Psychopathology week7

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  Schizophrenia and Other Psychotic Disorders; Medication-Induced Movement Disorders

This week, you explore psychotic disorders, including schizophrenia. You also explore medication-induced movement disorders and formulate a diagnosis for a patient in a case study.

Learning Objectives

Students will:

  • Apply concepts, theories, and      principles related to patient interviewing, diagnostic reasoning, and      recording patient information
  • Formulate differential      diagnoses using DSM-5-TR criteria for patients with      schizophrenia, other psychotic disorders, and medication-induced movement      disorders across the life span

 Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders

Psychotic disorders and schizophrenia are some of the most complicated and challenging diagnoses in the DSM. The symptoms of psychotic disorders may appear quite vivid in some patients; with others, symptoms may be barely observable. Additionally, symptoms may overlap among disorders. For example, specific symptoms, such as neurocognitive impairments, social problems, and illusions may exist in patients with schizophrenia but are also contributing symptoms for other psychotic disorders.

For this Assignment, you will analyze a case study related to schizophrenia, another psychotic disorder, or a medication-induced movement disorder.

  • Review this week’s Learning Resources and consider the insights      they provide about assessing and diagnosing psychotic disorders. Consider      whether experiences of psychosis-related symptoms are always indicative of      a diagnosis of schizophrenia. Think about alternative diagnoses for      psychosis-related symptoms.
  • Download the Comprehensive Psychiatric      Evaluation Template, which you will use to complete this Assignment. Also      review the Comprehensive Psychiatric Evaluation Exemplar to see an      example of a completed evaluation document. 
  • By Day 1 of this week, select a specific video      case study to use for this Assignment from the Video Case Selections      choices in the Learning Resources. View your assigned video case and      review the additional data for the case in the “Case History Reports”      document, keeping the requirements of the evaluation template in mind.
  • Consider what history would be necessary to      collect from this patient.
  • Consider what interview questions you would      need to ask this patient.
  • Identify at least three possible differential      diagnoses for the patient. 

Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis.

Incorporate the following into your responses in the template:

  • Subjective: What details did      the patient provide regarding their chief complaint and symptomology to      derive your differential diagnosis? What is the duration and severity of      their symptoms? How are their symptoms impacting their functioning in      life? 
  • Objective: What observations      did you make during the psychiatric assessment?  
  • Assessment: Discuss the patient’s      mental status examination results. What were your differential diagnoses?      Provide a minimum of three possible diagnoses with supporting evidence,      listed in order from highest priority to lowest priority. Compare the      DSM-5-TR diagnostic criteria for each differential diagnosis and explain      what DSM-5-TR criteria rules out the differential diagnosis to find an      accurate diagnosis. Explain the critical-thinking process that led you to      the primary diagnosis you selected. Include pertinent positives and      pertinent negatives for the specific patient case.
  • Reflection notes: What would      you do differently with this client if you could conduct the session      over? Also include in your reflection a discussion related to      legal/ethical considerations (demonstrate critical thinking beyond      confidentiality and consent for treatment!), health promotion and disease      prevention taking into consideration patient factors (such as age, ethnic      group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background,      etc.).

References

https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.Medication_Induced_Movement_Disorders

https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x02_Schizophrenia_Spectrum

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer. 

  • Chapter 7, Schizophrenia Spectrum and Other Psychotic      Disorders
  • Chapter 29.2, Medication Induced-Movement Disorders
  • Chapter 31.15, Early-Onset Schizophrenia

https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/schizophrenia-and-other-psychotic-disorders

https://www.youtube.com/watch?v=BdB6MgWAP1k

NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar

INSTRUCTIONS ON HOW TO USE EXEMPLAR AND TEMPLATE—READ CAREFULLY

If you are struggling with the format or remembering what to include, follow the
Comprehensive Psychiatric Evaluation Template

AND
the Rubric
as your guide. It is also helpful to review the rubric in detail in order not to lose points unnecessarily because you missed something required. Below highlights by category are taken directly from the grading rubric for the assignment in Weeks 4–10. After reviewing the full details of the rubric, you can use it as a guide.

In the
Subjective section, provide:

· Chief complaint

· History of present illness (HPI)

· Past psychiatric history

· Medication trials and current medications

· Psychotherapy or previous psychiatric diagnosis

· Pertinent substance use, family psychiatric/substance use, social, and medical history

· Allergies

· ROS

·
Read rating descriptions to see the grading standards!

