Read Chapter 4 of Hacking Leadershipand write three paragraphs about what you learned and how you think you might use this in your school work and career.
This is not a book report: it should be you explaining what you’ve learned from this chapter.
Contents
Prologue
Chapter 1: Hacking the Leadership Gap
OverviewThe Commoditization of Leadership
The Leadership Gap Defined
Hacking the Control Gap
The Awareness GapFinding the Blind Spots
The Key to ClarityWhite Space
Hacking the Status Quo
Hacking the Preparation Gap
Chapter 2: Hacking the Purpose Gap
Following in the Footsteps of GreatnessThe Movement Hack
Individual PurposeHacking the Purpose Continuum
Hacking the Pursuit Gap
Hacking the Passion Gap
Finding Organizational Purpose Begins with Hacking Why
Hacking the Profit Gap
Chapter 3: Hacking the Future Gap
How to See around CornersHacking the Vision Gap
To Hack the Future You Must Have Clear Perspective on the Past
To Hack the Future You Must Understand How to Navigate the
Present
Hacking the New Normal
Great Leaders Hack the Future by Pulling It Forward
Hacking Generational Complexity
Chapter 4: Hacking the Mediocrity Gap
Hacking the Impulsivity Gap
Hacking the Impossibility Gap
Hacking the Safety Gap
Hacking Political Correctness
Chapter 5: Hacking the Culture Gap
Hacking the Gap between Strategy and Culture
The Right FoundationHacking the Culture Construct
Hacking the Management Construct
Hacking the Scarcity Gap
Hacking the Courage Gap
Hacking the Arrogance Gap
Hacking the Rumor Mill
Hacking Diversity
Hacking Scalability
Hacking the Me Too GapDont Copy, Create
Chapter 6: Hacking the Talent Gap
Hacking the Trust Gap
Hacking the Loyalty Gap
Hacking the Four Dimensions of Talent
Hacking the Hiring Gap
Hacking the Definition Gap
Hacking the Quality GapSupply versus Demand
Hacking the Consensus Gap
Hacking the One-Size-Doesnt-Fit-All Gap
Hacking the Pressure Gap
Hacking the Turnover Gap
Chapter 7: Hacking the Knowledge Gap
Hacking Static Thinking
Hacking the Decision Gap
Hacking the Competency Gap
Hacking the Learning Gap
Hacking the Reading Gap
Hacking the Communication Gap
Hacking the Sensitivity Gap
Hacking the Story
Hacking Verbosity
Chapter 8: Hacking the Innovation Gap
Hacking the Idea TrapWhat Innovation Is Not
Hacking the Change Gap
Hacking the Gap between Incremental and Disruptive
Hacking the Next Level
Hacking the Competition
Hacking the Flexibility Gap
Chapter 9: Hacking the Expectation Gap
Hacking the Alignment Gap
Hacking the Discipline Gap
Chapter 10: Hacking the Complexity Gap
Hacking Complexity
Hacking Smart
Chapter 11: Hacking the Failure Gap
Hacking Perfection
Hacking a Defensive Mind-set
Hacking Succession
Final Thoughts
About the Author
Index
More Praise for Mike Myatts Hacking
Leadership
Great leaders are aware of gaps and blind spots in their organizations, teams,
and lives. Learn the secrets of great leaders when you read Mike Myatts Hacking
Leadership!
Marshall Goldsmith, 2 million-selling author of the New York Times bestsellers,
MOJO and What Got You Here Wont Get You There
Hacking Leadership is a thought-provoking, status-quo-shattering jolt of
leadership wisdom that can propel anyone in the direction of their full leadership
potential. At a time when scores of people are content settling for What Is, Mike
challenges us to ask ourselves, What If? Instead of simply writing another book
on leadership, hes penned a powerfully persuasive narrative that reminds us the
only limits to our leadership are those we impose on ourselves. Hacking
Leadership is a must read for everyone!
Brigadier General John E. Michel, Commanding General NATO Air Training
Command-Afghanistan, and author of (No More) Mediocre Me: How Saying No to
the Status Quo Will Propel You From Ordinary to Extraordinary
Hacking Leadership merits a place on every twenty-first century leader s short
list of must-read books. Written from the heart and the mind of the renowned
leadership expert Mike Myatt, this remarkable manual for action will inspire you
to the greatest leadership contribution in your work and life.
James Strock, author, Serve to Lead, Theodore Roosevelt on Leadership, Reagan
on Leadership, former George H.W. Bush appointee as chief law enforcement
officer for the U.S. EPA
Mikes insights are logical, entertaining and well outlined. Deep experience with
a myriad of leaders enables him to understand the landscape, and his passionate
pursuit of innovation lets him crack it open. Hacking Leadership is a fresh take on
what it means to be an effective leader and take action.
Thomas X. Geisel, CEO, Sun Bancorp, Inc.
Every leader I know, including myself, has leadership gaps, and all of us need a
resource and framework for not only identifying the gaps, but also a practical
roadmap to help close those gaps. Hacking Leadership is an essential tool for
every leader to have in their toolbox for working on their own leadership and
thus improving the team and overall organization. Mike reminds us all not to
settle for the status quo, and the important role each of us has to bring about the
change we seek. True leaders do something about it, and are willing to mix things
up and hack away at their leadership, with the constant pursuit of excellence and
thus their true leadership potential.
Brad Lomenick, president and key visionary, Catalyst, author, The Catalyst
Leader
Cover image: iStockphoto.com/ROMAOSLO
Cover design: Wiley
Copyright 2014 by Mike Myatt. All rights reserved.
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To my familythey inspire me to be better.
To my friendsthey challenge me to do better.
To my clientsthey require me to think better.
To my co-workersthey motivate me to lead better.
Prologue
In my office hangs a plaque given to me as a gift. It originally read, It Is What It Is.
After a few weeks of reading that phrase several times a day, what I once regarded
as a harmless saying began to challenge my thinking and poke at my convictions. It
became clear to me this seemingly innocent phrase embodied much of whats wrong
with leadership today. So I did what any good leader would doI took action.
I rummaged through my desk drawer and found my whittling knife. I then
proceeded to carve the following inscription beneath the original statement: Until
You Decide To Change It. What once served as a statement of defeat now reads as
instructive encouragement; the text no longer lulls people who read it into a state of
complacencyit now propels them forward.
This simple piece of wall art (prior to my modification) is sadly representative of
many who hold positions of leadership. Burdened by common practice, busyness,
and an aversion to change, many leaders today suffer from an acute case of mental
numbness. They have fallen prey to the slow seduction of the status quo. As time has
passed, they have succumbed to accepting what is instead of pursuing what if. They
make safe choices instead of smart choicesthey have forgotten what it is to be a
leader.
