Follow attached instructions due 07/17/2022 at 6pm

For this Assignment, you will document information about a patient that you examined at your practicum site, using the Comprehensive Psychiatric Evaluation Note Template provided. You will then use this note to develop and record a case presentation for this patient.

To Prepare

Review this week’s Learning Resources and consider the insights they provide about impulse-control and conduct disorders.
Select a patient for whom you conducted psychotherapy for an impulse control or conduct disorder during the last 6 weeks. Create a Comprehensive Psychiatric Evaluation Note on this patient using the template provided in the Learning Resources. There is also a completed template provided as an exemplar and guide. All psychiatric evaluation notes must be signed, and each page must be initialed by your Preceptor. When you submit your note, you should include the complete comprehensive evaluation note as a Word document and pdf/images of each page that is initialed and signed by your Preceptor. You must submit your note using SafeAssign.
Please Note: Electronic signatures are not accepted. If both files are not received by the due date, Faculty will deduct points per the Walden Grading Policy.

NRNP/PRAC 6645 Comprehensive Psychiatric

Evaluation Note Template

INSTRUCTIONS ON HOW TO USE EXEMPLAR AND TEMPLATE—READ CAREFULLY

If you are struggling with the format or remembering what to include, follow the Comprehensive Psychiatric Evaluation Template
AND
the Rubric as your guide. It is also helpful to review the rubric in detail in order not to lose points unnecessarily because you missed something required. Below highlights by category are taken directly from the grading rubric for the assignments. After reviewing full details of the rubric, you can use it as a guide.

In the Subjective section, provide:

· Chief complaint

· History of present illness (HPI)

· Past psychiatric history

· Medication trials and current medications

· Psychotherapy or previous psychiatric diagnosis

· Pertinent substance use, family psychiatric/substance use, social, and medical history

· Allergies

· ROS

· Read rating descriptions to see the grading standards!

In the Objective section, provide:

· Physical exam documentation of systems pertinent to the chief complaint, HPI, and history

· Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.

· Read rating descriptions to see the grading standards!

In the Assessment section, provide:

· Results of the mental status examination,
presented in paragraph form.

· At least three differentials with supporting evidence. List them from top priority to least 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

.

· Read rating descriptions to see the grading standards!

Reflect on this case. Include what you learned and what you might do differently. 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.).

(The comprehensive evaluation is typically the initial new patient evaluation. You will practice writing this type of note in this course. You will be ruling out other mental illnesses so often you will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for all illnesses which could be impacting your patient. For example, anxiety symptoms, depressive symptoms, bipolar symptoms, psychosis symptoms, substance use, etc.)

EXEMPLAR BEGINS HERE

CC (chief complaint): A brief statement identifying why the patient is here. This statement is verbatim of the patient’s own words about why they are presenting for assessment. For a patient with dementia or other cognitive deficits, this statement can be obtained from a family member.

HPI: Begin this section with patient’s initials, age, race, gender, purpose of evaluation, current medication, and referral reason. For example:

N.M. is a 34-year-old Asian male who presents for psychotherapeutic evaluation for anxiety. He is currently prescribed sertraline by (?) which he finds ineffective. His PCP referred him for evaluation and treatment.

P.H. is a 16-year-old Hispanic female who presents for psychotherapeutic evaluation for concentration difficulty. She is not currently prescribed psychotropic medications. She is referred by her mental health provider for evaluation and treatment.

Then, this section continues with the symptom analysis for your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis.

Paint a picture of what is wrong with the patient. This section contains the symptoms that is bringing the patient into your office. The symptoms onset, the duration, the frequency, the severity, and the impact. Your description here will guide your differential diagnoses. You are seeking symptoms that may align with many DSM-5 diagnoses, narrowing to what aligns with diagnostic criteria for mental health and substance use disorders. You will complete a psychiatric ROS to rule out other psychiatric illnesses.

Past Psychiatric History: This section documents the patient’s past treatments. Use the mnemonic Go Cha MP.