In the
Objective section, provide:

· Physical exam documentation of systems pertinent to the chief complaint, HPI, and history

· Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.

·
Read rating descriptions to see the grading standards!

In the
Assessment section, provide:

· Results of the mental status examination,

presented in paragraph form.

· At least three differentials with supporting evidence. List them from top priority to least priority. Compare the
DSM-5-TR diagnostic criteria for each differential diagnosis and explain what
DSM-5-TR criteria rules out the differential diagnosis to find an accurate diagnosis.

Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case

.

·
Read rating descriptions to see the grading standards!

Reflect on this case. Include: Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (


demonstrate critical thinking beyond confidentiality and consent for treatment

!), social determinates of health, health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

(The comprehensive evaluation is typically the
initial new patient evaluation. You will practice writing this type of note in this course. You will be ruling out other mental illnesses so often you will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for all illnesses which could be impacting your patient. For example, anxiety symptoms, depressive symptoms, bipolar symptoms, psychosis symptoms, substance use, etc.)

EXEMPLAR BEGINS HERE

CC (chief complaint): A
brief statement identifying why the patient is here. This statement is verbatim of the patient’s own words about why presenting for assessment. For a patient with dementia or other cognitive deficits, this statement can be obtained from a family member.

HPI: Begin this section with patient’s initials, age, race, gender, purpose of evaluation, current medication and referral reason. For example:

N.M. is a 34-year-old Asian male presents for psychiatric evaluation for anxiety. He is currently prescribed sertraline which he finds ineffective. His PCP referred him for evaluation and treatment.

Or

P.H., a 16-year-old Hispanic female, presents for psychiatric evaluation for concentration difficulty. She is not currently prescribed psychotropic medications. She is referred by her therapist for medication evaluation and treatment.

Then, this section continues with the symptom analysis for your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis.

Paint a picture of what is wrong with the patient. First what is bringing the patient to your evaluation. Then, include a PSYCHIATRIC REVIEW OF SYMPTOMS. The symptoms onset, duration, frequency, severity, and impact. Your description here will guide your differential diagnoses. You are seeking symptoms that may align with many DSM-5-TR diagnoses, narrowing to what aligns with diagnostic criteria for mental health and substance use disorders.

Past Psychiatric History: This section documents the patient’s past treatments. Use the mnemonic
Go
Cha
MP.

General Statement: Typically, this is a statement of the patients first treatment experience. For example: The patient entered treatment at the age of 10 with counseling for depression during her parents’ divorce. OR The patient entered treatment for detox at age 26 after abusing alcohol since age 13.

Caregivers are listed if applicable.

Hospitalizations: How many hospitalizations? When and where was last hospitalization? How many detox? How many residential treatments? When and where was last detox/residential treatment? Any history of suicidal or homicidal behaviors? Any history of self-harm behaviors?

Medication trials: What are the previous psychotropic medications the patient has tried and what was their reaction? Effective, Not Effective, Adverse Reaction? Some examples: Haloperidol (dystonic reaction), risperidone (hyperprolactinemia), olanzapine (effective, insurance wouldn’t pay for it)

Psychotherapy or
Previous Psychiatric Diagnosis: This section can be completed one of two ways depending on what you want to capture to support the evaluation. First, does the patient know what type? Did they find psychotherapy helpful or not? Why? Second, what are the previous diagnosis for the client noted from previous treatments and other providers. Thirdly, you could document both.

Substance Use History: This section contains any history or current use of caffeine, nicotine, illicit substance (including marijuana), and alcohol. Include the daily amount of use and last known use. Include type of use such as inhales, snorts, IV, etc. Include any histories of withdrawal complications from tremors, Delirium Tremens, or seizures.

Family Psychiatric/Substance Use History: This section contains any family history of psychiatric illness, substance use illnesses, and family suicides. You may choose to use a genogram to depict this information. Be sure to include a reader’s key to your genogram or write up in narrative form.

Social History: This section may be lengthy if completing an evaluation for psychotherapy or shorter if completing an evaluation for psychopharmacology. However, at a minimum, please include:

Where patient was born, who raised the patient

Number of brothers/sisters (what order is the patient within siblings)

Who the patient currently lives with in a home? Are they single, married, divorced, widowed? How many children?

Educational Level

Hobbies:

Work History: currently working/profession, disabled, unemployed, retired?

Legal history: past hx, any current issues?