There is no shortage of debate surrounding leadership when it comes to
philosophy, style, definitional distinctions, nuances, complex theory, and so and so
forth. That said, I believe most reasonable people would agree leadership is nothing
if not personal. Leadership can represent a pursuit, discipline, practice, passion,
calling, skill, competency, obligation, duty, compulsion, or even an obsession. Ive
known those who have worshiped at the altar of leadership as a religion, and a bit of
reflection will reveal more than a few leadership revolutions dotting the historical
timeline. My goal for Hacking Leadership is to challenge your thinking and your
perceptions with regard to the state of leadership. So, my question is this; whats
next for leadership?
In my first book Leadership Matters (2007), I made the following statement:
Whether through malice or naivet, those who trivialize the value of leadership
place us all at risk. Poor leadership cripples businesses, ruins economies,
destroys families, loses wars, and can bring the demise of nationsLeadership
Matters.
On an individual basis, a persons perceived leadership ability, or lack thereof,
will in large part determine their station in life; the schools theyre admitted to, the
jobs they hold, the family life they create, the influence they acquire, and the
financial security they achieve. On a collective basis, the quality of leadership has a
ripple effect (positive or negative) that can impact generations. Leadership, good or
bad, is a contagion.
Nothing impacts our world like leadership, and sadly, the practice of leadership is
broken. We live in a society where the pace of change has never been faster and
more dramatic, yet our leadership practices have remained painfully stagnant. Using
eighteenth, nineteenth, or twentieth-century leadership practices in the twenty-first
century simply doesnt work. Its time for a fresh perspectiveits time to begin
Hacking Leadership.
Core leadership principles have remained largely the same since the dawn of time.
The problem with todays leaders is they dont understand how to integrate time-
tested principles with evolving leadership practices built for twenty-first century
success. The world in which you attempt to implement previously successful
strategies and tactics has changed and is ever changing. Organizations, their
employees, and the various constituencies they serve are far different today from
what they were centuries, decades, or even a few years ago.
Heres the thingthese core leadership principles need not be abandoned, but
outdated and ill conceived practices must be hacked in order to reestablish
leadership equilibrium. Hacking Leadership puts the practice of leadership under a
transformative lens for the purpose simplifying the complex, while not throwing the
baby out with the bathwater.
Its important for leaders to embrace the practice of change as it applies to their
own tradecraft. Ive spent much of my adult life committed to the belief and practice
there is always room for innovation, development, and improvement. As much as
some dont want to hear it, this applies to leadership as well. When leaders hold
themselves to a higher standard of rigor, discipline, accountability, and transparency
everyone wins.
Ive often said the rigidity of a closed mind is the first step in limiting opportunity.
So let me ask you this question: When was the last time you changed something
about you? Not someone or something else, but your thinking, your philosophy,
your vision, your approach, your attitude, or your development. Most leaders are
quite skilled at embracing changeexcept when the focus of the change initiative
happens to be on them. Show me a person that never changes their mind, and Ill
show you a static thinker who has sentenced their mind to a prison of mediocrity
and wasted potential.
Smart leaders challenge everythingespecially conventional thought, best
practices, and dominant logic. When I refer to dominant logic, Im referencing
existing behaviors/practices, which lock organizations into a pattern of once-
productive thinking that no longer is (false truths held as real). Anything in business
can be improved, everything can be reimagined, and many things can flat-out be
eliminated. The trick is knowing what items to focus onwhich items to hack.
I want to pause here and set the tone moving forward by giving you my definition
of hacking:
hacking [hak-ing]present participle of hack (verb) to discover an alternate
path, clever and skillful tricks, shortcuts and workarounds, breaking the code,
deciphering complexity, influencing outcomes, acquiring access, creating
innovative customizations to existing/outdated methodologies.
Everyone has blind spots, and leadership gaps exist in every organization. The
purpose of this book is to equip leaders at every level with an actionable framework
to identify blind spots and close leadership gaps. Hacking Leadership offers a fresh
perspective that will make it easy for leaders to create a road map to identify, refine,
develop, and achieve their true leadership potential.
Hackers are innovative thinkers who acquire and distribute knowledge, tips, and
tricks for solving complex problemsthey reinvent strategies, protocols, and
practices to create more effective solutions to both existing problems and new
challenges. They adopt the mind-set of innovating around best practices in pursuit
of next practices.
Most of us are all too familiar with the statement you dont know what you dont
knowtheres never been a more dangerous cop-out for leaders than rationalizing
ignorance. The fact of the matter is the best leaders are poignantly aware of what
they dont know, and exhaust all efforts to close those knowledge gaps.
In many respects, leadership is nothing more than identifying personal, team,
organizational, and market blind spots and then dealing with them in the most
effective fashion. Therefore its critically important for leaders to understand that
most blind spots exist in the form of gapspositional gaps, philosophical gaps,
strategic gaps, operational gaps, expectation gaps, knowledge gaps, and so on. Gaps
exist in every organization: The issue is whether you recognize them, and if so, how
you choose to deal with them.
Many leaders choose to be ignorant of gaps and pretend they dont exist. The
problem is that when leaders fall into a gap, it often resembles a crevasse from
which there is no escape. Smart leaders proactively seek out gaps in an effort to
bridge, close, fill, jump, or navigate around whatever chasm they happen to be
facing. The better you become at turning gaps into opportunities (hacking the gaps),
the better leader youll become.
Ive had the privilege of working with thousands of leaders around the globe. Im
honored to count among my clients many past and present chairmen and CEOs of
some of the worlds leading organizations. What these men and women have
consistently taught me is that holding a position of leadership is not the same thing
as being a good leader; understanding the basic tenants of leadership is not the same
thing as being able to successfully apply them, and that leadership isnt a destination
its a journey.
While many things can cause leaders to stumble, Ive found there are 11 specific
leadership gaps, which if not properly identified, understood, and addressed can be
fatal. In each of the 11 chapters that follow, I address a particular topic by framing it
within the context of a leadership gap. I then go on to offer a series of hacks to help
you reframe your thinking so that you can either avoid or altogether eliminate the
gap.
Finally, I want to share with you my opinions and biases about most business
books, as well as offer a few insights for how you can get the most out of this work.
Most business books are full of fluff, and while they may be entertaining, they often
serve no real purpose other than to transfer some of your wealth to the author. In the
final analysis, a book is only as valuable to leaders as their willingness to
discerningly pull the useful concepts off the pages and place them into practice.
Books are little more than words on a page unless you choose to make them
something more.
I would certainly encourage you to challenge the concepts put forth in this book.
