Psychiatric Care After Drug Overdose: Case Study

Psychiatric Care After medicine Overdose Case StudyCase Scenario MarcellaHelen FarelMarcella is a 15 year old bi-racial female who was admitted to the local community hospital in Chester, Pennsylvania for a medicate all overdose. The attending psychiatrist, Dr. Miller has referred Marcella to me to be evaluated for a possible mall economic consumption rowdyism and to be screened for the potential risk of show uping nitty-gritty economic consumption disorder.Carefully describe the clients demographic characteristics.Marcella is a 15-year-old bi-racial (Caucasian and African American) female who attends high school full-time.What is the presenting trouble?Marcella has been referred for blanket of a possible core group commit disorder and the possible risk of future union put on problems after cosmos treated at a local community hospital for attempting suicide with prescription pain medications.What is the pertinent family archives?Marcella is being raised by her gran dparents with sporadic input from her single m new(prenominal). Bethany, Marcellas m other(a), has n perpetually been married and has raised Marcella as a single mom since her birth.What is the substance use register of the clients family?Marcellas grandparents both drank alcohol throughout their adult lives and as well as experimented with various other drugs. Her stepfather uses marijuana on a daily basis because he feels that it helps with the pain from a back injury. Her mother developed a substance use problem at the age of 14, unawares after her father killed himself, and it rapidly progressed.What are some of the direct and indirect messages Marcella may have received from her family near substance use?Children and teenagers are intemperately turnd by their parents. Having a parent who uses drugs is a strong predictor of adolescent substance abuse. The messages that Marcella may have received are my parents and grandparents use drugs so and then it is okay for me to use them as well.What is Marcellas education and employment history?Marcella is a full-time high school student and has not had any graphic symbol of employment at this point but has through with(p) some babysitting.What is significant in terms of risk factors, about Marcellas academic history?Marcella has done well academically throughout elementary school but for the last four years her grades in high school have been steadily dropping. tell apart Marcellas social history?Marcella can name further two friends and also states that she doesnt like people so having only two friends is elegant with her.What is Marcellas self- cover of her substance use history?Marcella states that she has used alcohol a few times with her friends and also used alcohol on special do at family gatherings. She also states that her suicide attempt was the first time she used pain pills or any non-prescribed drugs.What is significant in terms of risk factors about Marcellas description of her relationshi ps with family members?When asking Marcella about her relationship with her family members she stated that she never had a father and she isnt sure if her mother even knows who her father was. She also states that he has never been a part of her life. She bluntly states that she hasnt had a mother for the past few years as well. She describes her grandmother as the only one who would care if she had succeeded in her suicide attempt.Accurately identify risk and protective factors for developing a substance use disorder as cogitate to the client in the case scenario.Many factors have been identified that help determine which individuals are likely to abuse drugs. The factors that are associated with the greater potential for drug abuse are known as risk factors, and those associated with the least potential for drug abuse are known as protective factors. (NIDA, 2003. pg. 6). risk of infection factors influence drug use in some ways. The more than risks the adolescent is exposed to the more likely he or she is to use and abuse drugs. (NIDA, 2003. pg. 7). Having a family history of substance abuse puts the adolescent at risk for drug abuse. The presence of protective factors can lessen the impact of some risk factors, such as parental support and involvement this can reduce the influence of strong risks, such as having substance ab apply peers. (NIDA, 2003. pg. 7).Some risk factors that could have an influence on Marcella are warmheartedness use among parents.Poor attachment with parents.Social difficultiesNegative emotionalityEarly substance useAcademic failureLow commission to schoolSome protective factors that could lessen the impact of a few of the risk factors arePositive physical developmentFamily connectedness (attachment and bonding with grandmother) living in a stable home (grandparents)Supportive relationship with family (grandmother).(NIDA, 2003).Discuss other relevant factors in the case scenario that could lead to the development of a substance u se disorder.Other risk factors often relate to the quality of relationships outside of the family, such as in their schools, with their peers, teachers, and in the community. (NIDA, 2003. pg. 9). Difficulties in these settings can be life-and-death to the adolescents emotional, cognitive, and social development. Some of the risk factors are academic failure and poor grapple skills. (NIDA, 2003. pg. 9).Other risks that can influence adolescents to start using drugs are the availability of the drugs and the belief that drug abuse is generally tolerated. (NIDA, 2003. pg. 9).Screening and discernment are part of a process that aims to identify and measure the psychic health and substance use related needs and behaviors of adolescents. It isdifficult to determine where back ends and valuement begins. Screening determines the need for a more comprehensive assessment but does