Trauma history: Any childhood or adult history of trauma?

Violence Hx:
Concern or issues about safety (personal, home, community, sexual (current & historical)

Medical History: This section contains any illnesses, surgeries, include any hx of seizures, head injuries.

Current Medications: Include dosage, frequency, length of time used, and reason for use. Also include OTC or homeopathic products.

Allergies:
Include medication, food, and environmental allergies separately. Provide a description of what the allergy is (e.g., angioedema, anaphylaxis). This will help determine a true reaction vs. intolerance.

Reproductive Hx:
Menstrual history (date of LMP), Pregnant (yes or no), Nursing/lactating (yes or no), contraceptive use (method used), types of intercourse: oral, anal, vaginal, other, any sexual concerns

ROS: Cover all body systems that may help you include or rule out a differential diagnosis. Please note: THIS IS DIFFERENT from a physical examination!

You should list each system as follows:
General:
Head:
EENT: etc. You should list these in bullet format and document the systems in order from head to toe.

Example of Complete ROS:

GENERAL: No weight loss, fever, chills, weakness, or fatigue.

HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

SKIN: No rash or itching.

CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema.

RESPIRATORY: No shortness of breath, cough, or sputum.

GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.

GENITOURINARY: Burning on urination, urgency, hesitancy, odor, odd color

NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness.

HEMATOLOGIC: No anemia, bleeding, or bruising.

LYMPHATICS: No enlarged nodes. No history of splenectomy.

ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.

Physical exam (If applicable and if you have opportunity to perform—document if exam is completed by PCP): From head to toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History.
Do not use “WNL” or “normal.” You must describe what you see. Always document in head-to-toe format i.e., General: Head: EENT: etc.

Diagnostic results: Include any labs, X-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines).


A

ssessment

Mental Status Examination: For the purposes of your courses, this section must be presented in paragraph form and not use of a checklist! This section you will describe the patient’s appearance, attitude, behavior, mood and affect, speech, thought processes, thought content, perceptions (hallucinations, pseudohallucinations, illusions, etc.)., cognition, insight, judgment, and SI/HI. See an example below. You will modify to include the specifics for your patient on the above elements—DO NOT just copy the example. You may use a preceptor’s way of organizing the information if the MSE is in paragraph form.

He is an 8-year-old African American male who looks his stated age. He is cooperative with examiner. He is neatly groomed and clean, dressed appropriately. There is no evidence of any abnormal motor activity. His speech is clear, coherent, normal in volume and tone. His thought process is goal directed and logical. There is no evidence of looseness of association or flight of ideas. His mood is euthymic, and his affect appropriate to his mood. He was smiling at times in an appropriate manner. He denies any auditory or visual hallucinations. There is no evidence of any delusional thinking.   He denies any current suicidal or homicidal ideation. Cognitively, he is alert and oriented. His recent and remote memory is intact. His concentration is good. His insight is good. 

Differential Diagnoses:
You must have at least three differentials with supporting evidence. Explain what rules each differential in or out and justify your primary diagnostic impression selection. You will use supporting evidence from the literature to support your rationale. Include pertinent positives and pertinent negatives for the specific patient case.

Also included in this section is the reflection. Reflect on this case and discuss whether or not you agree with your preceptor’s assessment and diagnostic impression of the patient and why or why not. What did you learn from this case? What would you do differently?

Also include in your reflection a discussion related to legal/ethical considerations (
demonstrating critical thinking beyond confidentiality and consent for treatment!), social determinates of health, health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

References (move to begin on next page)

You are required to include at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting.

© 2021 Walden University Page 1 of 3

NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Template

Week (enter week #): (Enter assignment title)

Student Name

College of Nursing-PMHNP, Walden University

NRNP 6635: Psychopathology and Diagnostic Reasoning

Faculty Name

Assignment Due Date

Subjective:

CC (chief complaint):

HPI:

Past Psychiatric History:

·
General Statement:

·
Caregivers (if applicable):

·
Hospitalizations:

·
Medication trials:

·
Psychotherapy or
Previous Psychiatric Diagnosis:

Substance Current Use and History:

Family Psychiatric/Substance Use History:

Psychosocial History:

Medical History:

·
Current Medications:

·
Allergies:

·
Reproductive Hx:

ROS:

· GENERAL:

· HEENT:

· SKIN:

· CARDIOVASCULAR:

· RESPIRATORY:

