Psychiatric Case
After studying Module 6: Lecture Materials & Resources, discuss the following
Case Study
A 74-year-old African American woman, Ms. Richardson, was brought to
the hospital emergency room by the police. She is unkempt, dirty, and
foul-smelling. She does not look at the interviewer and is apparently
confused and unresponsive to most of his questions. She knows her
name and address, but not the day of the month. She is unable to
describe the events that led to her admission.
The police reported that they were called by neighbors because Ms.
Richardson had been wandering around the neighborhood and not
taking care of herself. The medical center mobile crisis unit went to her
house twice but could not get in and presumed she was not home.
Finally, the police came and broke into the apartment, where they were
met by a snarling German shepherd. They shot the dog with a
tranquilizing gun and then found Ms. Richardson hiding in the corner,
wearing nothing but a bra. The apartment was filthy, the floor littered
with dog feces. The police found a gun, which they took into custody.
The following day, while Ms. Richardson was awaiting transfer to a
medical unit for treatment of her out-of-control diabetes, the psychiatric
provider attempted to interview her. Her facial expression was still
mostly unresponsive, and she still didn’t know the month and couldn’t
say what hospital she was in. She reported that the neighbors had
called the police because she was “sick,” and indeed she had felt sick
and weak, with pains in her shoulder; in addition, she had not eaten for 3
days. She remembered that the police had shot her dog with a
tranquilizer and said the dog was now in “the shop” and would be
returned to her when she got home. She refused to give the name of a
neighbor who was a friend, saying, “he’s got enough troubles of his
own.” She denied ever being in a psychiatric hospital or hearing voices
but acknowledged that she had at one point seen a psychiatrist “near
downtown” because she couldn’t sleep. He had prescribed medication
that was too strong, so she didn’t take it. She didn’t remember the
name, so the interviewer asked if it was Thorazine. She said no, it was
“allal.” ‘Haldol?”, ask the interviewer. She nodded.
The interviewer was convinced that was the drug, but other observers
thought she might have said yes to anything that sounded remotely like
it, such as “Elavil.” When asked about the gun, she denied, with some
annoyance, that it was real and said it was a toy gun that had been
brought to the house by her brother, who had died 8 years ago. She was
still feeling weak and sick, complained of pain in her shoulder, and
apparently had trouble swallowing. She did manage to smile as the
team left her bedside.
Submission Instructions:
• Your initial post should be at least 500 words, formatted, and cited in current
APA style with support from at least 2 academic sources. Your initial post is
worth 8 points.
• You should respond to at least two of your peers by extending, refuting/
correcting, or adding additional nuance to their posts. Your reply posts are worth
2 points (1 point per response.)
• All replies must be constructive and use literature where possible.
Questions: Remember to answer these questions from your textbooks and clinical
guidelines to create your evidence-based treatment plan. At all times,
explain your answers.
1. Summarize the clinical case including the significant subjective
and objective data.
2. Generate a primary and two differential diagnoses. Use the
DSM5 to support the assessment. Include the DSM5 and ICD 10
codes.
3. Discuss a pharmacological treatment would you prescribe? Use
the clinical guidelines to support the rationale for this treatment.
4. Discuss non-pharmacological treatment would you prescribe?
Use the clinical guidelines to support the rationale for this
treatment.
5. Describe a health promotion intervention that would be
appropriate for this patient.