More importantly, I would encourage you to challenge your own thinking. Dont
just read the book; study the material and commit to becoming a better leader. The
day you stop hacking leadership is the day you should stop leading. Good luck and
good hacking. . . .
Chapter 1
Hacking the Leadership Gap
The plausibility of impossibility only becomes a probability in the absence of
leadership.
OverviewThe Commoditization of
Leadership
Whether you believe leadership has evolved or devolved over time, there is no
disputing the practice of leadership has become a contentious topic steeped in
ethereal, ambiguous rhetoric. Everyone seems to have an opinion of what
constitutes good leadership, but if good leadership is so easy to define and identify,
why then does it seem so hard to come by?
Society has essentially commoditized leadership resulting in a leadership bubble
of sorts. Because leadership has become the latest version of an entitlement
program, too many unqualified leaders have been allowed to enter the ranks.
This is not just a business problemits a global leadership problem. The media
is littered with daily examples of those placed in positions of leadership who failed
to lead. Leaders are often selected, promoted, and retained on entirely the wrong
basis. When leadership is perceived as little more than a title granting access to a
platform for personal gain, rather than a privilege resulting in an opportunity to
serve, well continue to find ourselves in a crisis of leadership.
Those of you familiar with my work know Im a dyed in the wool leadership guy.
. . . I believe all things begin and end with leadership. In fact, I hold this thesis so
dear, Ive said for years businesses dont fail, projects dont fail, and products
dont failleaders fail.
With principled, effective leadership, all things are possible. Its only when optics
become more important than ethics, when profit becomes more important than
purpose, when process becomes more important than people, and when politics
becomes more important than doing the right thing, that individuals and
organizations lose their direction. Sadly, this is where much of the world finds itself
today. The good news is by hacking current leadership frameworks and dynamics
we can find our way back to true north.
The best leaders understand leadership is the key to unlocking and realizing
limitless potential. I want you to think about leadership like thisthe only boarders
to leadership are those which are self-imposed. The only limits on your personal,
team, or organizational leadership are the ones you submit to.
So, you have a choiceyou can limit your worldview, or you can expand ityou
can embrace the status quo, or you can shatter ityou can follow best practices, or
you can lead innovation around them to identify next practices. Real leaders dont
limit themselves, but more importantly they refuse to limit those they lead.
All truly great leaders Ive had the opportunity to work with have had one thing in
commonthey have a clear understanding of their strengths and weaknesses.
Theyve learned to check their ego, enhance their level of self-awareness, and
understand how others perceive them. They are clear thinkers who understand their
role and are prepared to act accordingly.
This is a foundational chapterone that sets the tone you can build upon chapter
by chapter as you move forward. Therefore, the balance of this chapter will offer
some insights into how you can hack away at the self-rationalizations and
justifications keeping you from reaching your leadership potential.
The Leadership Gap Defined
Those who become what they do not understand will not like the outcome. Its
imperative you define yourself on both an aspirational and practical level as a
leader in order to lead well. Leadership isnt just a role or a titleits a choice. The
best leaders choose to be better, they choose to be differentthey choose to lead
well. The seminal question you must ask yourself as a leader is why should anyone
be led by you?
Think about it like thisaside from having a job, how are people better off for
being led by you? In order to consistently receive the right answer to the
aforementioned question, a leader must first gain an understanding of the following
three critical leadership gaps:
1. The Development Gap: This refers to the gap between how you assess your
current leadership ability and your true potential as a leader. An accurate
understanding of this gap indicates whether you see leadership as a destination
or as a continuum. It will determine whether you grow and develop your
leadership skills, or whether you will follow the path of least resistance and rest
upon your laurels. Keep this in mindit is impossible for a leader who is not
growing and developing to lead a growing and developing enterprise.
2. The Influence Gap: While influence can be generated in all directions, for
purposes of this discussion Im referring to the gap between your self-
assessment and the assessment of your leadership ability by your peers. Your
understanding of this gap, and willingness to do something about it, will
determine your ability to build a cohesive team. Leaders who dont have the
trust and respect of their team wont be able to generate the influence necessary
to perform at the expected levels.
3. The Reality Gap: This refers to the difference between how you view
yourself and how those you lead feel about you. A leader who loses the faith and
confidence of their workforce wont be able to attract and retain talent, will have
a culture on life support, and subpar performance that ensures only one thing
a limited shelf life.
Lets stop right here and do a quick gut check. I want you to rate yourself as a
leader on a scale from 1 to 10, with 1 representing the worst in leadership and 10
being the best in leadership. I dont want you to rate your leadership potential, but
rather how you are currently performing as a leader. This is a risk-free evaluation,
as nobody will see your score but you; do this now and write the number here ____.
Heres what we know to be true based upon the empirical evidence gleaned from
conducting thousands of interviews with senior executives. Regardless of your
position/title, you likely rated yourself between a 6 and an 8. Am I right? The reality
is regardless of how transparent you tried to be, 90+ percent of all people in
leadership positions wont rate themselves below a 6. Similarly, 90+ percent of
people in leadership positions wont rate themselves higher than an 8.
While this first set of data might not shock you, heres something else we know
about leadership self-evaluationsleaders consistently overrate themselves. How
do we know this? Because we have also surveyed thousands of subordinates and
peers, as well as those whom the leaders report to. This next set of data will shock
you.
When we ask those who work for and with you to rate you on the same scale with
which you conducted your self-assessment, they rate you on average 200 basis
points lower than you rate yourselfthats right, two full percentage points lower.
So, if you rated yourself an 8 your co-workers likely rate you a 6. If you rated
yourself a 6, then they likely rated you a 4. How does that make you feel?
The difference between your self-assessment score and how others rate you is
what I refer to as the leadership gap. Whether the leadership gap is perception or
reality doesnt really matterits nonetheless the gap all leaders must learn to hack.
Put yourself in the shoes of those who rated youhow impassioned and
motivated would you be to awaken each morning to go to work for a leader who
rates somewhere between a 4 and 6?
Where leadership always runs amok is when hubris overshadows humility, and
self-serving motives take the place of service beyond self. Leadership is not about
the power and the accolades bestowed upon the leader; its about the betterment of
those whom the leader serves. At its essence, leadership is about people. At its core,
leadership is about improving the status quo, inspiring positive change, and
challenging conventional thinking.
As long as positional and philosophical arguments are more important than
forward progress, as long as being right is esteemed above being vulnerable and
open to new thought, as long as ego is elevated above empathy and compassion, as
long as rhetoric holds more value than performance, and as long as we tolerate
these things as acceptable behavior we will all suffer at the hands of poor
leadership.
