What is the diagnosis and is there more than one? What is the best…

Question Answered step-by-step What is the diagnosis and is there more than one? What is the best… What is the diagnosis and is there more than one?  What is the best treatment/intervention? Karen was admitted to a psychiatric unit four months ago at a local hospital because of a suicide attempt.  She is a divorced, 41 years old, African American woman and the mother of three adolescents.  She says she has been using an increasing amount of cocaine in the preceding weeks in order to get the same “high” she used to. If she stops using cocaine she feels very ill. She gets very tired, has “funky dreams” and feels like she is “walking like a turtle”.  Recently, Karens older daughter (age 16) made charges of sexual molestation against her mother’s live in boyfriend.  The boyfriend denies the charges. No charges were filed by police. Karen is devastated by the accusation and unsure about whom to believe.  She does not understand how her boyfriend could have done such a thing.          Although she is a registered nurse, Karen license was suspended five years ago because of drug use and she has been unemployed since then.  She has completed a number of drug treatment programs but has been unable to stay sober. She has had a series of stormy relationships with boyfriends.  She states that she has have a boyfriend at all times.  She admits that she gets involved very quickly and the relationships seem to end just a fast. She needs to have a man in her life to feel secure. She says that a number of her relationships have ended because she was convinced that they were cheating on her. She admits that she has been in abusive relationships but “it is better than being alone”. The family lives in a neighborhood characterized by frequent violence and heavy drug trafficking.  She has been mugged several times and nearly raped on several other occasions.  Her son was once grazed by a bullet from a drive by shooting.           In addition to two previous hospitalizations precipitated by suicide threats, Lois has an extensive history of outpatient treatment with a variety of therapists. She has often been nonadherent with treatment recommendations, frequently “acted out” strong feelings toward her therapists with suicidal gestures and sexual promiscuity and repeatedly abused substances.  Her last therapist has described her as “untrusting, extremely paranoid when under stress”, and  “hostile” and “dependent”.          Karen has described frequent episodes over the last three years lasting about two weeks to a month in which she feels sad and edgy, she has sleep issues (difficulty falling asleep, awakening frequently during the night) weight loss, loss of interest in seeing her friends, shopping, going to the gym and even sex.  She says that she has no energy, feels “jumpy and fidgety”, is anxious but doesn’t know why. She feels like she is worthless and non one likes her.  She says her life is worthless and she feels guilty all the time, even for things that happened many years ago. She has stomach and back aches “pretty much all the time. She has attempted suicide on a number of occasions-“but not seriously, I didn’t really want to die” .  Her most recent attempt in which she took an overdose of oxycodone almost resulted in her death.   She reports at other times she has weeks where feels like she is going to “jump out of her skin” she is so happy.  During these times, she does enjoy shopping, too much in fact because she spends “way too much money”.  She said that during these episodes she has started many projects and has not finished any of them.  Karen says that during these times she feels that she is “on top of the world” but “cannot seem to keep a thought in her head”.  She stated that during these episodes her son has refused to talk with her because “he cannot understand what the hell she is talking about half the time and cannot get a word in”.The staff has stated that at times Karen is a very difficult patient and is described as being “particularly difficult”.  She hurls racial epithets at the staff and precipitated an explosion of racial tensions on the ward.  She will speak only to African American personnel and would dismiss suggestions made by white clinicians.   She says she feels that the white staff are trying to poison her.         Several weeks into the current hospitalization Lois began having dreams about being sexually abused by her father.  She admitted to having these dreams in the past but never told anyone about them because she felt hat “no one would believe her”. She eventually reported that she was abused and that the abuse began when she was 6 and ended after she began to menstruate at age 12.    Psychology Social Science Social Psychology PSY 2012 Share QuestionEmailCopy link Comments (0)