· GASTROINTESTINAL:

· GENITOURINARY:

· NEUROLOGICAL:

· MUSCULOSKELETAL:

· HEMATOLOGIC:

· LYMPHATICS:

· ENDOCRINOLOGIC:

Objective:

Physical exam: if applicable

Diagnostic results:

Assessment:

Mental Status Examination:

Differential Diagnoses:

Reflections:

References

© 2021 Walden University Page 1 of 3

Assignment week7 Schizophrenia and Other Psychotic Disorders; Medication-Induced Movement Disorders

At age 18, Rose rented her first apartment in the city. Although she had a short commute to work, Rose did not enjoy the chaos and noise of the city. Within months, Rose left her apartment in the city for a small, rural cabin in the country. It was then that Rose began to withdraw from family and friends. Generally, she avoided contact with others. Her co-workers noticed random, obscure drawings on scrap paper at her desk. Additionally, her co-workers noticed other strange behaviors. Frequently, Rose would whisper to herself, appear startled when people approached her desk, and stare at the ceiling at various times throughout the day.  

For individuals with disorders such as schizophrenia and other psychotic disorders, the development of mental disorder seldom occurs with a singular, defining symptom. Rather, many who experience such disorders show a range of unique symptoms. This range of symptoms may impede an individual’s ability to function in daily life. As a result, clinicians address a patient’s ability or inability to function in life.

This week, you explore psychotic disorders, including schizophrenia. You also explore medication-induced movement disorders and formulate a diagnosis for a patient in a case study.

Learning Objectives

Students will:

· Apply concepts, theories, and principles related to patient interviewing, diagnostic reasoning, and recording patient information

· Formulate differential diagnoses using 
DSM-5-TR criteria for patients with schizophrenia, other psychotic disorders, and medication-induced movement disorders across the life span

Assignment: Assessing and Diagnosing Patients With Schizophrenia, Other Psychotic Disorders, and Medication-Induced Movement Disorders

Psychotic disorders and schizophrenia are some of the most complicated and challenging diagnoses in the 
DSM. The symptoms of psychotic disorders may appear quite vivid in some patients; with others, symptoms may be barely observable. Additionally, symptoms may overlap among disorders. For example, specific symptoms, such as neurocognitive impairments, social problems, and illusions may exist in patients with schizophrenia but are also contributing symptoms for other psychotic disorders.

For this Assignment, you will analyze a case study related to schizophrenia, another psychotic disorder, or a medication-induced movement disorder.

· Review this week’s Learning Resources and consider the insights they provide about assessing and diagnosing psychotic disorders. Consider whether experiences of psychosis-related symptoms are always indicative of a diagnosis of schizophrenia. Think about alternative diagnoses for psychosis-related symptoms.

· Download the Comprehensive Psychiatric Evaluation Template, which you will use to complete this Assignment. Also review the Comprehensive Psychiatric Evaluation Exemplar to see an example of a completed evaluation document. 

· By Day 1 of this week, select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.

· Consider what history would be necessary to collect from this patient.

· Consider what interview questions you would need to ask this patient.

· Identify at least three possible differential diagnoses for the patient. 

Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis.

Incorporate the following into your responses in the template:

·
Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life? 

·
Objective: What observations did you make during the psychiatric assessment?  

·
Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.

·
Reflection notes: What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

References

https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.Medication_Induced_Movement_Disorders

https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x02_Schizophrenia_Spectrum

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015).
Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

· Chapter 7, Schizophrenia Spectrum and Other Psychotic Disorders

· Chapter 29.2, Medication Induced-Movement Disorders

· Chapter 31.15, Early-Onset Schizophrenia

https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/schizophrenia-and-other-psychotic-disorders

https://www.youtube.com/watch?v=BdB6MgWAP1k

VIDEO 24 TRANSCRIPT

Video: Training Title 24, In Test Section Index, Episode 24 (Santa Monica, CA: Symptom Media, 2016)

Training Title 24

Top of Form

00:00:00BEGIN TRANSCRIPT: 

00:00:00[sil.] 

00:00:15OFF CAMERA Your roommates, Rachel and Liz, shared some information with me. They said that you were fine, and that shortly after your aunt died, that you started acting in a different sort of strange way. Started having thoughts and hearing things that others couldn’t hear. 

00:00:35JESS They think I’m living in a movie. Rachel and Liz. That’s who they think I am. I see a lot of movies. So maybe they’re right. Maybe I am a movie 

00:00:45OFF CAMERA I’m not sure I understand how you can be a movie. 