I think most of us understand at a high level that companies live and die by the
quality of their leadershipbut how many of you really internalize this deep down
at a personal level? If youre ready to dig deep and get serious about leadership, the
first thing to understand is how control limits your ability to lead.
Hacking the Control Gap
The most common mistake I see leaders make is to attempt to lead through control.
As counterintuitive as it might seem, in order to gain influence you must surrender
control. The reality is youll rarely encounter the words leadership and surrender
used together in complementary fashion. Society has labeled surrender as a sign of
leadership weakness, when in fact it can be among the greatest of leadership
strengths. Leaders who fail to learn how to hack the control gap fail to lead up to
their potential.
Let me be clear, Im not encouraging giving in or giving upI am suggesting
you learn the ever so subtle art of letting go. Leaders simply operate at their best
when they understand their ability to influence is much more fruitful than their
ability to control. Heres the thingthe purpose of leadership is not to shine the
spotlight on yourself, but to unlock the potential of others so they can in turn shine
the spotlight on countless more. Control is about powernot leadership. Surrender
allows leaders to stop impeding themselves and focus on adding value to those
whom they serve.
If youre still not convinced the art of leadership is learning that the focus point
should be on surrender not control, consider this: Control restricts potential, limits
initiative, and inhibits talent. Surrender fosters collaboration, encourages
innovation, and enables possibility. Controlling leaders create bottlenecks rather
than increase throughput. They signal a lack of trust and confidence and often come
across as insensitive if not arrogant. When you experience weak teams, micro-
management, frequent turf wars, high stress, operational strain, and a culture of
fear, you are experiencing what control has to offernot very attractive is it?
Surrender allows the savvy leader to serve, but control demands that the
egocentric leader be served. Surrender allows leadership to scale and a culture of
leadership to be established. Surrender prefers loose collaborative networks to rigid
hierarchical structures allowing information to be more readily shared and
distributed. Leaders who understand surrender think community, ecosystem, and
culturenot org chart. Surrender is what not only allows the dots to be connected,
but its what allows the dots to be multiplied. Controlling leaders operate in a world
of addition and subtraction, while the calculus of a leader who understands
surrender is built on exponential multiplication.
I have found those who embrace control are simply attempting to consolidate
power, while those who practice surrender are facilitating the distribution of
authority. When what you seek is to build into others more than glorifying self, you
have developed a level of leadership maturity that values surrender over control.
Surrender is the mind-set that creates the desire for leaders to give credit rather than
take it, to prefer hearing over being heard, to dialogue instead of monologue, to
have an open mind over a closed mind, to value unlearning as much as learning.
Control messages selfishness, while surrender conveys selflessnesswhich is more
important to you?
Keep this in mindwe all surrender, but not all surrender is honorable. Some
surrender to their ego, to the wrong priorities, or to other distractive habits. Others
surrender to the positive realization that they are not the center of the universe
they surrender to something beyond themselves in order to accomplish more for
others. Bottom linewhat you do or dont surrender to will define you. Assuming
you surrender to the right things, surrender is not a sign of leadership weakness, but
is perhaps the ultimate sign of leadership confidence. Ill leave you with this quote
from William Booth: The greatness of a mans power is the measure of his
surrender.
Once you recognize where you stand with regard to the leadership gap and you
get past limiting control issues, its time to identify your blind spots. This requires
deep introspection and a heightened sense of self-awareness.
The Awareness GapFinding the
Blind Spots
Leader Bewareignorant bliss, no matter how enjoyable, is still ignorant. If youre
in a position of leadership and dont feel you have any blind spots, youre either
very nave or very arrogant. All leaders have blind spotsthe question is what are
they doing about them? The reality is most leader
SHOW MORE…
Psychopathology 8
Substance-Related and Addictive Disorders
Many individuals seeking treatment meet the criteria for both mental health and substance-related disorders. Regardless of whether you specialize in substance-related disorders, all advanced practice nurses should know their signs and symptoms and how to assess and diagnose them. There are assessment and screening tools available to clinicians, and a plethora of information can be obtained through the diagnostic interview. It takes time and experience to know what types of questions to ask to gain the most information, in addition to a basic knowledge of the substances and behaviors you are trying to assess. It can be complicated to sort out substance use disorders from other mental health disorders, but most clients seeking treatment have comorbidities.
This week, you apply DSM-5-TR substance use and addictive criteria as you formulate a diagnosis for a patient in a case study.
For this Assignment, you will practice assessing and diagnosing a patient in a case study who is experiencing a substance-related or addictive disorder. With this and all cases, remember to consider the patients cultural background.
To Prepare:
Review this weeks Learning Resources and consider the insights they provide.
Review the Comprehensive Psychiatric Evaluation template, which you will use to complete this Assignment.
select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the Case History Reports document, keeping the requirements of the evaluation template in mind.
Consider what history would be necessary to collect from this patient.
Consider what interview questions you would need to ask this patient.
Identify at least three possible differential diagnoses for the patient.
Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis.
Incorporate the following into your responses in the template:
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 patients 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-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR 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.).
Learning Objectives
https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x16_Substance_Related_Disorders
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadocks synopsis of psychiatry (11th ed.). Wolters Kluwer.
Chapter 20, Substance Use and Addictive Disorders
Chapter 31.16, Adolescent Substance Abuse
WEEK 8 VIDEO # 115
VIDEO # 115
VIDEO #115
Search transcript
00:00:15>> I see in your chart that you asked
00:00:15your familyphysician to
00:00:20prescribe oxycodone for your elbow pain,
00:00:20andthat your family physician
00:00:25is worried that some of other medications,
00:00:30drugs you may use may interact with the oxycodone?
00:00:35>> Oxycodone is that’s the same as OxyContin?
00:00:35>> Yeah.Oxycodone is the generic name.
00:00:40>> Yeah, Idid ask for OxyContin,
00:00:45butI don’t take any other medications or drugs.
00:00:50I’m opposed to putting anything unhealthyin my body.
00:00:55>> Okay. What else have you tried?
00:01:00>> Nothing else works.
00:01:00>> Ibuprofen, acetaminophen?
00:01:00>> Noteven close.
00:01:05>> No?
00:01:05>> Yeah. I mean,
00:01:05I’m allergic to codeine.
00:01:05>> Allergic?
00:01:05>> Yeah,like in Tylenol three.
00:01:10A little while back, my friend
00:01:10was in a motorcycle accidentand had some leftover,
00:01:15and I tried one of those,
00:01:15and I was way allergic.
00:01:20>> What was the allergic response you had?
00:01:25>> My face flushed like real bad,
00:01:25besides it didn’twork.
00:01:30>> Have you tried morphine?
