Take this scenario and make it original Upload an initial post of your most inte

Take this scenario and make it original
Upload an initial post of your most interesting client that you’ve encountered during this clinical experience. The Initial post should be thoughtfully and professionally executed with evidence-based resources clearly integrated and synthesized into all discussion posts. You must provide at least 1 evidence-based resource/reference for all DB posts.
An interesting patient from clinical this week was a 37 year old male with a psychiatric history of Generalized Anxiety Disorder, Panic Disorder without Agoraphobia, and Attention Deficit Hyperactivity Disorder, inattentive type. His anxiety is triggered by change. During his visit he reported his anxiety level at a 10/10, with several panic attacks. His anxiety and panic attacks were triggered from his dog having to have an unplanned surgery. He reported that the more he would think about his dog, his mind and thoughts would just keep spiraling and then he would exhibit a panic attack. His symptoms included feeling like his heart was racing, feeling short of breath, profuse sweating, and feeling like something was sitting on his chest or a chocking sensation. He also reported that last month he had to ration his stimulant medication for his ADHD. He has been taking it 2-3 times per week because his pharmacy did not have any to provide him for his prescriiption most of the month. There has been a shortage of generic Adderall and Concerta since February 2023. For some reason, many manufacturers of these medications have limited production or stopped all together. Many insurance companies will deny medication claims for the branded medications due to the cost. And this increased demand is also leading to shortages of the branded medications (Price & Price, 2023).
ADHD and Generalized Anxiety Disorder often co-occur in individuals. Persistent ADHD symptoms may exacerbate anxiety symptoms in an individual (Fuller, et al., 2022, p. 708). With this patient having an increase in his ADHD symptoms from not having his medication, his anxiety was likely already more heightened. With the added stress and changes from his dog having to be at the vet from the surgery, the increased frequency of panic attacks makes sense. Those with ADHD and GAD tend to have less supportive and strong relationships with others. His dog is his support and a safety mechanism. The loss of that protective factor increases the vulnerability of his mental health ( Fuller, et al., 2022, p. 712).
Patient medications: Concerta 36 mg, Effexor 75 mg, Abilify 2 mg, and hydroxyzine pamoate 50 mg PRN
References
Fuller-Thomson, E., Carrique, L., & MacNeil, A. (2022). Generalized anxiety disorder among adults with attention deficit hyperactivity disorder. Journal of affective disorders, 299, 707-714.
Price, M. Z., & Price, R. L. (2023). Generic stimulant shortage update: From bad to worse. Current Psychiatry, 22(3), e2-e3
SCENARIO #2
The patient this week is a 48-year-old white female that presents with major depressive disorder (F33.0), and generalized anxiety disorder (F41.1). Patient reported that she is having a difficult time controlling her emotions as she feels angry with outbursts a lot, which is not like her. She also reported that she is also having trouble using her coping skills as she cannot concentrate on her positive imagery or keep focused on tasks. Patient reported going to her mother’s to spend time with family and being able to attend a family celebration with numerous family members outside, glad to see her uncle, who is recuperating slowly. Patient reported on her concerns and worry regarding family and her own health and agreed to speak with her provider or nurse regarding her medications. Patient reports that she doesn’t feel like herself. Patient had reported that she had a recent change in her estradiol and was switched to a patch by her Obgyn. She reports that she has been on the patch for 3 weeks and can tell that it’s working as her hot flashes are working. Reports that she does think that the mood issues started the same time as the patch. Patient called this afternoon regarding issues she has been having with her mood, reports that it has been getting worse since last provider visit. Last saw her Psych provider on 7/7, and was advised to follow up with her ob-gyn in regard to her medication from them, as this may have been contributing to the low mood. Patient reported today that her obgyn advised that the patch and estradiol were not contributing factors to the mood, and she should follow back up with Psych to see if she can get started on a psychiatric medication for mood. Patient had become upset and crying because her current Psych provider was out of town and felt that she wasn’t being helped as she should be. Mother (of this 48-year-old patient) had called and reported she was going to “spend as much money as it would take to file a complaint against the company” for not helping her daughter) Patient was advised patient that she will be able to see another provider while hers is out of town, and this seemed to calm the patient down, and she reported that she felt better that someone was listing to her. It seems that all the client wanted was help with her mood and couldn’t wait until her other provider returned. The staff was able to get the client in on Friday for a follow-up visit to address her concerns. Client verbalized understanding and will sign ROI on Friday. Patient stated she was not feeling suicidal and was able to contract for safety. Her protective factors are her parents and other family members.
Clients current medications are:
Klonopin 1mg qam , 0.5mg qafternoon and 1mg qhs
Trazodone 300mg qhs
Buspar 10mg tid
Psychiatry and psychology describe clinical depression as a persistent and severe form of mild sadness that occurs in everyday life. The patient’s presentation is consistent with studies that report more severe negative emotions and variable positive emotions in patients with major depression attending ecological momentary assessment sessions. When someone has depression, mood fluctuates rapidly between opposite emotions that appear to be polar opposites. (Bowen et al., 2017)This patient’s mood had fluctuated a few times between deep sadness and laughing at the end. She reported that it’s difficult for her to get her emotions under control, and she is hoping that she can start a medication that will help.

References
Bowen, R., Peters, E., Marwaha, S., Baetz, M., & Balbuena, L. (2017). Moods in clinical depression are more unstable than severe normal sadness. Frontiers in Psychiatry, 8. https://doi.org/10.3389/fpsyt.2017.00056Links to an external site.