Running head: PRACTICUM –WEEK 4 JOURNAL ENTRY 1

Practicum –Week 4 Journal Entry

Student’s Name:

Institutional Affiliation:

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Practicum –Week 4 Journal Entry

The purpose of this paper is to identify the pertinent history of the patient without

violating the HIPAA regulations, explain the diagnosis of the patient using the DSM-5 and

explain the effectiveness of cognitive-behavioral therapy to the patient. Moreover, the paper

explores the legal and ethical implications when counseling the patient.

The Patient

The patient in these cases is a 61-year-old Caucasian who is admitted to the hospital. In

the hospital, the patient is on a voluntary status. She presents with suicidal ideation, depression,

and aggressive behavior. She seeks to commit suicide by overdosing herself. Based on the

evaluation, the patient is awake, alert, and much disoriented. She recalls well the events that led

to her hospitalization and indicates that she is depressed and frustrated. She reports that she is

frustrated because her roommate attached her, and they fought. Her behavior is very

unpredictable, and she is unable to contract to safety at this moment. Being uncomfortable in a

nursing home is a significant trigger of her condition, and she is not willing to go back to the

nursing home. She reports auditory hallucinations and voices that are informing her to commit

suicide and to hurt others. Also, she experiences visual hallucinations of seeing faces and

shadows.

Past Psychiatric History

The patient presently indicates psychiatric symptoms, involving hallucinations, and

wanting to hurt others who need it. She is not afraid of hurting herself and those who are close to

her. Inpatient psychiatric hospitalization will be of benefit to her condition. Past psychiatric

history indicates that she has had bipolar disorder, schizophrenia, and depression.

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Current Medication

The current prescribed drug therapy is Seroquel 300mg, which will be administered at

bedtime. This drug will help to cure psychotic symptoms and to stabilize her moods. Besides,

Depakote 250 mg is prescribed to her to stabilize her moods. Lexapro 5mg daily is prescribed for

depression and Klonopin 1 mg every six hours for severe chronic anxiety. Her outpatient

medication list includes Benazepril, lamotrigine, famotidine, and chlorpromazine.

Medical History

The patient has per internist medical history, and she is allergic to sulfa. Previously she

had suffered from hyperlipidemia, hypertension, gastroesophageal reflux disorder, and type 2

diabetes mellitus. Moreover, she had substance abuse secondary to meth and tobacco use with

underlying bronchitis. She had no past surgical history and hospitalization. The patient smokes

almost a pack of tobacco in a day and denies having taken alcohol.

DSM-5 Diagnosis

Based on the diagnostic and statistical manual of mental health disorder (DSM), the

patient presents symptoms that indicate that she is suffering from schizophrenia

disease.Schizophrenia is a severe and chronic mental disorder that is characterized by

disturbance in behavior, thoughts, and perceptions. It involves a range of emotional, behavioral,

and cognitive symptoms (Murder & Galderisi, 2017). There is no lab test for this condition; the

treatment that is available involves recognition constellation of the symptoms that are affecting

the occupational and emotional functioning of the patient.

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According to the Diagnostic and statistical methods, the prevalence of the condition is

approximately 0.3% in a lifetime. According to DSM 5 diagnosis, for a patient to be diagnosed

with schizophrenia disorder, then the patient should show hallucinations, delusions, disorganized

speech, catatonic behavior, and diminished emotional expression( APA, n.d.). The patient

should at least show disorganized speech, hallucinations, or delusions for at least one month. The

patient is experiencing visual and auditory hallucinations that are disturbing to her. She is

hearing sounds that are telling her to kill herself and hurt others. Her friend had hurt her, and she

wants to hurt her; also, the patient is experiencing delusions.

Other associated features of this condition that are eminent in the patient include

dysphoric mood, anxiety, and phobias, social cognition deficits, hostility, and aggression. This

condition has functionality consequences and suicidal risk behavior. A study conducted

indicated that 6% of people diagnosed with schizophrenia commit suicide (Medscape, 2019).

About 20% of the patients also make attempts to commit suicide more than one time, and the

majority of them may have significant suicidal thoughts (Murder & Galderisi, 2017). The

suicidal behavior occurs in response to the hallucinations.

Besides, the suicide risk remains to be high in the lifespan of patients who are suffering

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from schizophrenia disorder (Murder & Galderisi, 2017). Therefore, the patient in this case study

needs medical therapy as well as cognitive behavior therapy to avert suicidal risk. The condition

is also associated with occupational and social dysfunction. Maintaining employment or

completing education remains to be a significant challenge for patients who are suffering from

schizophrenia disorder. The patient stays with her roommate at the nursing residence, and she is

not willing to go back there to continue with her education.