00:01:30>> Well, that’s addictive,isn’t it?
00:01:35>> Yeah, well all the pain medications
00:01:35or most of them are addictive.
00:01:35Anti-inflammatorymedications are not usually addictive.
00:01:45>> Yeah, I tried morphine and the codeine,didn’t work.
00:01:50>> Okay.
00:01:50>> Yeah, I get headaches too,
00:01:55so ideally I need something that works for both.
00:02:00I’d rather not take two medications if I don’t have to.
00:02:05Less medications the better,
00:02:05that’s what grandma always said.
00:02:05>> Grandma? Okay.
00:02:05>> Yeah.
00:02:10>> Have you ever tried Dilaudid?
00:02:10>> Yeah.They gave that to me in the ER once,
00:02:15but justmade me dizzy and constipated.
00:02:20Constipated for like a month.
00:02:25>> Oh, wow.
00:02:25>> I almost had to go back to
00:02:25the hospital for constipation.
00:02:25Can you imagine having to go to
00:02:25the hospitalfor constipation?
00:02:30>> Oh my goodness.
00:02:30>> Yeah, that’s how bad it was.
00:02:30>> Have you tried Demerol?
00:02:35>> Yeah, it kindof worked for my headache.
00:02:40It comes in a shot, right?
00:02:40>> Yeah.An injection.
00:02:45>> Yeah, they gave that to me at the hospital.
00:02:45But that’s the thing,you
00:02:50can only get it at the hospital,
00:02:50so it’s not like it’s going to work for me everyday.
00:02:55It didn’t do anything for my elbow.
00:02:55OxyContin it’s the onlything that works for both.
00:03:00The only thing that works for both.
00:03:00>> You do seem set on the oxycodone?
00:03:00>> Because itworks.
00:03:05>> What else have you tried other than medications?
00:03:10>> Other than medications?
00:03:10>> Yeah.
00:03:10>> Yoga.
00:03:10>> Okay.
00:03:10>> Yeah.Tried that. Other kinds of meditation.
00:03:20I mean, that’s the thing with meditation is,
00:03:20it works while you’re doingit,
00:03:25but then as soon as you stop, zilch. Biofeedback.
00:03:30>> Good.
00:03:30>> One doc tried that, same thing.
00:03:30Works while you’re doing it,
00:03:35but then when you stop doesn’t help at all. What else?
00:03:40Like warm, hot compresses,
00:03:45candles, long walks on the beach, massages.
00:03:50>> Wow.
00:03:50>> My boyfriend is really good at massages actually.
00:03:55He’s studied with this guru in India.
00:03:55>> Oh, wow.
00:03:55>> Yeah, swear to God
00:04:00>> You have tried a lot of solutions.
00:04:00Let me ask youmore about your medication history.
00:04:05>> I only take stuff for my headache andmy elbow.
00:04:10>> Okay.
00:04:15>> Like I said, I don’t like
00:04:15putting unhealthy things in my body.
00:04:15Vitamins, I take vitamins.
00:04:20>> Yeah? Okay.
00:04:20>> Like fish oils, some supplements,
00:04:20but nothingcorporate, nothing pharmaceutical.
00:04:25I don’twant to put that in me.
00:04:30Even coming here today,
00:04:35asking for this, it goes against my values.
00:04:35>> I see. Okay.
00:04:35>> But I got tofunction.
00:04:40>> Do you drink alcohol?
00:04:40>> Onspecial occasions
00:04:45like weddings, funerals, birthdays.
00:04:50I got a ton of friends, so
00:04:50whenever we have a birthday we’re going to drink.
00:04:55Let me think, like holidays,
00:04:55New Years,and Christmases.
00:05:00There’s Christmas and then we also celebrate
00:05:05Russian Orthodox Christmas on January 7th.
00:05:10>> How often on the average?
00:05:15>> When you add it all up,
00:05:15once, maybe twice a week, I guess.
00:05:20>> Will you drink enough to get intoxicated?
00:05:20>> Depends on who I’m drinking with.
00:05:25As Zane, that’s my boyfriend,
00:05:30he drinks a lot, so
00:05:30I drink a little more when I’m with him.
00:05:30>> Any legal problemsfrom the drinking?
00:05:35>> Once. Sodumb.
00:05:40Yeah, just one little charge for drinking.
00:05:45I was the tiniest little bit over the limit.
00:05:45So yeah,I got that and I had to take that course,
00:05:50that stupid, boring course.
00:05:50But I learned my lesson.If you’re
00:05:55a little bit over the limit,
00:05:55stick to the back roads.
00:05:55>> So youwill still drive?
00:06:00>> Well, yeah, but I’m super careful.
00:06:00>> You think after you’vebeen drinking,
00:06:05that’s an okay idea to drive?
00:06:05>> It’s betterthan letting Zano drive.
00:06:10>> Zano?
00:06:10>> Zane, Zano, sameperson.
00:06:15Yeah. He doesn’t even have his license anymore.
00:06:15Not that it stops him.
00:06:20>> What about marijuana?
00:06:20>> Do I useit?
00:06:25>> Yeah.
00:06:25>> Marijuana medicallyhelps with my headaches,
00:06:30so yeah, I use it.
00:06:35It’s my right. Yeah, it’s
00:06:35your right. It’s everybody’s right.
00:06:40>> How often?
00:06:40>> Not often.
00:06:45Two, four times a week, sometimes none.
00:06:50It’s expensive. Then when you do getsome,
00:06:55suddenly everybody is your best friend and you
00:06:55got to share, you know how it is.
00:06:55>> Doyou ever grow marijuana?
00:07:00>> I used to. But thenwe
00:07:05moved and it’s not legal in this backward state.
00:07:05Wherewe live it’s pretty public,
00:07:10its not really private.
00:07:10>> Do you ever have any side effects
00:07:15from using marijuana like memory problems?
00:07:15>> I was born with memory problems,
00:07:20Doc, I don’t think it’s from the marijuana.
00:07:20>> Any legal trouble with the marijuana?
00:07:25>> Once. I mean, I’m super careful.
00:07:30But Zano, he went away for
00:07:30a year for selling
00:07:35the tiniest little bit to an undercover cop,
00:07:35which is total entrapment,
00:07:40which is how I lost custody of Camper.
00:07:40>> Camper?
00:07:45>> My son.
00:07:45>> Oh.
00:07:45>> Yeah. He’s staying with
00:07:45my ex husband’sparents right now.
00:07:50They take good care of him.
00:07:50>> How long have you been divorced?
00:07:55>> Oh no, I never married that guy.
00:07:55>> Oh.
00:07:55>> No way I would marry that jerk.
00:08:00No, I don’t know.