not provide actual schooling about the diagnosis or possible treatment needs. The screening process should ta ke no continuing than thirty minutes and in some instances will be shorter. (NCBI, 1999. pg. 9). An appropriate screening procedure must take into consideration several variables pertaining to the client, such as their age, ethnicity, culture, gender, sexual orientation, socioeconomic status, and literacy level. (NCBI, 1999. pg. 10). It is important that the contents of the test be appropriate for clients from a variety of backgrounds and cultures. (NCBI, 1999. pg. 10). There are three primary components to preliminary screening content domains, screening methods, and instruction sources. The screening procedure focuses on verified indicators of substance related problems among adolescents. These indicators fall into two categories those that indicate substance use problem severity and those that arepsychosocial factors. (NCBI, 1999. pg. 11). There is no set number of uncovered red sags or indicators that mandate a referral for a comprehensive assessment. Many of the screening qu estionnaires provide a set of scores to assist with the decision in obtaining a comprehensive assessment. (NCBI, 1999. pg. 11). Regardless, if there are several red flags or a few that are meaningful, it is recommended to refer the adolescent for a more comprehensive assessment. (NCBI, 1999. pg. 11). The comprehensive assessment follows a positive screening for a substance use disorder and may lead to long term intervention efforts such as treatments. (NCBI, 1999. pg. 11). The screening procedures identify if the adolescent has a significant substance use problem and the comprehensive assessment confirms the problem and helps toclarify other problems that may be connected with the adolescents substance use disorder. Comprehensive information can be used to develop a proper set of interventions. (NCBI, 1999. pg. 17).There are many different purposes of the comprehensive assessment.To report in more detail the vicinity, nature, and unpredictability of substance utilization reported am id a screening, including whether the pre-adult meets symptomatic criteria for abuse or colony. (NCBI, 1999. pg. 17).To focus the particular treatment needs of the client if substance misuse or substance dependence is confirmed, so that limited resources are not misdirected. (NCBI, 1999. pg. 17).To allow the evaluator to take in more about the nature, connects, and results of the adolescents substance-utilizing conduct. (NCBI, 1999. pg. 17).To vouch that related issues not hailed in the screening procedure (e.g., issues in medicinal status, mental status, social functioning, family relations, educational performance, and delinquent behavior) are recognized. (NCBI, 1999. pg. 17).To inspect the degree to which the adolescents family (as characterized prior) capacity be included in the comprehensive assessment but also in possible subsequent interventions. (NCBI, 1999. pg. 17).To distinguish particular qualities of the adolescent, family, and other social backings (e.g., coping skil ls) that could be utilized within creating a fitting treatment plan (financial information is significant here as well). (NCBI, 1999. pg. 17).To develop a written report thatIdentifies and accurately diagnoses the severity of the use.Identifies factors that contribute to or are related to the substance use disorder.Identifies a corrective treatment plan to address these problem areas. lucubrate a plan to ensure that the treatment plan is implemented and monitored to its conclusion.Makes recommendations for referral to agencies or services. (NCBI, 1999. pg. 17).A valid, standardized, and clinically relevant assessment is crucial for effective intervention with adolescent substance abusers. (NIH, 2005. para. 6). The advantages of standardized assessments are that theyProvide a benchmark against which clinical decisions can be compared and validatedAre less prone to clinician biases and inconsistencies than more traditional assessment methods andProvide a common language which improved communication in the field can develop. (NIH, 2005. para 6).Until recently clinicians have relied on clinical judgment or locally developed procedures to diagnose adolescent substance use problems. This has begun to change since standardized and clinically valid instruments such as The medicine Use Screening Inventory Revised (DUSI-R), The Teen-Addiction Severity Index (T-ASI), have been introduced into the literature. Developmental appropriateness is critical to the effectiveness of using these instruments in work with adolescents. (NIH, 2005. para. 7).The Drug Use Screening Inventory-Revised (DUSI-R) is a 159-item instrument that documents the level of involvement with a variety of drugs and quantifies severity of consequences associated with drug use. The profile identifies and prioritizes intervention needs and provides an informative and smooth-spoken method of monitoring treatment course and aftercare. The DUSI-R is a self-administered instrument. (NCBI, 1999. pg. 69).The p urpose of this instrument is to comprehensively evaluate adolescents and adults who are suspected of using drugs to identify or flag problem areas to quantitatively monitor treatment progress and outcome and to estimate likelihood of drug use disorder diagnosis. (NCBI, 1999. pg. 69). A decision tree approach is used and the information acquired should be viewed as implicative and not definitive in that the findings should generate hypotheses regarding the areas requiring comprehensive diagnostic evaluation by using other instruments. The DUSI-R is structured and formatted for self-administration using paper and pencil or computer. The areas assessed are substance use behavior, behavior patterns, health status, psychiatric disorder, social skill, family system, school work, peer