25 Sep PSY 6670 Diagnosis and Treatment Planning Comprehensive Final

1. John is a 35 year Caucasian man with dual diagnosis of 295.3 continuous and 303.90 and has been referred for treatment by the homeless shelter he is living in currently.  John recently moved to Orlando from Atlanta and lives alternately on the street and in homeless shelters.  He currently is working as a janitor in a local church part time.  This was secured for him by another local shelter.  He is able to go to work. John drinks daily and his active delusions are at times frightening for the other janitor, a 62 year old woman.  He does not admit to having hallucinations.  John has negative symptoms as well as the delusions including flat affect and inappropriate mood at times that is not congruent with what he is experiencing. John has been referred to you for evaluation and treatment.  John is currently on Seroquel but does not take it consistently. John is of above average intelligence and has a degree in Biology from the University of Georgia.  John’s family has little or no contact with him.  What assessments would you need to conduct in order to appropriately deal with John?  Develop a comprehensive treatment plan for John including medications.  

2. Karen is a 19 year old married pregnant woman married to a 22 year old man in the military.  She has no history of mental illness.  She reports her mother has a history of depression and her grandmother has been treated with “nerve pills” She currently is reporting significant anxiety.  She reports being unable to sleep longer than 1-2 hours at a time.  She has tremendous fears that she is going to lose her baby even though her Ob/Gyn has assured her that the baby is developing fine.  She is in the 3rd trimester.  She is visibly trembling and reports worrying constantly about her baby.  Her husband is due to be deployed to Iraq within a few months.  She has lots of familial support and talks with her mother daily but lives 14 hours from her family of origin on a military base.  She has one very close friend who also married to someone in the military.  Karen states I worry about everything.  She does report that she has been a worrier since she was in high school.  She reports that her husband is supportive but is gone training 2-3 weeks of the month and is not home.  Karen does not work outside the home.  What else do you want to know in order to develop a DSM IV TR diagnostic impression.  Write your Principle & any Provisional diagnoses and Z codes. Being pregnant, is their any medication that she may be prescribed?  If so what and why?