General Statement: Typically, this is a statement of the patients first treatment experience. For example: The patient entered treatment at the age of 10 with counseling for depression during her parents’ divorce. OR The patient entered treatment for detox at age 26 after abusing alcohol since age 13.

Caregivers are listed if applicable.

Hospitalizations: How many hospitalizations? When and where was last hospitalization? How many detox? How many residential treatments? When and where was last detox/residential treatment? Any history of suicidal or homicidal behaviors? Any history of self-harm behaviors?

Medication trials: What are the previous psychotropic medications the patient has tried and what was their reaction? Effective, Not Effective, Adverse Reaction? Some examples: Haloperidol (dystonic reaction), risperidone (hyperprolactinemia), olanzapine (effective, insurance wouldn’t pay for it)

Psychotherapy or Previous Psychiatric Diagnosis: This section can be completed one of two ways depending on what you want to capture to support the evaluation. First, does the patient know what type? Did they find psychotherapy helpful or not? Why? Second, what are the previous diagnosis for the client noted from previous treatments and other providers. (Or, you could document both.)

Substance Use History: This section contains any history or current use of caffeine, nicotine, illicit substance (including marijuana), and alcohol. Include the daily amount of use and last known use. Include type of use such as inhales, snorts, IV, etc. Include any histories of withdrawal complications from tremors, Delirium Tremens, or seizures.

Family Psychiatric/Substance Use History: This section contains any family history of psychiatric illness, substance use illnesses, and family suicides. You may choose to use a genogram to depict this information (be sure to include a reader’s key to your genogram) or write up in narrative form.

Psychosocial History: This section may be lengthy if completing an evaluation for psychotherapy or shorter if completing an evaluation for psychopharmacology. However, at a minimum, please include:

· Where patient was born, who raised the patient

· Number of brothers/sisters (what order is the patient within siblings)

· Who the patient currently lives with in a home? Are they single, married, divorced, widowed? How many children?

· Educational Level

· Hobbies

· Work History: currently working/profession, disabled, unemployed, retired?

· Legal history: past hx, any current issues?

· Trauma history: Any childhood or adult history of trauma?

· Violence Hx: Concern or issues about safety (personal, home, community, sexual (current & historical)

Medical History: This section contains any illnesses, surgeries, include any hx of seizures, head injuries.

Current Medications: Include dosage, frequency, length of time used, and reason for use. Also include OTC or homeopathic products.

Allergies: Include medication, food, and environmental allergies separately. Provide a description of what the allergy is (e.g., angioedema, anaphylaxis). This will help determine a true reaction vs. intolerance.

Reproductive Hx: Menstrual history (date of LMP), Pregnant (yes or no), Nursing/lactating (yes or no), contraceptive use (method used), types of intercourse: oral, anal, vaginal, other, any sexual concerns

Diagnostic results: Include any labs, X-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines).

A

ssessment

Mental Status Examination: For the purposes of your courses, this section must be presented in paragraph form and not use of a checklist! This section you will describe the patient’s appearance, attitude, behavior, mood and affect, speech, thought processes, thought content, perceptions (hallucinations, pseudo hallucinations, illusions, etc.), cognition, insight, judgment, and SI/HI. See an example below. You will modify to include the specifics for your patient on the above elements—DO NOT just copy the example. You may use a preceptor’s way of organizing the information if the MSE is in paragraph form.

He is an 8 yo African American male who looks his stated age. He is cooperative with examiner. He is neatly groomed and clean, dressed appropriately. There is no evidence of any abnormal motor activity. His speech is clear, coherent, normal in volume and tone. His thought process is goal directed and logical. There is no evidence of looseness of association or flight of ideas. His mood is euthymic, and his affect appropriate to his mood. He was smiling at times in an appropriate manner. He denies any auditory or visual hallucinations. There is no evidence of any delusional thinking. He denies any current suicidal or homicidal ideation. Cognitively, he is alert and oriented. His recent and remote memory is intact. His concentration is good. His insight is good.

Differential Diagnoses: You must have at least three differentials with supporting evidence. Explain what rules each differential in or out and justify your primary diagnosis selection. Include pertinent positives and pertinent negatives for the specific patient case.

