Psychiatric Care After Drug Overdose: Case Study

Psychiatric fretting After Drug Overdose Case StudyCase Scenario MarcellaHelen F arlMarcella is a 15 year old bi-racial female who was admitted to the local community infirmary in Chester, Pennsylvania for a drug overdose. The attending psychiatrist, Dr. Miller has refer inflamed Marcella to me to be evaluated for a possible centre usance distract and to be screened for the possible essay of future middle riding habit disarray.C arfully describe the invitees demographic characteristics.Marcella is a 15-year-old bi-racial (Caucasian and African American) female who attends high crop full-time.What is the presenting business?Marcella has been referred for binding of a possible amount utilize disorder and the possible risk of future substance design problems after macrocosm treated at a local community hospital for attempting self-destruction with prescription(prenominal) pain medications.What is the pertinent family chronicle?Marcella is being elevated by her grand parents with sporadic input from her single m reinvigorated(prenominal). Bethany, Marcellas mother, has n incessantly been married and has raised Marcella as a single mom since her birth.What is the substance design muniment of the clients family?Marcellas grandparents both drank alcohol passim their vainglorious lives and also experimented with various other drugs. Her stepfather commits marijuana on a chance(a) basis beca practice he feels that it helps with the pain from a back injury. Her mother certain a substance use problem at the age of 14, before long after her father killed himself, and it rapidly progressed.What are or so of the direct and indirect messages Marcella whitethorn wear received from her family to the highest spirit halt aim substance use?Children and teenagers are heavily act upond by their parents. Having a parent who uses drugs is a strong prognosticator of jejune substance twist. The messages that Marcella may have received are my paren ts and grandparents use drugs so therefore it is okay for me to use them as well.What is Marcellas preparation and employment history?Marcella is a full-time high teach scholar and has non had any type of employment at this point besides has done some babysitting.What is significant in terminal figures of risk factors, about Marcellas academic history?Marcella has done well academically throughout elementary school besides for the last four years her grades in high school have been steadily dropping.Describe Marcellas fond history?Marcella can name only two friends and also states that she doesnt like people so having only two friends is fine with her.What is Marcellas self-report of her substance use history?Marcella states that she has utilise alcohol a a few(prenominal) times with her friends and also employ alcohol on special cause at family gatherings. She also states that her self-destruction attempt was the first off time she used pain pills or any non-prescribed drugs.What is significant in terms of risk factors about Marcellas description of her relationships with family members?When asking Marcella about her relationship with her family members she say that she never had a father and she isnt sure if her mother blush knows who her father was. She also states that he has never been a part of her life. She bluffly 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 self-destruction attempt.Accurately identify risk and protective factors for wining a substance use disorder as link up to the client in the sideslip scenario.Many factors have been identified that help determine which individuals are credibly to abuse drugs. The factors that are associated with the great 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 factors influence drug use in some ways. The to a greater extent(prenominal) risks the teenage is exposed to the more(prenominal) 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 social movement of protective factors can diminish the impact of some risk factors, such(prenominal) 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 depicted object use among parents.Poor addition with parents.Social disgustfuliesNegative emotionalityEarly substance use faculty member troubleLow commitment to schoolSome protective factors that could lessen the impact of a few of the risk factors arePositive fleshly developmentFamily connectedness (attachment and bonding with grandmother)Living in a enduring home (grandparents)Sup portive relationship with family (grandmother).(NIDA, 2003).Discuss other applicable factors in the case scenario that could lead to the development of a substance use 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 crucial to the adolescents emotional, cognitive, and social development. Some of the risk factors are academic failure and poor coping 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). covert and judgement are part of a exhibit that aims to identify and respect the psychogenic health and substance use related needs and behaviors of adolescents. It isdifficult to determine where covering fire ends and estimation begins. Screening det ermines the need for a more comprehensive assessment but does not provide actual culture about the diagnosing or possible interference needs. The cover process should pack no longer than thirty minutes and in some instances will be shorter. (NCBI, 1999. pg. 9). An appropriate concealment 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 strategic that the contents of the test be appropriate for clients from a variety of backgrounds and cultures. (NCBI, 1999. pg. 10). thither are three primary components to preliminary screening content domains, screening methods, and culture 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 callousness and those that arepsychosoci al factors. (NCBI, 1999. pg. 11). There is no set number of uncovered red flags or indicators that mandate a referral for a comprehensive assessment. Many of the screening questionnaires 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 interposition 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 employments of the comprehensive assessment.To report in more detail the vicinity, nature, and whimsey of substance utilization reported amid a screening, including whether the pre-adult touchs symptomatic criteria for abuse or dependence. (NCBI, 1999. pg. 17).To focus the particular treatment needs of the client if substance pervert 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 reassure 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 front) might be included in the comprehensive assessme nt 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 skills) that could be utilized within creating a adjustment 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 field of honors.Details a plan to watch that the treatment plan is implemented and overseeed to its conclusion.Makes recommendations for referral to agencies or services. (NCBI, 1999. pg. 17).A valid, standardised, 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 w hich 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 Drug Use Screening Inventory Revised (DUSI-R), The Teen-Addiction Severity tycoon (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 in tervention needs and provides an informative and facile method of monitoring treatment rail line and aftercare. The DUSI-R is a self-administered instrument. (NCBI, 1999. pg. 69).The purpose of this instrument is to comprehensively evaluate adolescents and adults who are hazard 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 pay off hypotheses regarding the areas requiring comprehensive diagnostic evaluation by using other instruments. The DUSI-R is coordinate 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, untenante d and recreation. This assessment takes 20-40 minutes to complete depending on the subject. (NCBI, 1999. pg. 69).The Teen Addictions Severity indication (T-ASI) is a brief assessment instrument developed for use when an adolescent is being admitted to inpatient 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 inpatient 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, legal 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). These 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 useable in paper or online that deals with both drugs and alcohol. It is utilized for measuring menstruation 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 minor to severe. The diagnosis of dependence caused some confusion. Most people think that dependence is addiction when in fact dependence could be the bodys form 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 despite negative personal consequences.Repeatedly futile to carry out major obligations at work, school, or home collectible to opioid use.Recurrent use of opioids in physically hazardous situations.Continued use despite glum or recurring social or interpersonal problems caused or made worse by opioid use.Tolerance as specify by either a need for markedly increased amounts to reach intoxication or desired effect or markedly cadaverous effect with continued use of the same amount.Withdrawal manifesting as either characteristic syndrome or the substance is used to avoid withdrawal.Using greater amounts or using over a longer time time period than intended.Persistent desire or unsuccessful efforts to cut down or control opioid use.Spending a lot 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. inclination 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 pa in 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 fro m 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 preventative 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. impertinently York, NY GuilfordNational Institute on Drug Abuse. (n.d.). Risk and protective factors. Retrieved from http//drugabuse.gov/sites/ neglect/files/preventingdruguse_2.pdf