Archive for the ‘Psychopathology Paper’ Category
Running head: PSYCHOPATHOLOGY PAPER 3 Psychopathology Paper 3 H.F.C.C. Psychiatric Nursing 150 By Nancy Taji Running head: PSYCHOPATHOLOGY PAPER 3 Definition of Medical Diagnosis: Alcoholism in this case scenario is characterized by the DSM-IV-TR criteria for substance dependence. To qualify for a diagnosis of substance dependence there must be at least three of the following criteria met within a twelve month period. 1. Presence of tolerance of the drug. 2. Presence of withdrawal syndrome. 3. Substance is taken in larger amounts for longer periods than intended. 4. Unsuccessful or persistent desire to cut down or to control use. 5. Increased time spent in getting, taking and recovering from the substance. 6. Reduction or absence of important social, occupational or recreational activities. 7. Substance used despite knowledge of recurrent physical or psychological problems. (DSM-IV-TR, APA, American Psychiatric Society 2000) Alcohol related disorders such as alcohol intoxication, alcohol withdrawal and substance induced delirium are also associated with the diagnosis of alcoholism. Psychodynamics: The psychodynamics of alcoholism are multifactorial. Alcoholism touches everyone in one way or another. It has been around since mankind first invented alcohol. The early original schools of Freudian psychology thought alcoholism to be a learned response that eventually became a habit. This school of thought was called nurture, or the environment. As science progressed throughout the century, alcoholism Running head: PSYCHOPATHOLOGY PAPER 3 was viewed as a genetic defect, or occurring due to nature. Presently theorist view alcoholism as arising out of epigenetic causes. In other words nature and nurture combined. Basically this theory places importance on genes as well as environment. In any case alcoholism is considered a disease. It is a disease that robs those who are affected by it of their lives, their families and their futures. Alcoholism can turn a mild man into a wife beater and a child molester, and can turn a women into a wonton harlot. It devastates the lives of all whom it touches. (Varcarolis, 2002) Case Presentation: The client is a 45 year old Caucasian female who appears her stated age. She was admitted to the hospital with the following symptoms of slurred speech, unsteady gait, dehydration and a disheveled appearance along with strong fumes of alcohol emanating from her breath. The client was one week post admission upon this case study. Her appearance was that of a graciously mannered, well groomed lady. Her hair was in a meticulous braid, and she wore a loose fitting sweatshirt and stretch pants. She carried her self with an air of self confidence and met her eyes directly with the person that was talking to her. Her eyes were bright and clear. She spoke in a even toned voice depicting appropriated expressions of joy or sorrow when the conversation warranted. She stated that she has had an addiction to alcohol for the past twenty years. She expressed concern that her liver may now be damaged and that her doctor had ordered some liver tests to be run. She explained in detail about her life and the tragedies that she had to face beginning at a young age, with the death of her boyfriend at the wheel of the car that she was also in, and the sexual abuse by her alcoholic father. She Running head: PSYCHOPATHOLOGY PAPER 3 was able to talk about these past experiences calmly. She went on to explain that she would binge drink on the weekends and eventually wind up drinking throughout the week to simply keep the hangovers at bay. Consequently, she would always loose her job. She did say that she did very well for a time as a manager for an apartment complex. When asked what attributes she like about herself she could not describe any. She stated that she didn’t really like herself and had tried to commit suicide on several occasions using prescription pills and alcohol. Evidently, she had recently been diagnosed with bipolar disorder. She stated that the medication that she was on helped her keep her moods steady. She stated that the depressive mood was totally exhausting and that it was impossible to function. She thought that her late father may have also suffered from a bipolar disorder. When asked about her family, she replied that her sister who was 7 years her junior was also an alcoholic as was her mother. She wanted to remain in the hospital for a few more days although her doctor was going to release her. She stated that she needed to start taking care of herself and that realizing that she needs help is a positive step. She said that she may not have asked to stay for further treatment if she hadn’t restructured her thoughts about herself. Running head: PSYCHOPATHOLOGY PAPER 3 Table 1 Textbook Characteristics of Alcoholism versus Client Characteristics Observed Textbook Characteristics of Alcoholism 1. Presence of tolerance to the drug 2. Presence of withdrawal syndrome. 3. Substance is taken in larger amounts for longer period. 4. Increased time spent in getting taking and recovering. 5. Incapacitated from social, family and occupational events due to substance 6. Using substance despite knowledge of its harm. (Varcarolis, 2002) Characteristics Observed in Client 1. Client states that she must drink large amounts of beer and whiskey 2. Client states that without the alcohol she has tremors and is on Antabuse. 3. Client states that she has been drinking for over twenty years. 4. Client says that her binge drinking on weekends spills over into the weekdays. 5. She states that while she is drinking she is incapacitated from all family, social and occupational functions. 6. Client acknowledges harm of the substance yet continues to use it. Running head: PSYCHOPATHOLOGY Table 2 Nursing Interventions for Client 1. Tolerance to alcohol: Client will attend group therapy and acknowledge to refrain from drinking. 2. Withdrawal symptoms: Client will remain hydrated with fluids that contain electrolytes and take vitamin B. 3. Larger Amounts for Longer Periods: Client will participate in cognitive restructuring to identify positive strengths and build self confidence. 4. Unsuccessful to cut down or control use: Client will participate in Alcoholics Anonymous. 5. Increased time in obtaining and recovering from substance: Client will work with therapy and counseling to cognitively restructure life style. 6. Reduction and absence from activities: Client will engage in recreational and occupational therapy. 7. Substance used despite knowledge of harm: Client will refrain from the use of alcohol and verbalize harm, possible using biofeedback as a tool. (Varcarolis, 2002) Running head: PSYCHOPATHOLOGY PAPER 3 Table 3 Medical Interventions Medical Interventions Suggested for Alcoholism 1. Anti Alcohol drug 2. Anti anxiety medication 3. Vitamins and fluids 4. Group Therapy 5. Family Therapy 6. Alcoholics Anonymous 7. Rest (Varcarolis, 2002) Medical Interventions Implemented for Client 1. Antabuse 2. Halcyon 0.25mg P.O. at 2400 3. Dosages of Thiamine and I.V. of D5/lactated ringers 4. Client attends Group therapy 5. Client attends family therapy 6. Attends Alcoholics Anonymous 7. Client is convalescing in hospital (Clients Chart) Running head: PSYCHOPATHOLOGY PAPER 3 References Varcarolis, E. (2002). Foundations of Psychiatric Mental Health Nursing. (4th ed.) New York, N.Y., Saunders
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