00:00:45JESS Because they listen to our apartment. 

00:00:50[Whispers] 

00:00:50JESS They listen from next door. 

00:00:50OFF CAMERA Who listens? 

00:00:55JESS Russian men and whores. They drill all night long. That’s how they send their information back. Drilling. 

00:01:05OFF CAMERA Drilling. They send messages by drilling? 

00:01:10JESS Doesn’t surprise me. Most people don’t understand. 

00:01:15OFF CAMERA Your roommates said that your favorite aunt that died, she’s the one who raised you. 

00:01:20JESS Maybe she did. Maybe she didn’t. Who told you? Can you prove it? I can’t. 

00:01:30OFF CAMERA Liz and Rachel told me. 

00:01:30JESS Good for them. 

00:01:35OFF CAMERA And your roommates said you had some new neighbors that moved in. Are these the neighbors you’re talking about? 

00:01:45JESS They’re not neighbors. They’re Russians. They don’t answer their door. I tried to banging on their door and they didn’t answer. Figures. I mean they only speak English. They don’t speak English, they speak Russian in code. 

00:02:00OFF CAMERA You know, your roommate, Rachel, told me your new neighbors speak Spanish. They speak Spanish. 

00:02:10JESS They lie. But what do you expect? 

00:02:15OFF CAMERA What do they do? Your neighbors? 

00:02:20JESS I don’t want to talk about this any more. 

00:02:25OFF CAMERA You know, Jess, I imagine what you are experiencing right now feels very frightening. I hear from a lot of the people who, hear voices that maybe aren’t there, that it’s very frightening. And it’s upsetting. Are you experiencing anything like that? 

00:02:40JESS Yes. I hear them talking when no one else can. I mean not Rachel, not Liz. That’s why I went down to my car yesterday. Because if I’m very, very still, the Russians can’t code me. 

00:02:55OFF CAMERA What do you mean code you? 

00:03:00JESS You know. You act like you don’t know, but you know. 

00:03:05OFF CAMERA How long did you stay in your car? 

00:03:10JESS Six hours. I watched them move in and out. 

00:03:15OFF CAMERA So do you sometimes see things that your roommates don’t see? 

00:03:20JESS No. But I know things that they don’t know. 

00:03:30OFF CAMERA Jess, I realize it is difficult sometimes for people to tell me things but it really helps me with their background. Has anything happened recently? Anything traumatic? 

00:03:40JESS I think that secret government papers are traumatic. Like blueprints. I mean, they have blueprints of buildings. My apartment is a building. 

00:03:55OFF CAMERA What are the blueprints? 

00:03:55JESS They’re all over the walls. That’s what they want. 

00:04:00OFF CAMERA The neighbors? 

00:04:00JESS The Russians. They’re terrorists. You’ll find out too late. 

00:04:10OFF CAMERA Has anyone else seen these blueprints Jess? 

00:04:10JESS I can stop them from seeing them. I covered the walls, I marked up the walls. I just need more markers. 

00:04:20OFF CAMERA Jess, do you drink alcohol or take drugs? 

00:04:25JESS My body is my temple. No. 

00:04:30OFF CAMERA Have you been taking any prescription medications? 

00:04:35JESS Yes I did. I was. 

00:04:40OFF CAMERA So you stopped taking your medications? 

00:04:45JESS Yes I stopped taking my medications. The medications were part of the problem. But you know all about that, don’t you? 

00:04:55OFF CAMERA Jess, do you have any thoughts of hurting yourself, or hurting any other people? 

00:05:00JESS Rachel and Lizzy? I don’t think they’re in on it. Time will tell. 

00:05:10[sil.] 

00:05:10END TRANSCRIPT 

VIDEO 29 TRANSCRIPT

00:00:00BEGIN TRANSCRIPT: 

00:00:00[sil.] 

00:00:15OFF CAMERA Mr. Feldman? I understand you called us last week for an appointment. 

00:00:20MR. FELDMAN My parents. 

00:00:25OFF CAMERA Excuse me? 

00:00:25MR. FELDMAN My parents called for the appointment. 

00:00:25OFF CAMERA Oh. Do you know why your parents called for an appointment? 

00:00:30MR. FELDMAN No. 

00:00:35OFF CAMERA When your parents called me they said you were having some difficulty in school. Where are you in school? 

