a problem with drinking when she was younger and has a good relationship with him now. CASE STUDY TWO – 26-year-old BIPOC Female
Childhood: Normal developmental achievements. Had nightmares on and off as a child. Always had difficulty falling asleep. Overdose at age 13 when parents separated.
Adolescence: Graduated high school.
Adulthood: Went to college off and on and finally graduated in the past year. Has a job as a sales
representative that she enjoys. Currently lives with boyfriend and thinks they have good relationship.
Review of Systems (ROS):
Constitutional:
-Sleep: Reports nightmares and night sweats. Problems with going to sleep and staying asleep. Takes over the counter Diphenhydramine as needed.
-Appetite: fair. Weight is within low to normal limits.”
NEURO: Denies HA’s, seizures, dizziness or syncopal episodes.
CARDIOPULMONARY: Denies CP, palpitations, SOB, cough, wheeze, edema.
GU/Reproductive: Reports regular menses. Uses OCP for birth control. Denies dysuria, frequency, or urgency.
INT: Scarring- superficial self-inflicted cut marks.
Psychiatric: See HPP/HPI above.
All other systems non-contributory.
MENTAL STATUS EXAMINATION
Appearance: Petite, thin, dressed in an attractive outfit. Appeared slightly anxious during the interview but did smile and laugh appropriately.
Behavior and Psychomotor activity: Good eye contact. No unusual movement.
Consciousness: Alert
Orientation: Oriented to person, place, time
Memory: Intact
Concentration and Attention: Within normal limits.
Intellectual Functioning: Average or above.
Speech and Language: Normal rate and volume.
Perception: No abnormalities evident.
Thought Process: Circumstantial but logical and coherent. Says her “mind runs 24/7”.
Thought Content: Within normal limits
Suicidality and Homicidality: Denied. Does report reactivity to stress that triggers self-injurious behavior like cutting
Mood: Feels “steady”
Affect: Appears mildly anxious.
Impulse Control: Good during interview but reports rapid impulse to cut when stressed.
Judgement/Insight/Reliability: Good
Diagnosis:
You agree with the historical diagnosis of borderline personality disorder.
Instructions:
For the patient you chose earlier, write a paper of 2-3 pages (using APA formatting and citations) discussing the following seven points based on the diagnosis given:
What medication do you choose? Provide the name, dose, and prescription instructions.
If your patient is NOT currently taking a medication:
What class of medication are you choosing and why?
Why you chose this med and not others. Include the pharmacodynamic action of the medication you are choosing versus the other options.
Include either a research article or evidenced based guideline that supports your decision making and selection process. Give rationale and reference your information.
If your patient is already prescribed a medication:
Do you choose to continue the medication as currently prescribed? Do you make changes to the current dose and/or instructions? Do choose to change the medication?
State your decision and answer the following questions:
(If you choose to change medications, state what medication you choose. Provide the name, dose, and prescription instructions. CASE STUDY TWO – 26-year-old BIPOC Female)
What class of medication are you choosing (whether changing or staying with current med) and why?
Why you chose this medication and not others. Include the pharmacodynamic action of the med you are choosing versus the other options.
Include either a research article or evidenced based guideline that supports your decision making and selection process. Give rationale and reference your information.
List 3-5 instructional points you would include in educating the patient/family.
Note: There are probably many things you could include in your instruction but do not exceed 5 points. Select the most important points relative to this medication and this case. Don’t just copy and paste into this section. Make it meaningful to this patient.
What are the potential side effects and/or adverse drug reactions and how should they be managed? What would you expect (common or nuisance) that your patient might experience, and what are your worst-case scenarios? If these occur, what would you want your patient to do? Are there any monitoring considerations or tests you want to order? (Medication levels, blood tests, EKG, other screenings?)
What are potential drug interactions for THIS patient and what would your education and management be? (Note: This answer may be none.) Don’t just copy and paste drug interactions into this area. What is applicable for this patient? If the answer is none, can you think of potential concerns or what instructions would you provide to them?
How would you monitor the efficacy of this medication? Specifically, when would you expect this medication to work? When would you want to see this patient again? How will you know it is working? Are there lab tests or other information that you would need to gather to see if this medication is efficacious?
What are alternative treatment plans should this option fail? Specifically address what medication, how and when you would use it.
How would this treatment change if the patient was pregnant? Specifically, what risk category risk in pregnancy is this medication? How would you approach this medication with a pregnant patient?
Click on “Add Submission” and upload your paper below. “SAVE”, and then “Submit for grading”
Your Instructor will be using the attached grading rubric. Note the different criteria in rubric before you submit.
NOTE: You will post your paper in the last week Discussion Forum and will be expected to choose one other paper from your same case study topic area to review and comment on. This will be a great time to reach out to see what other possibilities there are for treatment and for you and others to discuss those treatments in a constructive way. Did you or others miss something, which approach might be better, etc. Is there a way you can help others in your cohort about different methods of treatment?
Refer to the Syllabus for point value of this assignment. Your Activity Completion checkbox will be marked when you submit to