Also included in this section is the reflection. Reflect on this case and discuss whether or not you agree with your preceptor’s assessment and diagnostic impression of the patient and why or why not. What did you learn from this case? What would you do differently?

Also include in your reflection a discussion related to legal/ethical considerations (demonstrating critical thinking beyond confidentiality and consent for treatment!), social determinates of health, 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.).

Case Formulation and Treatment Plan.

Includes documentation of diagnostic studies that will be obtained, referrals to other health care providers, therapeutic interventions with psychotherapy, education, disposition of the patient, and any planned follow-up visits. Each diagnosis or condition documented in the assessment should be addressed in the plan. The details of the plan should follow an orderly manner. *see an example below—you will modify to your practice so there may be information excluded/included—what does your preceptor document?

Example:

Initiation of (what form/type) of individual, group, or family psychotherapy and frequency.

Documentation of any resources you provide for patient education or coping/relaxation skills, homework for next appointment.

Client has emergency numbers: Emergency Services 911, the Client’s Crisis Line 1-800-_______. Client instructed to go to nearest ER or call 911 if they become actively suicidal and/or homicidal. (only if you or preceptor provided them)

Reviewed hospital records/therapist records for collaborative information; Reviewed PCP report (only if actually available)

Time allowed for questions and answers provided. Provided supportive listening. Client appeared to understand discussion. Client is amenable with this plan and agrees to follow treatment regimen as discussed. (This relates to informed consent; you will need to assess their understanding and agreement.)

Follow up with PCP as needed and/or for:

Write out what psychotherapy testing or screening ordered/conducted, rationale for ordering

Any other community or provider referrals

Return to clinic:

Continued treatment is medically necessary to address chronic symptoms, improve functioning, and prevent the need for a higher level of care OR if one-time evaluation, say so and any other follow up plans.

References (move to begin on next page)

You are required to include at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting.

Page 1 of 6

NRNP/PRAC 6645 Comprehensive Psychiatric Evaluation Template

Week (enter week #): (Enter assignment title)

Student Name

College of Nursing-PMHNP, Walden University

NRNP 6635: Psychopathology and Diagnostic Reasoning

Faculty Name

Assignment Due Date

Subjective:

CC (chief complaint):

HPI:

(include psychiatric ROS rule out)

Past Psychiatric History:

· General Statement:

· Caregivers (if applicable):

· Hospitalizations:

· Medication trials:

· Psychotherapy or Previous Psychiatric Diagnosis:

Substance Current Use and History:

Family Psychiatric/Substance Use History:

Psychosocial History:

Medical History:

· Current Medications:

· Allergies:

· Reproductive Hx:

Objective:

Diagnostic results:

Assessment:

Mental Status Examination:

Differential Diagnoses:

Reflections:

Case Formulation and Treatment Plan:

References

Page 3 of 3

Week 7: Impulse Control Disorder

Lori Sfakios

College of Nursing-PMHNP, Walden University

NRNP 6645: Psychotherapy with Multiple Modalities Practicum

Dr. Lavon Williams

October 13, 2021

Impulse Control Disorders

Impulse control disorders are a category of disorders that involve the inability to control

emotions and behaviors. And is most evident through impulsive aggression. Disorders in this

category include intermittent explosive disorder, kleptomania, pyromania, oppositional defiance

disorder, and conduct disorder. Intermittent explosive disorder (IED) is an example that consists

of a person’s inability to control their emotions. Intermittent explosive disorder is marked by

significant psychosocial dysfunction (Patoilo et al., 2021). Serotonin function has shown to be

altered in clients with IED when compared with healthy controls (Coccaro and Grant, 2019).