00:08:00It’s been like four years since I’ve even seen him.
00:08:05Something like that, four years.
00:08:05>> What happened?
00:08:10>> Lucas, my ex,
00:08:10he freaked out becausehe caught
00:08:15me doing just a few lines of coke,
00:08:15but everybody was doingit back then.
00:08:20Anyway, hismom found the mirror,
00:08:25and the razors, and Lucassaid I had to quit.
00:08:30For whatever Ilied,
00:08:35and when he caught me,
00:08:35I know it wasbad to lie about that,
00:08:40but I don’t know it’s in the past.
00:08:45Water under the bridge. You live, you learn, you move on.
00:08:45>> Right. Doyou use cocaine now?
00:08:50>> No, hardly ever.
00:08:55I don’t know, it’s been like a month maybe,
00:08:55or two months or something since I have.
00:08:55>> Any legalproblems from using cocaine?
00:09:05>> No, we hardly ever do it.
00:09:10>> Have you thought about stopping altogether?
00:09:15>> I hardly ever do it.
00:09:15Hardly evencounts.
00:09:20I don’t know, when I do it,
00:09:20it’s just to relieve tension
00:09:20orit’s this thing Zano
00:09:25and I do to bring eachother closer together,
00:09:30but I could quit anytime I wanted, easy.
00:09:35>> Does your boyfriend have children?
00:09:35>> Yeah, he’s got two kids.
00:09:40Yeah, butwe don’t see them much.
00:09:45His other with his ex.
00:09:45>> Oh?
00:09:50>> She’s a real snobby type. You know the type?
00:09:50It isa freaking tragedy
00:09:55because I see his two kids
00:09:55just going downthat same path.
00:10:00They’re just two little snobs.
00:10:00It’s a real shame.
00:10:05We’re not allowed to seethem anymore though,
00:10:10so I guess like what’s the difference?
00:10:10She went to courtand said we were unsuitable.
00:10:15Not suitable.
00:10:20Says it all real nice in court,
00:10:20and then not so nice over the phone,
00:10:20if you know what Imean?
00:10:25She’s a real bitch.
00:10:25>> Any other drugs?
00:10:25Ecstasy?LSD?
00:10:35>> This is going to make me sound like I’m
00:10:35some 1970shippy, druggo person.
00:10:40I’ve tried ecstasy twice,
00:10:45just twice, and LSD once,last year.
00:10:50That was a bad trip. I am not doing thatagain.
00:10:55>> Anything else?
00:10:55>> Like what?
00:11:00>> Stimulants?
00:11:00>> Like power drinksif I need to stay up?
00:11:05>> Sure
00:11:05>> Caffeine, I drink a lot of coffee.
00:11:10I don’t know if cigarettes,
00:11:10do they count as stimulants?
00:11:10>> Yeah.
00:11:10>> Yeah, I’mtrying to cut back.
00:11:15Two packs a day.
00:11:15>> Ritalin, Dexedrine?
00:11:20>> Oh, stimulants?
00:11:20>> Right
00:11:20>> Oh, yeah.Not a lot.
00:11:25Like hardly ever.
00:11:25I mean, ifZano and I are down for whatever reason,
00:11:30or sluggish from smokingpot,
00:11:35or just like if I need to get back up again.
00:11:35Yeah,Adderall, just 20 helps.
00:11:40>> Do you ever take prescription medications
00:11:40that arenot prescribed for you?
00:11:45>> Well, are you kidding me?
00:11:45Why would I do that?
00:11:50I told you I don’t like medications in the first place.
00:11:50>> Klonopin,Ativan, Xanax?
00:11:55>> Those?
00:11:55>> Yeah.
00:12:00>> Yeah, if my anxietyis acting up,
00:12:05if my meditation isn’t working?
00:12:10Yeah, a couple Xana bars,
00:12:10but not a lot.
00:12:10>> How often wouldyou estimate that is?
00:12:15>> I don’t know.
00:12:20Two? I don’t know.
00:12:20I need like a freaking calendar tokeep up with
00:12:25all your questions, Doc, God.
00:12:25>> So in the past,
00:12:30who prescribed the oxycodone for you?
00:12:30>> No one yet.Zano he
00:12:35takes them because he’s gotshoulder and back problems,
00:12:40and I tried one andit really works.
00:12:45To be honest it works fantastic.
00:12:45This transcript was automatically generated using speech recognition technology. Because this method relies on machine learning algorithms, the quality of transcripts may vary. To request this transcript be improved with enhanced accuracy, please email [emailprotected]
Title 151 Name: Daniela Petrov Gender: female Age:47 years old T- 98.8 P- 84 R 20 B/P 132/90 Ht 58 Wt 128lbs Background: Moved to Everett, Washington from Russia with her parents when she was 16 years old. Currently lives in Boise, Idaho. She has younger 1 brother, 3 older sisters. Denied family mental health or substance use issues. No history of inpatient detox or rehab denied self-harm hx; Menses regular. uses condoms for birth control Has fibromyalgia. She works part time cashier at Save A Lot Grocery Store. Dropped out of high school in 10th grade. Sleeps 5-6 hours on average, appetite good. Symptom Media. (Producer). (2018). Training title 151 [Vid
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image1.wmf WEEK 8 VIDEO #114
VIDEO #114
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00:00:00BEGIN TRANSCRIPT:
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00:00:15ALLY(ph) Really, come on. I’m missing first period.And now you want me to be late for my second class. Can we do this during my third period break?
00:00:25UNKNOWNI I’m sorry, Ally(ph) but principal Michaels requested that you and I take some time this morning and talk.I I know we worked together before right now, I’m going to have to put on my professional app.
00:00:35ALLY(ph) That’s ridiculous. Why?
00:00:35UNKNOWNWell, maybe you can tell me why.
00:00:40ALLY(ph) I have a class waiting for me.
00:00:45UNKNOWNWell, you been frequently late for your classes. In fact, let’s sayuh 22 days so far this year?
00:00:50ALLY(ph) It has not been 22 days.
00:00:55UNKNOWNYes, it has, something not right here at schoolor something not right at home.
00:01:00ALLY(ph) My personal life is fine.And personal.
00:01:05UNKNOWNI know you haven’t changed addresses so it can’t be the traffic.
00:01:10ALLY(ph) Jesus. The History Department had a party last night a Darrel’s(ph).Why don’t you bring him in here and question him?
00:01:20UNKNOWNSo are you saying the Darrel’s(ph) party is the reason that you were late? That was last night? I don’t understand.
00:01:25ALLY(ph) Okay. Alcohol was served.We had a bit much to drink. Not just me. We’re adults here.And I mean, the the school host of social hour on campus every month.