Individualized Care Plan

The care plan of the patient will include drug therapy and cognitive behavioral therapy.

The patient will be expected to take the medication prescribed to her by the nursing practitioners.

These medications will help to stabilize her moods and reduce the aggression she has towards

herself and those surrounding her. Cognitive-behavioral therapy will enable her to have a change

of perception and focus on her life.

Cognitive-behavioral Therapy

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Cognitive behavior therapy (CBT) is a psychotherapeutic treatment that helps patients to

understand the feelings and thoughts that influence their behavior (Dobson & Dobson, 2018). It

is a common treatment for conditions such as anxiety, depression , additions, and other mental

disorders. Moreover, they help the patient to deal with a specific disease. During the therapy, the

patients can learn how they can be able to identify and handle disturbing and destructive

thoughts that impact their wellbeing. These are the thoughts that have severe consequences that

negatively impact the behavior and emotional patterns of the patient. It more common in dealing

with mental conditions since it is affordable compared to other types of therapy. It has shown to

be more effective, especially in helping patients to deal with a wide variety of maladaptive

behavior.

Cognitive-behavioral therapy would be most effective in helping this particular patient to

overcome behavioral dysfunction and co-exist well with those who are around her (Naeem, F.,

Khoury, Munshi, Ayub, Lecomte, Kingdon & Farooq, 2016). It will help the patient to overcome

the desire to kill her, and hurt others, improve her capacity to deal with traumatic events such as

verbal and physical abuse, with her roommate. The desire to hurt others started from the fight she

had with her roommate. Managing how to control her traumatic events will enable her to go back

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to the nursing home and continue her education. CBT therapy has remained to be effective in

treating schizophrenia disorder because it focuses on the feelings, behavior, and thoughts of the

patient (Dobson & Dobson, 2018). Therefore, through the application of cognitive-behavioral

therapy will help to change the negative thoughts of the patient, and avert the risk of her hurting

others and committing suicide.

Legal and Ethical Implication

Dealing with patients who are experiencing emotional challenges who have suicidal

thoughts requires the therapist to confine themselves within the ethical code of conduct

standards. This will promote the wellbeing of the patient as well as those of the therapist. The

therapist must ensure that they seek consent from the patient before the start of the therapy. The

patient should commit that she has authorized the therapist to help her to change her situation.

Failure to seek informed consent from the patient will amount to a breach of professional code of

conduct which has legal Implication such as withdrawal of service license to the therapist

(American Psychological Association, n.d.).

The therapist must promote the best interest of the patient as well as those who are close

to her. The patient threatens to hurt herself and others; therefore, the therapist should guide the

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patient to ensure that she does not hurt herself. This could be through close observation since she

is hospitalized, and following up on her medication. The therapist needs to uphold the

confidentiality of the patient information (American Psychological Association, n.d.). .Patients

information is personal, and so should it be treated like. The patient may be having more

underlying factors that are influencing her decision to commit suicide. Therefore, the therapist

should ensure that she confines vital information between her and the patient if it is not life-

threatening.

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References

American Psychological Association. (n.d.). Ethical Principles of Psychologists and Code of

Conduct. Retrieved from https://www.apa.org/ethics/code/

APA. (n.d.). Diagnostic and Statistical Manual of Mental Disorders DSM-5 Fifth Edition.

Retrieved from

https://www.appi.org/diagnostic_and_statistical_manual_of_mental_disorders_dsm-

5_fifth_edition

Dobson, D., & Dobson, K. S. (2018). Evidence-based practice of cognitive-behavioral therapy.

Guilford Publications.Retrieved from

https://dl.uswr.ac.ir/bitstream/Hannan/130304/1/1606230204Cognitive-

Behavioral_TherapyB.pdf

Medscape. (2019, November 11). What are the DSM-5 criteria for schizophrenia? Retrieved

from https://www.medscape.com/answers/288259-13963/what-are-the-dsm-5-criteria-

for-schizophrenia

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Murder, S. R., & Galderisi, S. (2017). The current conceptualization of negative symptoms in

schizophrenia. World Psychiatry, 16(1), 14-24. Retrieved from

https://onlinelibrary.wiley.com/doi/pdf/10.1002/wps.20385

Naeem, F., Khoury, B., Munshi, T., Ayub, M., Lecomte, T., Kingdon, D., & Farooq, S. (2016).

Brief cognitive-behavioral therapy for psychosis (CBTp) for schizophrenia: literature

review and meta-analysis. International Journal of Cognitive Therapy, 9(1), 73-86.