relationship, void and recreation. This assessment takes 20-40 minutes to complete depending on the subject. (NCBI, 1999. pg. 69).The Teen Addictions Severity Index (T-ASI) is a brief assessment instrument d eveloped for use when an adolescent is being admitted to inmate care for substance use related problems. (NCBI, 1999. pg. 78). The purpose of this instrument is to provide basic information on an adolescent prior to entry into in diligent care for substance use related problems. (NCBI, 1999. pg. 78). This assessment is an objective face to face interview combined with opportunity for assessor to offer comments, confidence ratings (indication whether the information may be distorted), and severity ratings (indicating how severe the assessor believes is the need for treatment or counseling). (NCBI, 1999. pg. 78). The areas assessed are chemical use, school status, employment/support, family relationships, peer/social relationships, effective status (involvement with criminal justice program), psychiatric status, and contact list for additional information. The number of questions asked for each area are fewer in number than many of the other instruments used. (NCBI, 1999. pg. 78). Th ese screening tools are brief self-reports or interviews that are used as the first step in the process of evaluating whether an adolescent may or may not have a drug problem. The outcome of a screening is to determine the need for further, more comprehensive assessment. (NCBI, 1999. pg. 78).I would use the DUSI-R to assess Marcellas potential drug use because it is a self-report inventory that is available in paper or online that deals with both drugs and alcohol. It is utilized for measuring current status, recognizing areas in need of prevention, and evaluating the degree of change after treatment.Substance use disorder in the DSM-5 combines the DSM-IV categories of substance abuse and substance dependence into a single disorder using a measurement of mild to severe. The diagnosis of dependence caused some confusion. Most people think that dependence is addiction when in fact dependence could be the bodys normal response to a substance. In order for a patient to be diagnosed with Substance Use Disorder the patient must meet at least two of the eleven criteria for the diagnosis. A patient meeting 2-3 of the criteria indicates mild substance use disorder, meeting 4-5 criteria indicates moderate substance use disorder and meeting 6-7 criteria indicates severe substance use disorder. (BupPractice, 2014).The Diagnostic Criteria are as followsContinuing to use opioids patronage negative personal consequences.repeatedly unable to carry out major obligations at work, school, or home due to opioid use.Recurrent use of opioids in physically hazardous situations.Continued use despite persistent or recurring social or interpersonal problems caused or made worse by opioid use.Tolerance as defined by either a need for markedly increased amounts to achieve intoxication or desired effect or markedly diminished effect with proceed use of the same amount.Withdrawal manifesting as either characteristic syndrome or the substance is used to avoid withdrawal.Using greater amoun ts or using over a longer time period than intended.Persistent desire or unsuccessful efforts to cut down or control opioid use.Spending a mess hall more time obtaining, using, or recovering from using opioids.Stopping or reducing important social, occupational, or recreational activities due to opioid use.Consistent use of opioids despite acknowledgement of persistent or recurrent physical or psychological difficulties from using opioids.Craving or a strong desire to use opioids. (This is a new criterion added since the DSM-IV-TR). (BupPractice, 2014).During the assessment and evaluation with Marcella she stated that she tried alcohol a few times with friends and on special occasions at family gatherings and she denies having ever been intoxicated. She also states that the pain pills she took in the suicide attempt were her only use of non-prescribed drugs. According to the DSM-5, Marcella does not meet any of the criteria for the diagnosis of a substance use disorder. In order to be diagnosed with a substance use disorder Marcella must meet 2 of the 11 criteria for the diagnosis. After my assessment and evaluation of Marcella I have come to the conclusion that she does not meet any of the criteria to be diagnosed with a substance use disorder. While she did take prescription pain medication in an attempt to commit suicide it was the first and only time that she took any type of drug prescription or otherwise. Marcella continues to work on her other medical issues with the hospital psychiatrist.ReferencesAmerican Psychiatric Association. (2005). Substance-Related and addictive disorders. Retrieved from www.dsm5.org/Documents/Substance%20Use%20Disorder%20Fact%20sheet.pdfBupPractice. (2014). DSM-5 Substance use disorder. Diagnostic criteria. Retrieved from www.dsm5.org/Documents/Substance%20Disorder%20Fact%20sheet.pdfCenters for Substance Abuse Treatment. (1999).Screening and assessing adolescents for substance use disorders. Substance abuse and mental health services administration (US) (Treatment Improvement Protocol (TIP) Series, No. 31 Retrieved from http//www.ncbi.nlm.nih.gov/books/NBK64364/pdf/TOC.pdfNational Institute on Drug Abuse. (2003). Chapter 1 Risk and Protective Factors. In Preventing Drug Use Among Children and Adolescents. Retrieved from http//drugabuse.gov/publications/preventing-drug-abuse-among-children-and-adolescents?chapter-1-risk-factors-protective-factors.Miller, W.R., Forcehimes, A. A., Zweben, A. (2011). Treating addiction A guide for professionals. New York, NY GuilfordNational Institute on Drug Abuse. (n.d.). Risk and protective factors. Retrieved from http//drugabuse.gov/sites/ neglect/files/preventingdruguse_2.pdf