DB1: At least 250 words or more without the references included. 2-3 peer review articles publication within 5 years only US. Please in the intext citation appropriately. 1. Would Vivitrol be indicated for either of these clients? 2. Case study 1: Please answer the questions below and elaborate your answers. 2-3 references peer review articles publication within 5 yeas of publication. 27 y/o male HISTORY OF PRESENT ILLNESS: A 27 y/o male was brought to ER by his wife . He has been experiencing chest pain for 1 day starting at 2:00 am in the morning. He is triaged to the medical emergency department Where a medical hx. Is taken. The pt. has no history of MI, HTN, or other cardiac risk factors. The man is irritable and hypervigilent; he repeatedly asks the nurse if “you know what you are doing” and becomes increasingly guarded as the intern requests more details about his medical history, replying suspiciously, “you don’t need to know that”. The man’s wife asks if she can speak to the doctor alone, and says that her husband typically leaves his work as an investment banker on Friday night, stays out until late several nights a week, and has great difficulty going to work on time in the morning. On the weekends, he often sleeps 12-18 hrs. a day. She also noticed some weight loss over the past few months. Sometimes after a late night working or socializing with co-workers, he appears to be almost paranoid toward her, accusing her of cheating on him or talking about him behind his back. She denies his accusations and appears extremely concerned. She acknowledges that he has been under increased pressure at work to perform and stay late; several friends at work have been laid off in the past year. He denies feeling depressed and says the he is “just stressed out”. PAST PSYCHIATRIC HX: The pt. denies any past psychiatric history; he has never been hospitalized in a psych hospital or received psychiatric treatment. He admits that he “dabbled in drugs before, bu I am here for chest pain”. PAST MEDICAL HX: Other than seasonal allergies, the pt. denies any past or current medical problems. MENTAL STATUS EXAM; The pt. is alert and oriented and appears disheveled, dressed in work clothes that are unkempt. His speech has rapid rate, and mildly increased volume but is not pressured. He is restless and looks around the room frequently but does not exhibit psychomotor agitation. Pt describes his mood as “fine”, “just having chest pain”, but his affect is extremely anxious, irritable, and guarded. Thought process is linear and goal directed, but thought content shows some paranoid ideation toward his wife and ER staff. The pt. denies hallucinations and suicidal or homicidal ideation. His cognition is intact. Insight and judgment are deemed to be limited. PHYSICAL EXAM; VITAL SIGNS: HR=102/min.; B/P 170/90; Temp= 98.6F, resp.= 18/min. The pt. is breathing comfortably and is in no apparent distress. He does appear somewhat thin, and there are traces of dried blood in his left nostril. Cardiac exam reveals no signs or murmurs, rubs, or gallops. The remainder of the exam was likewise unremarkable. NEUROLOGIC EXAM; Gait is normal. No abnormal movements are noted. Pupils are dilated bilaterally. Cranial nerves 2-12 are intact. A mild tremor is noted in both hands. There are no sensory of motor deficits. LAB. TESTING: CPK=WNL; other cardiac enzymes show no indication of MI. DIAGNOSTIC TESTING: EKG: normal sinus rhythm at 102 bpm; flipped T waves in several leads. Chest x-ray normal. What is this man’s diagnosis? Answer: Substance Abuse Disorder mainly cocaine intoxication What are his differential diagnosis? Answer: Amphetamine intoxication, Schizophrenia, Bipolar Disorder, Mood Disorder, and other Substance-Induced Disorder, Generalized Anxiety Disorder, and Post-Traumatic Stress Disorder (PTSD). Are there any other labs you would run? Answer: Urine or blood drug screening, and Thyroid Panel , HIV test, and head CT What is your plan of care? -Detox plan -Cognitive Behavioral Therapy (CBT) -pharmacological management; would be SSRI and antidepressant medications etc…..
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