Interpretation of the Findings

Interpretation of the Findings

The patient’s height did not change over the period. During the initial diagnosis, the patient weighed 248#. The patient had gained weight during the second diagnosis and weighed 248#. The heart rate decreased from 82 to 78. The platelets count and the white blood cell count decreased and were out of range by 2.5L and 127L, respectively. The haemoglobin A1c also increased and was out the range by 5.8. These results were consistent with an increased risk of the presence of diabetes.

There were some metabolic effects that led to the addition of Seroquel medication for the patient. Since the medication is used for the treatment of the bipolar disorder, schizophrenia, and major depressive disorder, this was an indication that the patient could be having an increased blood sugar. One could note that the patient had poor glucose control and chances were that his blood sugar level was higher than it was supposed to be. He was at significant risk of heart, nerve, eye, and kidney damage

The Ativan dosage was increased from o.25mg to 0.5 mg. This is an indication that the patient was experiencing more trouble when trying to sleep as well as extreme anxiety disorders. The condition had been worsening since the initial diagnosis. The patient was not taking Tenex medication at the time of the second labs. This shows that the patient’s blood pressure had stabilized and that he could pay some attention. The presence of Depakote medication reveals how the patient was still struggling with hypomanic and depressed moods despite some improvement..

Addressing the Findings

Further Work-Up Recommendations

The family should keep a sleep log of 2-4 weeks, whereby they record bed and wake times, daytime naps, sleep duration, and activities. This will help in identifying the level of sleep disturbance to help in developing a tailored treatment program (Lau, Kozyra,  & Cheng, 2019). Seeing the patient twice a month will be important to observe his behaviour and development to make a diagnosis. Renal, thyroid, and liver function tests should be conducted. The calcium, serum methylmalonic acid, vitamin B-12, and folate levels should also be tested.

Med Changes

The patient should stop taking Zoloft and start taking Lexapro. Lexapro has better efficacy and tolerability due to varying binding site interactions.

Additional Focused Psychiatric Evaluation

Organizing face-to-face talks with the patient would provide an opportunity to ask questions that need to be answered verbally and through a questionnaire. This would help in reviewing the patient’s mood, thought content, level of anxiety, and perception (Hardin & Ryder, 2019). The conclusion will be made based on past and current psychiatric diagnoses. Close observation will be made to determine if the patient is responding to medication.

Psychoeducation I Plan To Provide

I will develop a brief psychoeducation of about ten sessions to provide useful information to the patient and his family members. The training will promote awareness and provide tools to manage, cope, and live with the patient. This will be a way of encouraging cooperation from the family as well as promoting medication compliance (Maheshwari et l., 2020). I will use a structured and systematic intervention that will integrate motivational and emotional aspects to enable the patient to cope with the condition and improve its treatment efficacy. I will also focus on educating the patient and the family about his psychological condition.

References

Hardin, K. A., & Ryder, Z. C. (2019). Sleep in Geriatric Psychiatry Inpatients. In Inpatient Geriatric Psychiatry (pp. 169-188). Springer, Cham.

Lau, T., Kozyra, E., & Cheng, C. (2019). Delirium: Risk Factors, Contributors, Identification, Work-Up, and Treatment. In Inpatient Geriatric Psychiatry (pp. 219-235). Springer, Cham.

Maheshwari, S., Manohar, S., Chandran, S., & Rao, T. S. S. (2020). Psycho-Education in Schizophrenia. In Schizophrenia Treatment Outcomes (pp. 275-284). Springer, Cham.