Case Study Response

Hello, you have presented a comprehensive history of this client. First, your chief complaint: “I have been craving alcohol, and all efforts to control or cut down alcohol use have been unsuccessful,” is well stated and indicates the primary reason for visiting a psychiatrist clinic. The chief complaint is a significant aspect of health assessment sing it guides a clinician in collecting relevant patient’s history to be used in making a differential diagnosis and developing the most appropriate treatment plan.

Secondly, the history of the presented illnesses is well captured, indicating the client’s initials, age, gender, ethnicity, and informant. The client, T.J, is a 17yo Caucasian male who visited the psychiatric clinic accompanied by his mother. The client and his mother provided a detailed report of the presented clinical manifestations, which align with the chief complaint. His mother reported that the client has been drinking alcohol excessively for the past nine months, compromising his daily activities both at home and school and social life. All efforts to reduce or stop alcohol consumption have been unsuccessful. Instead, the client spends most of his time obtaining and drinking alcohol. The client revealed that he spends most of his time gambling at the local casino to get money for buying alcohol. The client also experiences persistently low or depressed moods. This feeling usually occurs when the client has not taken alcohol for almost 24 hours. Mental healthcare providers should evaluate the visual risk of experiencing withdrawal symptoms, including staking, weakness, or sweating during health assessment (Oesterle et al., 2020). Thus, experiencing persistently low or depressed mood when the client fails to take alcohol for 24 hours indicates alcohol addiction. Additionally, a psychiatrist should encourage the client to provide more health-related information to guide him or her differential diagnosis. In the case study, the client reported losing interest in playing hockey, which was his favorite sport before developing the presented symptoms. Loss of interest in pleasurable activities indicates that major depressive disorder (MDD) is a potential diagnosis for this client (Dold et al., 2017). Furthermore, the mother reported reckless driving when drunk, qualifying for diagnoses associated with risky behaviors. However, the client denies suicidal thoughts or ideation. He also denies visual or audio hallucination.

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            Furthermore, other components of the patient’s history, including past psychiatric history, psychotherapy, substance current use, family psychiatric/substance use history, psychosocial history, and medical history were well documented and detailed enough to guide in making diagnosis and developing a treatment plan. The client denies a past psychiatric diagnosis. However, he reported a current history of alcohol abuse. He added that his elder brother has a history of substance use disorder. He was referred to a counselor three months ago following excessive alcohol intake. Nonetheless, all attempts to reduce or control alcohol consumption have been unsuccessful. Medical history also captures all significant aspects. It indicated that the client does not have any medical condition, current medication, or known allergies. A review of the systems (ROS) is also detailed and aligns with the health history provided by the client and his mother.

Lastly, objective data captured all significant components, including vitals, general, HEENT (head, eyes, ears, nose, and throat), neck, cardiovascular system, lungs, abdomen, musculoskeletal, neurological, and psychiatry. The client’s self-reported mood was “sad.” He appeared in cute distress and seemed to be sad. The findings of other systems were normal. Additionally, diagnostic tests, including alcohol use screening test and Carbohydrate-Deficient were positive.

Psychiatric and Mental Health Diagnosis

            I support your differential diagnosis for this client. Based on patient history, physical examination findings, and diagnostic test results, potential diagnoses for this client, including alcohol use disorder (AUD), major depressive disorder (MDD), antisocial Personality Disorder, and bipolar Disorder. I agree that AUD qualifies as the client’s primary diagnosis. This disorder is characterized by excessive consumption of alcohol, impacting one’s life negatively (Ben El Jilali et al., 2019). The client reported that excessive alcohol intake had compromised his daily activities both at home and school and social life. Additionally, people with AUD do not succeed in reducing or controlling alcohol consumption despite trying repeatedly (Ben El Jilali et al., 2019). He reported craving alcohol with no success in controlling or cutting down alcohol intake. Thus, AUD is justified as the primary diagnosis for this client.

Secondly, agree that MDD qualifies as a potential diagnosis for this client since he reported some symptoms associated with this mood disorder, including a lack of interest in activities he used to like such as playing hockey, and persistently experiencing low or depressed moods. Nonetheless, you disqualified major depression as a potential diagnosis for this client since some significant symptoms of MDD, including changes in appetite, reduced energy level, insomnia, lack of concentration, reduced self-esteem, and suicidal thoughts were not reported in this client. It was recommendable to conduct mental status exam before ruling out MDD in this client. According to Grossman and Irwin, D, J. (2016), mental status examination combines a patient’s health-related information that was collected from passive observation during clinical assessment and data acquired by questioning the client directly to determine the client’s current mental status. Therefore, mental status examination guides psychiatrists in distinguishing between mood disorders, cognitive impairment, and thought disorders. Generalized “psychomotor retardation” is the highly prevalent symptom of depression based on mental status exam findings. Thus, ruling out MDD in this client would be justified by the absence of generalized psychomotor retardation.

I also concur with you that the client qualifies for an antisocial personality disorder diagnosis. Drinking excessively makes this client consistently irresponsible, qualifying for this diagnosis. Additionally, the client qualifies for this diagnosis since he disregards his safety by driving recklessly when drunk. However, I agree that an antisocial personality disorder should be ruled since the client did not report some major symptoms of this condition, including breaking the law repeatedly, being impulsive, being deceitful, and irritability and aggressiveness. Lastly, I concur with you that the client qualifies for a Bipolar Disorder diagnosis. He reported some symptoms associated with the disorder such as experiencing persistently depressed moods. According to Baldessarini et al. (2020), bipolar disorder is characterized by extreme mood swings. However, you were justified to rule out this diagnosis due to the absence of some significant symptoms of bipolar disorder, including increased energy that depicts a mania episode.