00:00:50MR. FELDMAN State College. 

00:00:50OFF CAMERA How long have you been at State College? 

00:00:55MR. FELDMAN My freshman year. 

00:01:00OFF CAMERA And how is it going? 

00:01:05MR. FELDMAN Fine. 

00:01:10OFF CAMERA What courses are you taking at State? 

00:01:15MR. FELDMAN In high school I took advanced placement courses. Theoretical physics, advanced calculus is what I’m taking now. Although I’m thinking about double majoring in philosophy and physics. 

00:01:35OFF CAMERA That’s an interesting combination. 

00:01:35MR. FELDMAN Yes, the mysteries of life. The courses are mysteries, and just when you think you’ve understood it, it’s gone. 

00:01:45OFF CAMERA Gone? 

00:01:50MR. FELDMAN The totality of life precludes us from repeating it. I mean what’s the point? 

00:02:00OFF CAMERA Do you have a roommate at state? 

00:02:05MR. FELDMAN You could call him that. 

00:02:10OFF CAMERA Can you tell me about him? 

00:02:15MR. FELDMAN Oh no. 

00:02:15OFF CAMERA Why not? 

00:02:20[sil.] 

00:02:25MR. FELDMAN He put a microwave in there, but I know what that means. But I won’t tell. Not a word.. 

00:02:35OFF CAMERA A microwave oven? 

00:02:40MR. FELDMAN They had them in here too, in this building. But they’ll spare me, and they’ll spare you too, because you are with me, and what that’s about a bleeding degeneration of blood cells, bleeding the humanity from our rightful destiny… but this room spies on us. 

00:03:05OFF CAMERA I don’t understand what you mean. 

00:03:10MR. FELDMAN It’s in the eyes. You can hold of forever if you know how. 

00:03:20OFF CAMERA Mr. Feldman, did you come here with anyone else today? 

00:03:25[sil.] 

00:03:30MR. FELDMAN Sssshhhh. 

00:03:35OFF CAMERA Mr. Feldman, I think I may need to contact your parents. 

00:03:45SymptomMedia Visual Learning for Behavioral Health www.symptommedia.com 

00:03:45END TRANSCRIPT 

VIDEO 151 TRANSCRIPT

Search transcript

00:00:15>> I see in your chart that you asked 

00:00:15your family physician to 

00:00:20prescribe oxycodone for your elbow pain, 

00:00:20and that your family physician 

00:00:25is worried that some of other medications, 

00:00:30drugs you may use may interact with the oxycodone? 

00:00:35>> Oxycodone is that’s the same as OxyContin? 

00:00:35>> Yeah. Oxycodone is the generic name. 

00:00:40>> Yeah, I did ask for OxyContin, 

00:00:45but I don’t take any other medications or drugs. 

00:00:50I’m opposed to putting anything unhealthy in my body. 

00:00:55>> Okay. What else have you tried? 

00:01:00>> Nothing else works. 

00:01:00>> Ibuprofen, acetaminophen? 

00:01:00>> Not even close. 

00:01:05>> No? 

00:01:05>> Yeah. I mean, 

00:01:05I’m allergic to codeine. 

00:01:05>> Allergic? 

00:01:05>> Yeah, like in Tylenol three. 

00:01:10A little while back, my friend 

00:01:10was in a motorcycle accident and had some leftover, 

00:01:15and I tried one of those, 

00:01:15and I was way allergic. 

00:01:20>> What was the allergic response you had? 

00:01:25>> My face flushed like real bad, 

00:01:25besides it didn’t work. 

00:01:30>> Have you tried morphine? 

00:01:30>> Well, that’s addictive, isn’t it? 

00:01:35>> Yeah, well all the pain medications 

00:01:35or most of them are addictive. 

00:01:35Anti-inflammatory medications are not usually addictive. 

00:01:45>> Yeah, I tried morphine and the codeine, didn’t work. 

00:01:50>> Okay. 

00:01:50>> Yeah, I get headaches too, 

00:01:55so ideally I need something that works for both. 

00:02:00I’d rather not take two medications if I don’t have to. 

00:02:05Less medications the better, 

00:02:05that’s what grandma always said. 

00:02:05>> Grandma? Okay. 

00:02:05>> Yeah. 

00:02:10>> Have you ever tried Dilaudid? 

00:02:10>> Yeah. They gave that to me in the ER once, 

00:02:15but just made me dizzy and constipated. 