Patoilo et al. (2021) were able to further support IED as a diagnosis due to the results of their

study that significantly showed a higher response of anger by those diagnosed with IED than

healthy controls and psychiatric controls. The results of their study aligned with the premise that

persons with IED are more likely to misinterpret a social situation and exhibit anger than those

without IED. The purpose of this assignment is to complete a psychiatric evaluation and

formulate a treatment plan for a client who has the diagnosis of IED

CC: “I just need to stay sober. I am lonely and that gets me into trouble”

HPI: Client is a 63 male diagnosed with major depressive disorder, unspecified (F33.9),
generalized anxiety disorder (F41.1), opioid use disorder, severe (F11.20), and intermittent
explosive disorder (F63.81). He was referred to group therapy by his primary care provider
(PCP). He is currently participating in a methadone treatment program and is permitted to take
home his weekly supply of bottles. He was recently asked to bring his bottles in for a recall, and
he could not bring in his unused doses as he had been taking more than he should. He was honest
about his misuse and reported feeling depressed. He states, “I was feeling depressed after a
breakup, and I was taking extra methadone to see if it would help my mood, but it didn’t.” He
reports increasing anger due to the breakup and states, “My temper gets me in trouble. I pushed
my girlfriend away because I get jealous and angry.” He is currently on a selective serotonin
reuptake inhibitor (SSRI) for his depression and has been on weekly group psychotherapy but
would like individual therapy. He denies suicidal and homicidal ideations, auditory and visual
hallucinations.

Past Psychiatric History

 General Statement: The began feeling depressed and anxious around age 25.

 Caregivers (if applicable): self

 Hospitalizations: 7 previous inpatient hospitalizations- 5 for detox from opiates
beginning in 1997 and 2 psychiatric hospitalizations for depression and failed suicide
attempt in 2014.

 Medication trials: failed Prozac trial due to ineffectiveness

 Psychotherapy or Previous Psychiatric Diagnosis: Diagnoses include major depressive
disorder, generalized anxiety disorder, and intermittent explosive disorder. Currently in
group psychotherapy. Diagnosed with depression and anxiety at age 35 at which time he
first started psychotherapy. He has been in and out of psychotherapy since age 35. He
has history of overdose in attempt to end his life in 2014. The client has been on
medication assistance treatment for his illicit substance abuse since 2007. He reports
periods of sobriety from 1999-2007 then relapsed until 2007-2009 and has now been
clean from opiates and heroin for 11 years and alcohol and benzodiazepines for 7 years.

Substance Current Use and History: History of cannabis abuse and opiate abuse since age 17
and heroin use at age 33, last use in 2010. Around age 50, he began abusing alcohol and
benzodiazepines. He currently smokes a pack a day; denies illicit substance use, and alcohol use.

Family Psychiatric/Substance Use History:

 No known substance abuse history and no known psychiatric history

Psychosocial History

The client is a single 63-year-old Caucasian male that grew up in Connecticut and was raised by
his biological mother and father until age 3, when his parents divorced. When his parents
divorced, he lived primarily with his mother. At age 17, he began using cannabis and Vicodin
pills. The client dropped out of high school in the 9th grade stating, “I hated school. I never did
good in school.” He then began working various part-time jobs, and then his drug use escalated.
He reports constant ‘run-ins with the law because of my anger and impulsiveness.” He has a
history of assaultive behaviors, domestic violence cases, and multiple breaches of peace charges.
He has never been married but has been in long-term relationships and has no children. He
reports feelings of depression and anxiety around age 25, and anxiety. He reports multiple detox
periods and drug relapses. He has been sober for 11 years from heroin and seven years from
alcohol and benzodiazepines and is in a methadone maintenance program. Currently, the client
has no legal issues. He continues to go to alcoholic anonymous meetings and narcotics
anonymous meetings. He has no other activities outside the home and states, ‘the meetings keep
me socially connected.” He reports being up to date with annual physical examinations, yearly
dental and eye exams. He is unemployed and on disability.

Medical History: hepatitis C (remission after Harvoni treatment in 2015)

Current Medications: Methadone 190mg by mouth daily for opiate addiction/relapse
prevention; Vistaril 25 mg by mouth four times daily as needed for anxiety; Cymbalta 60mg by
mouth daily for depression

Allergies: no known drug allergies

 Allergies: no known drug allergies
 Reproductive Hx: condoms for birth control and STD prevention; currently not sexually

active.

