Tag: Differential diagnosis

Write what the 3 differential diagnoses are 150-to-200-word count. Taking into account the patient case study below and what are the criteria base on the DSM TR 5.
Differential diagnosis
1) Major Depressive Disorder (MDD)
2) Generalized anxiety disorder GAD
3) Post traumatic stress syndrome PTSD
Case study:
CC (chief complaint): “I have been feeling ashamed and worthless”
HPI: BD is a 38 y/o Caucasian male who presented to the outpatient services for a psychiatric evaluation for possible outpatient CBT. According to the patient, he received six weeks of CBT in this facility two years ago with positive results. The patient reported that it seems he divorced his wife for five years. He relocated to Chicago for a new job and to start a new life. The patient also reports having difficulty coming to terms with his previous attempt to commit suicide before his brother’s wedding. According to the patient, seems moving to Chicago two years ago, and his depression has gotten worst; he has developed anxiety and is finding it very difficult to gain control of his life. The patient reported an increase in ETOH use. BD is currently being treated with Sertraline 200 mg po daily, Buspirone 15mg PO TID PRN for anxiety, and Trazadone 150mg PO at bedtime for insomnia. According to BD, he has sought the help of a few different outpatient services for CBT therapy in Chicago, but none have been effective, like the one in the state of GA, where two years ago, he received CBT for six weeks. The patient took a leave and absence from his job in Chicago to return to Atlanta, GA, to seek the help of outpatient services, which he has found effective in the past.
Part 2
Reflection notes: Reflection notes: What would you do differently in a similar patient evaluation? Reflect on one social determinant of health according to the Healthy People 2030 (you will need to research) as applied to this case in the realm of psychiatry and mental health. As a future advanced provider, what are one health promotion activity and one patient education consideration for this patient for improving health disparities and inequities in the realm of psychiatry and mental health? Demonstrate your critical thinking.

A 29-year-old single, sexually active woman reporting that she is in a monogamous relationship, has experienced five attacks of acute cystitis in the past year, all characterized by dysuria, increased frequency, and urgency. Each case was diagnosed on the basis of the clinical picture and a laboratory finding of bacteriuria. The urine bacterial counts in these cases ranged from 104 to 106 organisms/ml. Lab tests indicated that the third and fourth infections were caused by Escherichia coli, while the fifth infection was caused by an enterococcus and the second infection was caused by Proteus mirabilis. Each infection responded to short-term treatment with trimethoprim sulfamethoxazole. The recurrences occurred at intervals of 3 weeks to 3 months following completion of antibiotic therapy. For the past two days, the woman has once again been experiencing dysuria, increased frequency, and urgency, so she goes to see her nurse practitioner provider. Her vital signs are T = 37.6°C, P = 100, R = 18, and BP = 110/75 mm Hg. Physical examination reveals a mild tenderness to palpation in the suprapubic area, but no other abnormalities. A bimanual pelvic examination reveals a normal-sized uterus and adnexae with no apparent adnexal tenderness. No vaginal discharge is noted. The cervix appears normal.

Questions:

What is the differential diagnosis for this set of symptoms? What is your preliminary diagnosis?
What tests should you order to confirm your preliminary diagnosis?
What are the possible causes of recurrent lower UTIs? Which of these is most likely in this case?
When would you collaborate with other professionals and refer your patient to a specialist and why?