00:02:20Constipated for like a month. 

00:02:25>> Oh, wow. 

00:02:25>> I almost had to go back to 

00:02:25the hospital for constipation. 

00:02:25Can you imagine having to go to 

00:02:25the hospital for constipation? 

00:02:30>> Oh my goodness. 

00:02:30>> Yeah, that’s how bad it was. 

00:02:30>> Have you tried Demerol? 

00:02:35>> Yeah, it kind of worked for my headache. 

00:02:40It comes in a shot, right? 

00:02:40>> Yeah. An injection. 

00:02:45>> Yeah, they gave that to me at the hospital. 

00:02:45But that’s the thing, you 

00:02:50can only get it at the hospital, 

00:02:50so it’s not like it’s going to work for me everyday. 

00:02:55It didn’t do anything for my elbow. 

00:02:55OxyContin it’s the only thing that works for both. 

00:03:00The only thing that works for both. 

00:03:00>> You do seem set on the oxycodone? 

00:03:00>> Because it works. 

00:03:05>> What else have you tried other than medications? 

00:03:10>> Other than medications? 

00:03:10>> Yeah. 

00:03:10>> Yoga. 

00:03:10>> Okay. 

00:03:10>> Yeah. Tried that. Other kinds of meditation. 

00:03:20I mean, that’s the thing with meditation is, 

00:03:20it works while you’re doing it, 

00:03:25but then as soon as you stop, zilch. Biofeedback. 

00:03:30>> Good. 

00:03:30>> One doc tried that, same thing. 

00:03:30Works while you’re doing it, 

00:03:35but then when you stop doesn’t help at all. What else? 

00:03:40Like warm, hot compresses, 

00:03:45candles, long walks on the beach, massages. 

00:03:50>> Wow. 

00:03:50>> My boyfriend is really good at massages actually. 

00:03:55He’s studied with this guru in India. 

00:03:55>> Oh, wow. 

00:03:55>> Yeah, swear to God 

00:04:00>> You have tried a lot of solutions. 

00:04:00Let me ask you more about your medication history. 

00:04:05>> I only take stuff for my headache and my elbow. 

00:04:10>> Okay. 

00:04:15>> Like I said, I don’t like 

00:04:15putting unhealthy things in my body. 

00:04:15Vitamins, I take vitamins. 

00:04:20>> Yeah? Okay. 

00:04:20>> Like fish oils, some supplements, 

00:04:20but nothing corporate, nothing pharmaceutical. 

00:04:25I don’t want to put that in me. 

00:04:30Even coming here today, 

00:04:35asking for this, it goes against my values. 

00:04:35>> I see. Okay. 

00:04:35>> But I got to function. 

00:04:40>> Do you drink alcohol? 

00:04:40>> On special occasions 

00:04:45like weddings, funerals, birthdays. 

00:04:50I got a ton of friends, so 

00:04:50whenever we have a birthday we’re going to drink. 

00:04:55Let me think, like holidays, 

00:04:55New Years, and Christmases. 

00:05:00There’s Christmas and then we also celebrate 

00:05:05Russian Orthodox Christmas on January 7th. 

00:05:10>> How often on the average? 

00:05:15>> When you add it all up, 

00:05:15once, maybe twice a week, I guess. 

00:05:20>> Will you drink enough to get intoxicated? 

00:05:20>> Depends on who I’m drinking with. 

00:05:25As Zane, that’s my boyfriend, 

00:05:30he drinks a lot, so 

00:05:30I drink a little more when I’m with him. 

00:05:30>> Any legal problems from the drinking? 

00:05:35>> Once. So dumb. 

00:05:40Yeah, just one little charge for drinking. 

00:05:45I was the tiniest little bit over the limit. 

00:05:45So yeah, I got that and I had to take that course, 

00:05:50that stupid, boring course. 

00:05:50But I learned my lesson. If you’re 

00:05:55a little bit over the limit, 

00:05:55stick to the back roads. 

00:05:55>> So you will still drive? 

00:06:00>> Well, yeah, but I’m super careful. 

00:06:00>> You think after you’ve been drinking, 

00:06:05that’s an okay idea to drive? 

00:06:05>> It’s better than letting Zano drive. 

00:06:10>> Zano? 

00:06:10>> Zane, Zano, same person. 

00:06:15Yeah. He doesn’t even have his license anymore. 