Review of Systems

 General: The client is a well-appearing 63-year-old who denies weight loss, fatigue,
chills, weakness, and insomnia.

 HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears,
Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

 SKIN: denies skin rashes and itching.

 CARDIOVASCULAR: denies chest pain, chest tightness, palpitations, or chest
discomfort. No palpitations or edema.

 RESPIRATORY: denies feeling short of breath, cough, or sputum.

 GASTROINTESTINAL: denies nausea; denies vomiting, or diarrhea, abdominal pain or
blood.

 GENITOURINARY: denies difficulty urinating

 NEUROLOGICAL: denies headache, fainting episodes, paralysis, ataxia, numbness, or
tingling in the extremities. He reports feeling dizzy when having a panic attack.

 MUSCULOSKELETAL: denies arthralgias, joint pain, or stiffness.

 HEMATOLOGIC: denies bleeding, or bruising.

 LYMPHATICS: denies swollen or tender nodes. No history of splenectomy.

 ENDOCRINOLOGIC: denies sweating, cold, or heat intolerance; denies excessive thirst
or urination

Psychiatric Review of Systems

 Mood-reports moderate depression and loneliness, denies anhedonia, denies
hopelessness, denies fatigue; denies lack of motivation

 Anxiety- reports moderate anxiety related to relationship and financial stressors
 Sleep-intermittent insomnia
 Psychotic Symptoms-denies delusions, denies auditory hallucinations, denies visual

hallucinations
 Appetite-reports good appetite, denies weight fluctuations
 Behavioral-denies legal issues
 Trauma-denies childhood trauma; denies sexual abuse; denies physical abuse

Objective:

Diagnostic results: 9/08/2021-urine toxicology- positive for methadone metabolites; cocaine
negative; benzodiazepine negative; cannabis negative; pcp negative; amphetamine negative

Recent EKG (6/3/2021) Normal sinus rhythm

PPD (5/17/2021) 0mm induration

Last physical 11/2020- no abnormal findings, unremarkable

Assessment

Mental Status Examination

Client is a 63-year-old male that appears well for stated age. He presents with flat affect and an
anxious, tense mood. His eye contact is good; speech is pressured, increase rate; thought process

was linear, logical, and relevant. He denies suicidal ideations and can identify a safety plan
should he begin to have feelings of suicidal ideations. He denies homicidal ideations. No
delusional or paranoid thought processes were observed. His attention is good; recent and remote
memory are intact; the client exhibits a good fund of knowledge. He denies auditory and visual
hallucinations.

Differential Diagnoses

Intermittent Explosive Disorder (F63.81)

•Criteria for intermittent explosive disorder include repetitive outbursts, verbal
altercations, and acts of verbal aggression that may or may not be present with physical
aggression and are out of proportion to the situation. These outbursts or acts of
aggression result from impulsive responses due to an inability to resist aggressive
impulses and are not typically premeditated (APA, 2013). Any other mental illness can
not explain the outbursts.

Generalized Anxiety Disorder (F41.1)

•Generalized anxiety disorder (GAD) is described as excessive periods of worry for a
period greater than six months and the person cannot control the worry. Three or more
symptoms include restlessness, insomnia, irritability, muscle tension, and sleep
disturbance (APA, 2013).

Major Depressive Disorder, recurrent, moderate (F33.1)

•The criteria for major depressive disorder include symptoms such as depressed mood for
most of the day, loss of interest or pleasure in activities, weight loss or gain, insomnia or
hypersomnia, fatigue, poor concentration, and all must be present for two weeks or more
(APA, 2013). The client’s symptoms have led to occupational and social dysfunction, and
in 2014 he attempted to end his life by overdosing. The client has had multiple episodes
of depression lasting longer than two weeks for the last 25+ years.