Treatment Plan

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I agree that the treatment plan for this client is aimed at cutting down alcohol intake and improving the client’s functioning capacity. Thus, a treatment consisting of pharmacological and non-pharmacological interventions would result in the achievement of treatment goals. I concur with you that naltrexone 50mg orally daily is an effective medication for managing a client’s symptoms due to its effectiveness in reducing heavy drinking days and enhancing abstinence in individuals diagnosed with AUD (Witkiewitz et al., 2019). Alternatively, the client could be prescribed disulfiram 500 mg orally. The FDA approved this drug for treating people with substance abuse disorder due to its superior outcomes (Kranzler & Soyka, 2018). Additionally, I support your choice of cognitive behavior therapy (CBT) as a non-pharmacological intervention for reducing presented symptoms due to its effectiveness in treating individuals diagnosed with AUD (Karsberg et al., 2021). Alternatively, motivational enhancement therapy (MET) could be used due to its effectiveness in managing symptoms presented by individuals diagnosed with substance use disorder (Leonardi et al., 2021). Thu, using MET would reduce alcohol and nicotine abuse in this client.

Health Promotion and Patient Education

I agree that the client should be educated about the dangers of excessive alcohol consumption. The client reported excessive consumption of alcohol and was diagnosed with AUD. Educating the client about the adverse effects of excessive alcohol intake on his health and overall well-being would change his thinking and focus on reducing alcohol intake. Additionally, the client should be educated about the dangers of engaging in unprotected sexual intercourse. According to Yazdi-Feyzabadi et al. (2019), alcohol abuse leads to risky sexual behaviors among adolescents. Thus, educating the client about the dangers of engaging in unprotected sexual intercourse will reduce the risk of contracting STIs, including HIV/AIDs.

Responses to Peer Questions

1. What are the most effective interventions for managing the client’s AUD symptoms?

Medications and non-pharmacological interventions are effective treatment interventions for people diagnosed with AUD. According to Kranzler and Soyka (2018), the US Food and Drug Administration approved disulfiram, naltrexone, and acamprosate in treating alcohol use disorder due to their effectiveness in managing presentable symptoms. Additionally, these drugs are tolerated by people with AUD. On the other hand, psychotherapies, including CBT and MET effective treatments for AUD. CBT is effective in treating individuals diagnosed with AUD (Karsberg et al., 2021). Furthermore, using MET in treating individuals diagnosed with substance use disorder leads to superior outcomes (Leonardi et al., 2021).

2. Does combining pharmacotherapy and cognitive behavioral therapy in treating teenagers with alcohol use disorders gives superior results?

Combined therapy is a common treatment intervention for AUD. Studies indicate the effectiveness of combining pharmacotherapy and cognitive behavioral therapy in treating adolescents diagnosed with AUD (Ray et al., 2020). Thus, using combined therapy in this client would improve reported symptoms.

References

Baldessarini, R. J., Vázquez, G. H., & Tondo, L. (2020). Bipolar depression: A major unsolved challenge. International journal of bipolar disorders, 8(1), 1-13. https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-019-0160-1

Ben El Jilali, L., Benazzouz, B., El Hessni, A., Ouichou, A., & Mesfioui, A. (2020). Prevalence of alcohol consumption and alcohol use disorders among middle and high school students in Khemisset, Morocco: a cross-sectional study. International Journal of Adolescence and Youth, 25(1), 638-648. https://doi.org/10.1080/02673843.2019.1700807

Dold, M., Bartova, L., Souery, D., Mendlewicz, J., Serretti, A., Porcelli, S., … & Kasper, S. (2017). Clinical characteristics and treatment outcomes of patients with major depressive disorder and comorbid anxiety disorders-results from a European multicenter study. Journal of psychiatric research, 91, 1-13. https://doi.org/10.1016/j.jpsychires.2017.02.020

Grossman, M, & Irwin, D, J. (2016). The Mental Status Examination in Patients with Suspected Dementia. Continuum Dementia; 2 (7): 385-403.

Karsberg, S. H., Pedersen, M. U., Hesse, M., Thylstrup, B., & Pedersen, M. M. (2021). Group versus individual treatment for substance use disorders: a study protocol for the COMDAT trial. BMC public health, 21(1), 1-9. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-10271-4

Kranzler, H. R., & Soyka, M. (2018). Diagnosis and pharmacotherapy of alcohol use disorder: a review. Jama, 320(8), 815-824. Doi:10.1001/jama.2018.11406

Oesterle, T. S., Kolla, B., Risma, C. J., Breitinger, S. A., Rakocevic, D. B., Loukianova, L. L., … & Gold, M. S. (2020, December). Substance use disorders and telehealth in the COVID-19 pandemic era: a new outlook. In Mayo Clinic Proceedings (Vol. 95, No. 12, pp. 2709-2718). Elsevier. https://doi.org/10.1016/j.mayocp.2020.10.011.

Ray, L. A., Meredith, L. R., Kiluk, B. D., Walthers, J., Carroll, K. M., & Magill, M. (2020). Combined pharmacotherapy and cognitive behavioral therapy for adults with alcohol or substance use disorders: a systematic review and meta-analysis. JAMA network open, 3(6), e208279-e208279. DOI: 10.1001/jamanetworkopen.2020.8279.

Witkiewitz, K., Litten, R. Z., & Leggio, L. (2019). Advances in the science and treatment of alcohol use disorder. Science advances, 5(9), eaax4043. Doi:10.1001/jama.2020.2012.

Yazdi-Feyzabadi, V., Mehrolhassani, M. H., Zolala, F., Haghdoost, A., & Oroomiei, N. (2019). Determinants of risky sexual practice, drug abuse and alcohol consumption in adolescents in Iran: a systematic literature review. Reproductive health, 16(1), 1-10. https://doi.org/10.1186/s12978-019-0779-5

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