00:01:40UNKNOWNSo what are you saying? Are you saying that you were drunk?
00:01:45ALLY(ph) I drank, but no.
00:01:45UNKNOWNWere you intoxicated enough that you passed out?
00:01:50UNKNOWNI woke up and Darrel’s(ph) cash responding.And, and fuck him for not waking me.He came to school on time but let’s be there lying on the couch.
00:02:00UNKNOWNHave you passed out other times?
00:02:05ALLY(ph) We have all passed out at times. I’m sure I’ve seen you drunk at those parties.
00:02:10UNKNOWNAre you still feeling intoxicated this morning?
00:02:15ALLY(ph) No, Course not.
00:02:15UNKNOWNHave you ever been drunk? While you were here teaching?
00:02:20ALLY(ph) No.
00:02:20UNKNOWNI’m asking that because we’ve had complaints.
00:02:25ALLY(ph) Complaints from who?
00:02:25UNKNOWNStudents, parents.
00:02:30ALLY(ph) Well, bring him in. Let them tell that to my face because it’s totally not true.
00:02:35UNKNOWNThey’ve complained that at different times you came into class and then you ordered the kids to read from their textbookor you ordered the kids to copy notes from the boardwhile you were sleeping with your head on the desk.
00:02:45ALLY(ph) You have to be kidding me.
00:02:50UNKNOWNSeveral students and several parents have complained.
00:02:55ALLY(ph) Exactly who, Alexis? Do you know how many problems she’s created for the teachers at the school.
00:03:00UNKNOWNBut you were drinking last night. And it sounds like you drank enough that you passed outand had to sleep on Darrel’s(ph) couch?
00:03:10ALLY(ph) Yes. I mean, I did.
00:03:15UNKNOWNSo, is there something going on in your personal life?
00:03:20ALLY(ph) No.
00:03:20UNKNOWNHow’s Ryan?
00:03:25ALLY(ph) Ryan? First time I’ve known you to travel slow here.We split up before the school year started. Last summer.
00:03:35UNKNOWNWhat happened?
00:03:35ALLY(ph) I’m really, really uncomfortablesharing anything about my relationships with you.
00:03:45UNKNOWNOkay, that’s fair. That is your personal life.
00:03:50ALLY(ph) Is there any reason I just can’t walk out of this office right now?
00:03:50UNKNOWNWell, I don’t know the specificsof what the Board of Education would decide if you don’t cooperate,but I’m guessing at something pretty serious.
00:04:00ALLY(ph) This is unbelievable.
00:04:05UNKNOWNWait, wait. Wait a minute. The administration asked me to speak with you.The school wants to work with you if you’ll cooperate. And as someone who really likes you.I am warning to understand. I’m hoping to help you.So just, okay, thank you. Good.Now, what’s going on?
00:04:30ALLY(ph) I don’t know.
00:04:30UNKNOWNOkay. How much did you drink last night?
00:04:35ALLY(ph) Too much.
00:04:35UNKNOWNHow often do you drink too much?
00:04:40ALLY(ph) I don’t know.
00:04:45UNKNOWNHow much would you estimate that you drink in a typical week?
00:04:50ALLY(ph) Every night.
00:04:50UNKNOWNDo you drink with friends, family, by yourself?
00:04:55ALLY(ph) Alone.Once in a while I’ll go to a bar with my friends or drink at school functions.Where I might add they do supply alcohol liberally.
00:05:05UNKNOWNYes.
00:05:10ALLY(ph) They’re removing our social hours to downtown.
00:05:10UNKNOWNDo you go out and drink other than with friends?
00:05:15ALLY(ph) Occasionally.
00:05:15UNKNOWNDo you drink alone at home?
00:05:20ALLY(ph) Few glasses of wine while a grade takes the edge off the day.
00:05:25UNKNOWNTakes the edge off.
00:05:30ALLY(ph) Yes. The kids here are getting worse by the year.The teachers talk about it. We all know what’s going on. They become they just become more more vicious, more mean.I’m talking about kids who have no hint of remorse, no empathy, no thoughtfulness for others.When was the last time you try teaching them?
00:05:45UNKNOWNI have to admit it has been a while.
00:05:50ALLY(ph) Just last week, I caught Alexis filming me on her phone.I was bent over picking up trash a student through on the floor.It was not flattering. And you know what she did?
00:06:00UNKNOWNNo.
00:06:05ALLY(ph) Send it out to the whole grade adding a really obscene title.
00:06:05UNKNOWNWas she punished?
00:06:10ALLY(ph) Do the kids here ever get punished? All she caught was a bucking set down with their neuter principal.And then her mom comes threaten Sueagain and naturally our fearless leader backs down.Michaels humiliated me. Did the administration tell you that?
00:06:25UNKNOWNNo.
00:06:30ALLY(ph) Humiliated me.I work for a place that has no backbone, no spine. Who runs this place here? The students or the teachers.
00:06:40UNKNOWNSounds horrible.
00:06:45ALLY(ph) And it goes on day after day. Rich kids who have no respect while you struggle to teach.I’m trying to pay bills here. Pay uh pay the gas,driving shitty car, pay off student loans.
00:06:55UNKNOWNThat does sound like a lot of stress.
00:07:00ALLY(ph) Sounds like.
00:07:00UNKNOWNDo you like teaching?
00:07:05ALLY(ph) Once upon a time when it had meaning.
00:07:05UNKNOWNWhat about now?
00:07:10ALLY(ph) We aren’t supported.
00:07:15UNKNOWNDo you think all of this stress is contributing to your drinking?
00:07:15ALLY(ph) Of course it is.
00:07:20UNKNOWNDo you drink during the day?
00:07:20ALLY(ph) No, no, absolutely not.
00:07:25UNKNOWNWhen you do drink, how much do you drink?
00:07:25ALLY(ph) Enough.
00:07:30UNKNOWNEnough to pass out?
00:07:30ALLY(ph) If I’m lucky.
00:07:35UNKNOWNHow much do you have to drink to get that feeling of being intoxicated?
00:07:40ALLY(ph) Five or six glasses of wine, a couple of mixed drinks.
00:07:45UNKNOWNDo you think that’s more than it takes most people to get intoxicated?
00:07:50ALLY(ph) I don’t know, but but I can.
00:07:50UNKNOWNSo, so do you think alcohol affects your body differentlythan it affects your friends?
00:07:55ALLY(ph) Yes, alcohol affects. Yes.
00:08:00UNKNOWNDo you drink more than your friends and the other teachers?
00:08:05ALLY(ph) II drink, but but you’re not understanding it, it affects me differently.