Substance Use Disorder, opioid, severe (F11.20)

•Substance use disorder is characterized by a pattern of opioid use that leads to distress
and dependence in the long-term. Criteria include increasing in dose and frequency of
opioids with persistent desire or cravings; opioid use that interferes with social and
occupational functioning; recurrent use even in dangerous situations that may put a
person at risk of harm to self and others; exhibits withdrawal syndrome when stopped
abruptly (APA, 2013). The client reports excessive opioid use that resulted in criminal
activity to satisfy his cravings. He reports when he could no longer afford pills; he would
purchase heroin. His use started around age 17 and lasted up until 11 years ago with
several periods of sobriety throughout those years.

Unspecified Attention-Deficit Hyperactivity Disorder, (F90.8)

•Unspecified attention-deficit hyperactivity disorder (ADHD) is defined in DSM 5 as a
disorder that involves distress or impairment in social, academic, and occupational
functioning. According to the American Psychiatric Association (2013), five or more of
the following symptoms must be present:

 failure to give attention to details
 difficulty concentrating
 failure to complete tasks
 difficulty organizing activities
 does not appreciate tasks and assignments that include great mental effort
 distracted by irrelevant thoughts
 exhibits restlessness and difficulty staying in one position
 talks excessively
 interrupts others and inappropriately intrudes

Primary Diagnoses

Intermittent explosive disorder (IED) is more common than once thought and mainly due

to the failure to report anger and aggression as a priority symptom (Gelegan and Tamam, 2018).

In the case of the client, he reports anger and angry outbursts since he was a teenager. He admits

his temperament led to many negative interactions with law enforcement and many failed

relationships throughout his life. Gelegan and Tamam (2018) report that IED is more common in

males and often leads to suicidal attempts, dysfunctional relationships, and unsuccessful

employment history. The most likely diagnosis that is appropriate at this time is IED. The client

has previously been diagnosed with major depressive disorder (MDD), generalized anxiety

disorder (GAD), and substance use disorder. These disorders are frequently co-occurring with

IED. IED was the first occurring disorder for this client, and the other comorbid diagnoses did

not come until the client was over 30 years of age. He does not recall feelings of depression and

anxiety when he was a teenager. He does report a history of being a ‘hot head and short-

tempered.” MDD and GAD may elicit some labile, irritable moods; however, not to the degree

that the client is experiencing. He does report that when he was abusing alcohol and opiates, his

anger and outbursts were increased. ADHD is most likely not an accurate diagnosis at this time.

Although there is a high prevalence of IED in clients with ADHD, there does not appear to be

sufficient data to support this diagnosis. The client reports a history of occupational and social

functioning and an ability to complete tasks when necessary. He does report impulsiveness and

poor academic functioning during childhood and adolescent years. There is a correlation between

untreated ADHD, adverse childhood experiences, IED, and early crime involvement (Barra et al.,

2020). The client reports having a ‘normal” upbringing and denies any adverse events such as

trauma or abuse.

Case Formulation and Treatment Plan

The client will continue weekly group psychotherapy and begin individual psychotherapy

for mood stabilization and his addiction. The recommended therapeutic techniques are cognitive

behavioral therapy (CBT), escape and avoidance, and motivational interviewing. Escape and

avoidance, according to Toohey (2021), are techniques for when a person is going to enter a

situation where they may be triggered. Escape and avoidance do not solve problems; however,

they diffuse situations that may elicit an aggressive response and are a short-term solution.

Motivational interviewing is a style of communication that motivates clients to commit to a

change that is a more social, and heads into a positive direction that is highly functional (Toohey,

2021). Motivational interviewing is a long-term solution. Cognitive restructuring is useful in

addressing and changing cognitive distortions, irrational beliefs, to more realistic thoughts and

beliefs that are more valid (Toohey, 2021).

The client will continue to attend his Alcoholics Anonymous and Narcotics Anonymous

meetings on an on-going basis as this has been a vital resource to his recovery. The current

medications include an opioid antagonist as well as an antidepressant for mood, and an

antianxiolytic for his anxiety. The client currently smokes one pack of cigarettes a day. Smoking

cessation education provided. The risks of smoking tobacco products discussed, and the client is

encouraged to discontinue. The client leads a relatively sedentary lifestyle and education

provided regarding extracurricular activities such as hiking, exercising, and walking. The

benefits of getting out into the community and becoming active were provided to the client. The

client will return in one week for his next group psychotherapy session and in one month for his

medication management appointment. He will submit random urine specimens for toxicology

testing when requested by staff. A therapist will follow-up with the client to initiate weekly

psychotherapy. Contacts for emergency services including 911 and the crisis hotline, 211, have

been given. The client has been advised to call the clinic if symptoms worsen and emergency

services at any time, he does not feel safe.

