St Thomas University Dementia Case Study

A 74-year-old African American woman, Ms. Richardson, was brought to the hospitalemergency 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
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.
Your initial post should be at least 500 words, formatted, and cited in current APA style with
support from at least 2 academic sources no more than 5 years old.
Summary of Clinical Case
The patient is Ms. JN, a 24 y/o female, whose chief complaint is excessive worry.
According to the patient, she has been worrying almost about everything as well as being
stressed out regarding her school life and upcoming examinations. Additional complaints include
lack of concentration, excessive fatigue, headaches that occur too often, neck muscle spasms,
and insomnia. She’s been described by the husband as a worrier since she gets worried that he
may be involved in an accident, him getting unemployed, along with some financial worries. As
she reports, her symptoms of anxiety have been overwhelming her in the recent 12 months.
Patient’s Problems in Order of Priority

Anxiety – The patient is concerned and “worried about everything”. She feels
impeding danger/doom. Has neck muscle spasms.

Fear – JN is fearful that her husband might lose his job, and maybe be involved in
an accident.

Fatigue – she is easily fatigued and loses concentration on class work

Ineffective coping – brought about by her being stressed out with her
responsibilities academically.

Insomnia – she has trouble falling asleep.
Pharmacological Treatment with Rationale
Use of Benzodiazepines such as Xanax 0.5mg three times a day. The concentration of a
critical neurotransmitter chemical known as GABA is increased once the patient takes the drug.
GABA works by inhibiting nerve cells from sending chemical messages to other nerve cells,
thereby introducing a sedative, hypnotic anxiolytic effects and muscle relaxant properties
(Rachman, 2019). Additionally, the drugs also cause feelings of drowsiness thereby assisting the
patient to fall asleep. Other medications that can be used include SSRIs such as Zoloft. These
drugs work by slowing the reuptake of serotonin thereby helping in mood stabilization and
anxiety (Rachman, 2019). Zoloft can be administered inform of a tablet at 50 mg once a day, to
be taken in the evening or morning.
Non-pharmacological Treatment with Rationale
First, I would start by trying to put the patient at ease so as to discuss with her the
available therapeutic options. Establishing a trusting relationship with the patient is crucial so as
to contribute to better care experiences (Poulsen, 2017). I would then recommend Cognitive
Behavioral Therapy (CBT), which will teach things such as positive reframing. This will help the
patient interrupt and change the worried thoughts that give rise to anxiety (Poulsen, 2017);
Decatastrophizing, which is also a useful CBT tool that will teach the patient how to challenge
and alleviate catastrophic thinking; and Assertiveness training (Poulsen, 2017). These treatments
will assist the patient in recognizing and correcting negative thinking and behavior associated
with fear and anxiety, allowing them to live a much more optimistic and productive life.
Use of relaxation techniques such as deep breathing exercises, meditation, guided
imagery, and music therapy. These relaxation techniques soothe and relieve the client’s anxious
mind, as well as reducing muscle tension (Poulsen, 2017).
Assessment of treatment’s appropriateness, cost, effectiveness, safety, and potential
for patient adherence.
The appropriateness of treatment can be determined by thoroughly identifying the
patient’s problems and sources. Next is establishing a therapeutic goal that will include steps into
the patient’s treatment plan. Then, I would choose the best drug and non-pharmacologic therapy,
apply and initiate them with sufficient detail, as I provide specifics, instructions, and warnings.
Following that, the effectiveness of the treatment is going to be determined by evaluating the
implemented therapies through quantifiable progress and improvements in the patient’s signs and
symptoms, stalled progression of the disease, and overall improved patient outcomes. Provision
of evidence of drugs’ side effects and toxicity will form part of the safety evaluation of the
pharmacological treatment. Adherence to the medication can be evaluated using a variety of
techniques, including interviews, self-report questionnaires, and tracking disease progression as
well as patient outcomes.
Poulsen, I. A. (2017). Non-pharmacological interventions to reduce anxiety in patients
undergoing conscious surgery.
Rachman, S. (2019). The treatment of anxiety disorders. Anxiety and the Anxiety Disorders, 453462.

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