Order Grand Rounds Discussion

Order Grand Rounds Discussion
1. Demonstrate adequate understanding of the common symptoms of major depression and PTSD.
2. Demonstrate a high level of knowledge on the underlying causes of posttraumatic stress disorder and suicide based on trauma, family issues, and life stressors.
3. Develop knowledge on mental status examination and prioritization of treatments for mental illness based on psychotherapy and pharmacology.
4. Demonstrate understanding of the possible lifestyle changes to improve physical and psychological outcomes among adults.
CC (chief complaint): “Suicidal thought to shoot himself in the head and frequent nightmares”
Order Grand Rounds Discussion
HPI: N.R is a 56-year-old male of African American origin who presented to the mental health facility with significant suicidal thoughts and nightmares. The police arrested him after he threatened to shoot himself in the head in front of his neighbor. N.R was placed on emergency hold by the police in response to the self-harm threat. He is a military veteran with seven years in Afghanistan. He has been unable to manage his grocery store due to suicidal thoughts experienced for the last four months. The patient told his neighbor, “I am going to shoot my head to remove demons that live inside.” The patient reported that he has been experiencing nightmares and hearing voices from his comrades who died in a raid during deployment. He has been planning to die by the bullet so that all his problems would come to an end. The patient reported that he has been unable to sleep for more than four hours at night. He prefers to sleep during daytime and feels tired most of the time. He reports feeling depressed most of the time for the last four months. He separated from his wife after ten years of marriage due to frequent physical violence. His patient records shared by psychiatrists show that he was treated for major depressive disorder two years ago. He reports that he has been unable to eat well due to poor appetite. The patient reports flashbacks related to his experience in the raid that resulted in the death of his best friend in the military. He has been trying to avoid discussions related to war or military action due to the negative memories. He experiences decreased interest in playing his favorite game with friends. He reports that he is always ready to shoot his enemies who are planning to attack at night. The patient reports that his family is not supportive and is happy about his current situation. The patient is aggressive and easily irritated during interactions. The patient reports feeling sad and having difficulty concentrating in the workplace.
Order Grand Rounds Discussion
Substance Current Use: Patient reports that he smokes two packets of cigarette every day. He reports occasional intake of alcohol at least once week when free. He denies illegal drug use or marijuana use. He was prescribed with morphine for pain management five years ago but did not develop dependence.
Past Psychiatric History: Patient was diagnosed with major depressive disorder 2 years ago and treated using medication. He has history of substance abuse disorder which was treated six years ago. He reports that he cannot remember his experience as a child related to trauma. He suffered trauma during military deployment in service.
Medical History: Has history of hypertension which is managed using medication and lifestyle change.
· Current Medications: Lisinopril 10 mg once daily for HTN and Prozac 20 mg once daily for depression.
· Allergies: Iodine.
· Reproductive Hx: Patient is heterosexual. He engages in sexual relationships with multiple women after divorce from his wife. He reports that he uses condoms for protecting against STI. He is unable to seek screening for prostate related problems due to the current mental illness.
Psychotherapy: Patient received cognitive behavioral therapy two years ago for depression.
Family Medical History: Father 76 years-old with history of diabetes mellitus and HTN. Mother 74 years with history of hypertension and hyperlipidemia. Younger brother, no known medical history.

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