This signature assignment aims for each student to bring together everything they have learned, and assess their ability to integrate their knowledge of the mental health disorders and therapeutic modalities presented in this course and apply it to a patient case study. Students will be presented with a detailed case study involving a patient with multiple mental health diagnoses.

Requirements

1. Conduct a thorough assessment

• Gather relevant information from the case study, including patient demographics, history, symptoms, and diagnostic criteria.
• Identify the primary and secondary diagnoses based on the DSM-5 criteria.
• Conduct a comprehensive assessment of the patient's mental status, including cognitive, affective, and behavioral components.

2. Develop a comprehensive treatment plan

• Outline the patient's individualized treatment goals.
• Propose appropriate therapeutic interventions, considering the patient's diagnoses, symptoms, and preferences.
• Integrate evidence-based practices, such as EMDR, CBT, trauma-focused therapy, and motivational interviewing, as applicable.
• Address potential challenges and barriers to treatment.

3. Address ethical considerations

• Discuss any ethical dilemmas or concerns that may arise in the case.]
• Consider the patient's autonomy, beneficence, nonmaleficence, and justice in decision-making.

4. Evaluate the effectiveness of treatment.

• Propose strategies for monitoring the patient's progress and evaluating the effectiveness of the treatment plan.
• Discuss potential outcomes and challenges that may arise during treatment.

Case Study

John, a 45-year-old male construction worker, presented to the clinic with a six-month history of depressive symptoms. He reported a loss of interest in once pleasurable activities. John also described persistent sadness and feelings of hopelessness, accompanied by irritability. Additionally, he experienced frequent awakenings and difficulty falling back asleep. His appetite had decreased, leading to weight loss.

John's past medical history was significant for major depressive disorder (diagnosed ten years ago), generalized anxiety disorder (diagnosed five years ago), and a traumatic brain injury sustained in a car accident three years ago. He also disclosed a history of alcohol abuse in the past.

Family history revealed that both his mother and sister had been diagnosed with depression.
John has a history of taking medications for his major depressive disorder, generalized depressive disorder, and traumatic brain injury. In the past, he has tried sertraline (Zoloft) for his depression. However, he experienced significant side effects such as nausea, insomnia, and sexual dysfunction. For his anxiety, he has been prescribed alprazolam (Xanax), which he found to be effective in reducing his anxiety symptoms. However, he was concerned about the potential for dependence and addiction. To manage his symptoms related to his traumatic brain injury, he has been on memantine (Namenda), which he has found to help improve his cognitive function. However, John has expressed a general dislike for taking medications and often avoids them if possible.

Socially, John was estranged from his ex-wife and had limited contact with his children. He lived alone and had few close friends. He reported currently abstaining from alcohol use. He appeared disheveled and unkempt during the mental status examination, suggesting poor self-care. His mood was depressed and hopeless, and his affect was blunted, indicating a reduced emotional range. His thought process was linear and goal-directed, but his thought content was dominated by negative thoughts about himself, his future, and his relationships. He was oriented to person, place, and time but exhibited mild impairment in concentration and attention. His judgment was impaired, and he had limited insight into his condition.

Instructions

1. Review the patient information in the case study, including their name, age, gender, race/ethnicity, marital status, and occupation.
2. Analyze the patient's presenting complaint and history of present illness, paying careful attention to details about the onset, duration, and progression of their current health concern.
3. Evaluate the patient's medical history, noting any previous diagnoses, surgeries, and chronic conditions to understand their health status.
4. Consider the patient's family history of illnesses and conditions and document any significant family medical history, including genetic conditions or diseases that could be hereditary.
5. Assess the patient's social history, including lifestyle, living situation, support system, and any substance use or abuse.
6. Perform a mental status examination based on the information in the case study to evaluate the patient's cognitive and emotional well-being, and document their appearance, mood, speech, thought processes, and overall behavior.
7. Develop an assessment of the patient's condition based on the gathered information and create a comprehensive treatment plan. This plan should include relevant interventions, medications, therapy, and follow-up care tailored to the patient's needs and considerations.
8. Document the assessment and treatment plan clearly, concisely, and organized, and ensure it complies with all applicable standards and regulations for patient care and privacy.
9. Integrate the evidence-based practices into a comprehensive plan or solution for the case study scenario.
10. Identify any ethical dilemmas or considerations within the case study, and evaluate how the ethical considerations may affect the decision-making process or potential solutions. Develop an ethical framework or guidelines for addressing the ethical factors within the case study.
11. Identify the potential challenges and barriers that may arise in implementing solutions or interventions in the case study. Develop strategies for addressing or overcoming these challenges and barriers. Create contingency plans or alternative approaches to mitigate potential obstacles.
12. Review the assignment rubric.