NRNP 6665 : Grand Rounds Discussion: Complex Case Study Presentation: ADHD

Objectives 1- To identify three different diagnoses with supporting evidence, listed in order from highest priority to lowest priority. 2- To understand the DSM-5 criteria for ADHD, Bipolar Disorder, and Generalized Anxiety Disorder. 3- To develop an appropriate care plan for the patient in the presented case including pharmacological and non-pharmacological interventions. Subjective: CC (chief complaint): “My daughter is irritable and blows up frequently. She cannot stay still, doesn’t pay attention in school, and has poor grades.” HPI: MT is a 14-year-old African American female with a past psychiatric history of ADHD who was referred to the clinic by her pediatrician for psychiatric evaluation. The patient and mother were seen at the clinic for initial evaluation. MT was diagnosed with ADHD two years ago, and the mother declined pharmacological treatment. Then, MT started on psychotherapy for anger management and social skills, but she was not consistent with therapy sessions due to her mother’s work schedule conflict. According to her mother, MT does not share her feelings, and sometimes she will explode in anger. Recently she punched a hole in the walls on two occasions. She gets irritated when she is asked to complete house shores like washing dishes, cleaning her room, or organizing things. She will either start crying or hit the wall. MT mother is concerned about her daughter behavior because MT father has bipolar disorder and she wanted to know at which point MT could be affected by the same or similar condition. MT denies feeling depressed or losing interest in her pleasurable activities. She has been self-isolated from her friends, and sometimes, from her family. MT stated: "Sometimes I just don't want to be bothered". MT denies suicida/homicidal ideations. She also denies hearing voices or seing things that are not there. Medications Trial: None Psychotherapy or Previous psychiatric diagnosis: MT has a psychiatric history of ADHD. She is enrolled in psychotherapy for anger management and social skills. Substance Current Use: MT denies smoking, drinking alcohol, or using illicit drug. Medical History: None • Current Medications: None • Allergies: No known Drug, Food, or environmental allergy. • Reproductive Hx: First menses at 13 y/o. Regular menses. Never been pregnant. Denies being sexually active. She is single and has no children. Psychosocial History: MT is a 9th-grade student who lives with her mother and younger brother in a townhouse in Bowie, Maryland. She enjoys reading and playing card games. She denies having any legal issues. She denies any history of trauma or abuse. MT denies using illicit drug, alcohol, or smoking. She reports poor grades in school and a lack of interest in school activities. General Statement: MT is a 14-year-old African American with a history of ADHD, not on medication but currently managed with psychotherapy. She has never been hospitalized. She denies suicidal/homicidal thoughts. ST is alert and oriented to person, time, place and situation. Family Psychiatric/Substance Current Use: - Father: Bipolar Disorder - Mother: Depression, Anxiety - Brother: ADHD ROS: • GENERAL: No chills, subjective fever, night sweats, weight loss. • HEENT: No headache, vision changes, eye pain, sore throat.