Conclusion

Clients with impulse control disorders are in danger of harming themselves and others.

The use of SSRIs in combination of CBT, specifically cognitive restructuring is beneficial for

decreasing aggressive behaviors, decreasing anger, decreasing negative thoughts, and improving

functional presynaptic serotonin transporters (Coccaro and Grant, 2019).

References

Barra, S., Turner, D., Müller, M., Hertz, P. G., Retz-Junginger, P., Tüscher, O., Huss, M., & Retz,

W. (2020). ADHD symptom profiles, intermittent explosive disorder, adverse childhood

experiences, and internalizing/externalizing problems in young offenders. European

Archives of Psychiatry and Clinical Neuroscience. https://doi-

org.ezp.waldenulibrary.org/10.1007/s00406-020-01181-4

Coccaro, E. F., & Grant, J. E. (2019). Pharmacological treatment of impulse control disorders. In

S. M. Evans & K. M. Carpenter (Eds.), APA handbook of psychopharmacology. (pp.

267–280). American Psychological Association. https://doi-

org.ezp.waldenulibrary.org/10.1037/0000133-012

Fariba K, Gokarakonda SB. Impulse Control Disorders. [Updated 2021 Jul 31]. In: StatPearls

[Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from:

https://www.ncbi.nlm.nih.gov/books/NBK562279/

Gelegen, V., & Tamam, L. (2018). Prevalence and clinical correlates of intermittent explosive

disorder in Turkish psychiatric outpatients. Comprehensive Psychiatry, 83, 64–70.

https://doi-org.ezp.waldenulibrary.org/10.1016/j.comppsych.2018.03.003

https://doi-org.ezp.waldenulibrary.org/10.1007/s00406-020-01181-4

https://doi-org.ezp.waldenulibrary.org/10.1016/j.comppsych.2018.03.003

Patoilo, M. S., Berman, M. E., & Coccaro, E. F. (2021). Emotion attribution in intermittent

explosive disorder. Comprehensive Psychiatry, 106, 152229. https://doi-

org.ezp.waldenulibrary.org/10.1016/j.comppsych.2021.152229

Rynar, L., & Coccaro, E. F. (2018). Psychosocial impairment in DSM-5 intermittent explosive

disorder. Psychiatry research, 264, 91–95. https://doi.org/10.1016/j.psychres.2018.03.077

Toohey, M. J. (2021). Cognitive behavioral therapy for anger management. In Handbook of

cognitive behavioral therapy: Applications., Vol. 2. (pp. 331–359). American

Psychological Association. https://doi-org.ezp.waldenulibrary.org/10.1037/0000219-010

https://doi.org/10.1016/j.psychres.2018.03.077

Make up as patient it cannot be the same as in this paper. This paper must be different rewritten altogether different references everything

To Prepare

· Review this week’s Learning Resources and consider the insights they provide about impulse-control and conduct disorders.

· Select a patient for whom you conducted psychotherapy for an impulse control or conduct disorder during the last 6 weeks. Create a Comprehensive Psychiatric Evaluation Note on this patient using the template provided in the Learning Resources. There is also a completed template provided as an exemplar and guide. All psychiatric evaluation notes must be signed, and each page must be initialed by your Preceptor. When you submit your note, you should include the complete comprehensive evaluation note as a Word document and pdf/images of each page that is initialed and signed by your Preceptor. You must submit your note using SafeAssign. Please Note: Electronic signatures are not accepted. If both files are not received by the due date, Faculty will deduct points per the Walden Grading

Follow attached instructions due 07/17/2022 at 6pm

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