impulse

Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
Objective: What observations did you make during the psychiatric assessment?
Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
Reflection notes: What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
PLEASE INCLUDE INTRODUCTION AND CONCLUSION
REFERENCES WITHIN FIVE YEARS FOR AT LEAST 5 OF THEM

TRANSCRIPT OF VIDEO FILE:

00:00:00______________________________________________________________________________

00:00:00BEGIN TRANSCRIPT:

00:00:00[sil.]

00:00:15MOTHER This is the doctor. Sit up straight, put your phone away.

00:00:20SHANE Whatever.

00:00:20OFF CAMERA Hello, Mrs. Morgan, Shane.

00:00:25MOTHER Nice to meet you. Shane?

00:00:25SHANE Nice to meet you, doctor.

00:00:30OFF CAMERA Nice to meet both of you. Can the two of you tell me about why you came here today?

00:00:35MOTHER Shane?

00:00:35SHANE It wasn’t my idea to come here; you tell him.

00:00:40MOTHER Well, everything was fine until he was about 13 years old. He started attending a different school when we moved across town. That’s when he started hanging out with this bad group of kids.

00:01:00SHANE You didn’t like my friends at Grove Park either.

00:01:00MOTHER Well, I didn’t like some of them. The rest of them were fine; I knew their parents. Anyway after he started hanging out with this bunch that’s when he got into trouble.

00:01:15OFF CAMERA What type of trouble?

00:01:20MOTHER Shane lead by Alex and Burton burned a barn.

00:01:20SHANE It was an accident.

00:01:25MOTHER The police investigation found they used two gallons of fuel to set it.

00:01:30SHANE Whatever; believe what you want.

00:01:30MOTHER They dumped cement powder into the gas tank of one of their teacher’s cars.

00:01:35SHANE [Snickering]

00:01:40MOTHER [Smack] It’s not funny.

00:01:40OFF CAMERA Were there legal charges? Other legal charges?

00:01:45MOTHER Well, Alex comes from a wealthy family so, of course, he got off, but the case against Shane and Burton is still pending.

00:02:00OFF CAMERA And are there other charges?

00:02:05MOTHER Shane, tell him. You wanted help.

00:02:05SHANE I never said I wanted help.

00:02:10MOTHER You did too. You were crying. You said you were sorry for what you did.

00:02:15SHANE I never did I was sorry.

00:02:20MOTHER And you wanted help. You did too.

00:02:25SHANE I said I was sorry that Alex was such a fricking dick and told his brother what we did; that’s it.

00:02:30OFF CAMERA So, Shane, what were the other charges?

00:02:35SHANE Just breaking and entering.

00:02:40MOTHER Just.

00:02:40SHANE It was an abandoned building not like somebody’s house or business.

00:02:45OFF CAMERA What kind of building?

00:02:50SHANE Some warehouse. It had some old rusty tractors and papers and stuff. I don’t know.

00:03:00OFF CAMERA Did you take anything?

00:03:00SHANE Just some old tools. Nothing else seemed worth anything.

00:03:05OFF CAMERA Did you take the tools so you could sell those for money?

00:03:10SHANE I think Alex sold for some pot money. I don’t know; I didn’t sell it.

00:03:15MOTHER Just an accomplice. What a relief.

00:03:15SHANE Mom, shut up.

00:03:20OFF CAMERA Have you ever shoplifted?

00:03:20MOTHER Has he? Tell him.

00:03:25SHANE You do it. You’re the one that’s so eager to tell him.

00:03:30MOTHER He stole electronics from Wal-Mart and then a bracelet from Harmon’s Jewelers.

00:03:45OFF CAMERA What kind of consequences do you have for Shane at home when he gets in trouble?

00:03:50MOTHER Consequences? Are you kidding? We don’t see him for days at a time despite our having a firm curfew.

00:04:00SHANE I stay with my friends. You know where I am.

00:04:00MOTHER Well, you say you’re staying at Burton’s house, but when I call Burton’s mom, she hasn’t seen you for days either despite her setting firm curfews.

00:04:10OFF CAMERA Do you miss any school?

00:04:15MOTHER Does he? I don’t think he even remembers what the school looks like.

00:04:20OFF CAMERA Shane, do you miss any school?

00:04:25SHANE Yeah. I got expelled for truancy. Okay, I wanted homeschooling anyway. That place sucks.

00:04:40MOTHER He started being truant even at the other school. He was only 11 years old and he lied about his homework assignments everyday about what happened in school making it sound like he went to school. He didn’t. God only knows where he was.

00:04:55OFF CAMERA Shane, have you had any times of hurting people, physically hurting people?

00:05:05MOTHER No. No. Nothing like that has ever happened unless it has happened and you hid that from me too.

00:05:15SHANE I never bullied or hurt anyone, Mother.

00:05:20OFF CAMERA Shane, what about hurting any animals?

00:05:20SHANE No. Well, just some old cat down the street.

00:05:30MOTHER Mrs. Weston’s cat? You were the one who killed Mrs. Weston’s cat?

00:05:35SHANE I didn’t kill her cat. I tied a can around its tail and it got excited and ran into traffic. It’s not my fault.

00:05:45OFF CAMERA Do you have any, either owned or have access to any guns or knives?

00:05:50SHANE Guns, no, but everyone has access to knives. Look at any kitchen.

00:05:55OFF CAMERA Sure, I’m sorry. What about knives that are weapons?

00:06:00SHANE No.

00:06:05OFF CAMERA Have you ever threatened anyone with a gun or a knife or any other kind of weapon?

00:06:10SHANE Just threatened Alex to punch him in his big mouth for saying he was going to screw my girlfriend, but he just said that to get a rise out of me. He whines and says I don’t show much emotion. I don’t care.

00:06:20MOTHER It’s true. He’s always been a quiet, calm kid. Thank goodness for that.

00:06:35[sil.]

00:06:35END TRANSCRIPT

 

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