00:08:15UNKNOWNHas it prevented you from doing thingsor interfered with relationships?
00:08:25ALLY(ph) Are you specifically talking about Ryan here?
00:08:25UNKNOWNYeah.
00:08:30ALLY(ph) Okay, Ryan did not leave me because I drink.
00:08:30UNKNOWNOkay.
00:08:35ALLY(ph) I’m seeing someone new. We weren’t even together for a year.
00:08:35UNKNOWNIs drinking wine, beer,other alcoholic drinks in the evenings. Is that something new for you?Or was that something typical than your past?
00:08:50ALLY(ph) No.Look, my father was an alcoholic growing up. When I was really little he drank.He got into AA and got sober.Mom was very supportive of him, but extremely strict with us in drinking.
00:09:10UNKNOWNHow did you feel about her being so strict with alcohol?
00:09:15ALLY(ph) As a teenager it sucked. I went out with my friends I got drunk. And then freshman year was a huge vendor.Eventually I just I mellowed out.
00:09:25UNKNOWNAnd after college?
00:09:25ALLY(ph) In grad school I drank here and there but not much.
00:09:30UNKNOWNDo you think your alcohol intake is less that when you were in collegeor is it gone the other way? Has it increased recently?
00:09:40[sil.]
00:09:50ALLY(ph) More.
00:09:55END TRANSCRIPT
Training Title 114 Name: Ally Chen Gender: female Age: 44 years old Background: Only child, raised by parents in Philadelphia, PA. Has PhD in biology and masters degree in high school education (812). Her supervisor has asked the school EAP counselor to intervene with concerns regarding potential substance use in effort to facilitate getting her help and be able to retain her. She is divorced, has a 4-year-old son who lives with his father. Appetite healthy, sleeping 9 hours/24 hrs., wakes 2-3 times during the night. Denied drug use. had DUI when she was age 21. Symptom Media. (Producer). (2018). Training title 114-2 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-114-2 Training Week 8: Substance-Related and Addictive Disorders
Many individuals seeking treatment meet the criteria for both mental health and substance-related disorders.Regardless of whether you specialize in substance-related disorders, all advanced practice nurses should know their signs and symptoms and how to assess and diagnose them.There are assessment and screening tools available to clinicians, and a plethora of information can be obtained through the diagnostic interview. It takes time and experience to know what types of questions to ask to gain the most information, in addition to a basic knowledge of the substances and behaviors you are trying to assess. It can be complicated to sort out substance use disorders from other mental health disorders, but most clients seeking treatment have comorbidities.
This week, you apply
DSM-5-TRsubstance use and addictive criteria as you formulate a diagnosis for a patient in a case study.
For this Assignment, you will practice assessing and diagnosing a patient in a case study who is experiencing a substance-related or addictive disorder. With this and all cases, remember to consider the patients cultural background.
To Prepare:
Review this weeks Learning Resources and consider the insights they provide.
Review the Comprehensive Psychiatric Evaluation template, which you will use to complete this Assignment.
select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the Case History Reports document, keeping the requirements of the evaluation template in mind.
Consider what history would be necessary to collect from this patient.
Consider what interview questions you would need to ask this patient.
Identify at least three possible differential diagnoses for the patient.
Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis.
Incorporate the following into your responses in the template:
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 patients 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-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR 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.).
Learning Objectives
https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x16_Substance_Related_Disorders
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015).
Kaplan & Sadocks synopsis of psychiatry(11th ed.). Wolters Kluwer.
Chapter 20, Substance Use and Addictive Disorders
Chapter 31.16, Adolescent Substance Abuse
00:00:00BEGIN TRANSCRIPT:
00:00:00[sil.]
00:00:20LISAWell I had to be here in thishospital if that answers your question.
00:00:25OFF CAMERAYes, thank you. Can I getyou a drink of water or something else to drink? Anything?
00:00:35LISAA drink isn’t going to convince me, right? You’re going tohave to convince me.
00:00:40OFF CAMERAWhat is you want me to persuade you to do?
00:00:45LISAGoing to rehab.
00:00:50OFF CAMERAWhat worries you about going to rehab?
00:00:55[sil.]
00:01:00LISAEverything.
00:01:00OFF CAMERAOkay. I tell you what let’s go back a littlebit and tell me about how you’re feeling today.
00:01:10LISAScared.
00:01:15OFF CAMERACan you tell me more about that feeling of being scared?
00:01:20LISAWell, I don’t want to be.I don’t want to be what people say I ambecause if I say it and I’m not going to say itbecause I ain’t going to change. I can’t.
00:01:35OFF CAMERAWhat do people say you are?
00:01:40LISAAnd I’m not.
00:01:45OFF CAMERAWhat don’t you want to be?
00:01:45LISAAn addict.
00:01:50OFF CAMERADo you use drugs and alcohol?
00:01:50LISAYeah sometimes I have adrink. You know with friends [inaudible] butit doesn’t matter. I’m in control.
00:02:00OFF CAMERADo you feel in control now?
00:02:05LISAMaybe I could just get thatdrink [inaudible].
00:02:10OFF CAMERASure. Sure.Here you go.
00:02:15LISAThank you.
00:02:20[sil.]
00:02:30LISAYou know what I just think I should leave.
00:02:30OFF CAMERAYou keepsaying you should leave. You said that earlier but do you really want to leave?
00:02:40LISANo.
00:02:45OFF CAMERAOkay. Tell me why you are here.
00:02:45LISABecause I’mscared.
00:02:50OFF CAMERAYou said that earlier. You think if you could –then I could figure out together why you’re scared and maybe we cancome up to a plan. Up with a plan and if we do that, then maybe your fears will disappear.
00:03:05LISANo not these fears [inaudible]because it’s over.
00:03:10OFF CAMERAWhat’s over?
00:03:10LISAEverything.The business.
00:03:15OFF CAMERAWhat do you mean?
00:03:20LISAJeremy.
00:03:25OFF CAMERAWho is Jeremy?
00:03:25LISAHe’s my boyfriend.I saw himnaked with Alisa [assumed spelling] with the same fucking name as me. Wenow have the same fucking boyfriend. In my office,he was screwing that fucking cunk.
00:03:45OFF CAMERASo you’rethe one who caught Jeremy cheating?
00:03:55LISAYeah. Cheating?Yeah that’s a clever word shrinks use.
00:04:05OFF CAMERASo you and Jeremy share an office?
00:04:05LISAYeah wedo commercials for local businesses, you know, build websites, that kind of stuff.We started a business together. He moved in with me.
00:04:15OFF CAMERAHow long agowas that?
00:04:20LISANine months.
00:04:20OFF CAMERADo you have any child