00:06:15Not that it stops him. 

00:06:20>> What about marijuana? 

00:06:20>> Do I use it? 

00:06:25>> Yeah. 

00:06:25>> Marijuana medically helps with my headaches, 

00:06:30so yeah, I use it. 

00:06:35It’s my right. Yeah, it’s 

00:06:35your right. It’s everybody’s right. 

00:06:40>> How often? 

00:06:40>> Not often. 

00:06:45Two, four times a week, sometimes none. 

00:06:50It’s expensive. Then when you do get some, 

00:06:55suddenly everybody is your best friend and you 

00:06:55got to share, you know how it is. 

00:06:55>> Do you ever grow marijuana? 

00:07:00>> I used to. But then we 

00:07:05moved and it’s not legal in this backward state. 

00:07:05Where we live it’s pretty public, 

00:07:10its not really private. 

00:07:10>> Do you ever have any side effects 

00:07:15from using marijuana like memory problems? 

00:07:15>> I was born with memory problems, 

00:07:20Doc, I don’t think it’s from the marijuana. 

00:07:20>> Any legal trouble with the marijuana? 

00:07:25>> Once. I mean, I’m super careful. 

00:07:30But Zano, he went away for 

00:07:30a year for selling 

00:07:35the tiniest little bit to an undercover cop, 

00:07:35which is total entrapment, 

00:07:40which is how I lost custody of Camper. 

00:07:40>> Camper? 

00:07:45>> My son. 

00:07:45>> Oh. 

00:07:45>> Yeah. He’s staying with 

00:07:45my ex husband’s parents right now. 

00:07:50They take good care of him. 

00:07:50>> How long have you been divorced? 

00:07:55>> Oh no, I never married that guy. 

00:07:55>> Oh. 

00:07:55>> No way I would marry that jerk. 

00:08:00No, I don’t know. 

00:08:00It’s been like four years since I’ve even seen him. 

00:08:05Something like that, four years. 

00:08:05>> What happened? 

00:08:10>> Lucas, my ex, 

00:08:10he freaked out because he caught 

00:08:15me doing just a few lines of coke, 

00:08:15but everybody was doing it back then. 

00:08:20Anyway, his mom found the mirror, 

00:08:25and the razors, and Lucas said I had to quit. 

00:08:30For whatever I lied, 

00:08:35and when he caught me, 

00:08:35I know it was bad to lie about that, 

00:08:40but I don’t know it’s in the past. 

00:08:45Water under the bridge. You live, you learn, you move on. 

00:08:45>> Right. Do you use cocaine now? 

00:08:50>> No, hardly ever. 

00:08:55I don’t know, it’s been like a month maybe, 

00:08:55or two months or something since I have. 

00:08:55>> Any legal problems from using cocaine? 

00:09:05>> No, we hardly ever do it. 

00:09:10>> Have you thought about stopping altogether? 

00:09:15>> I hardly ever do it. 

00:09:15Hardly even counts. 

00:09:20I don’t know, when I do it, 

00:09:20it’s just to relieve tension 

00:09:20or it’s this thing Zano 

00:09:25and I do to bring each other closer together, 

00:09:30but I could quit anytime I wanted, easy. 

00:09:35>> Does your boyfriend have children? 

00:09:35>> Yeah, he’s got two kids. 

00:09:40Yeah, but we don’t see them much. 

00:09:45His other with his ex. 

00:09:45>> Oh? 

00:09:50>> She’s a real snobby type. You know the type? 

00:09:50It is a freaking tragedy 

00:09:55because I see his two kids 

00:09:55just going down that same path. 

00:10:00They’re just two little snobs. 

00:10:00It’s a real shame. 

00:10:05We’re not allowed to see them anymore though, 

00:10:10so I guess like what’s the difference? 

00:10:10She went to court and said we were unsuitable. 

00:10:15Not suitable. 

00:10:20Says it all real nice in court, 

00:10:20and then not so nice over the phone, 

00:10:20if you know what I mean? 

00:10:25She’s a real bitch. 

00:10:25>> Any other drugs? 

00:10:25Ecstasy? LSD? 

00:10:35>> This is going to make me sound like I’m 

00:10:35some 1970s hippy, druggo person. 

00:10:40I’ve tried ecstasy twice, 

00:10:45just twice, and LSD once, last year. 

00:10:50That was a bad trip. I am not doing that again. 

00:10:55>> Anything else? 

00:10:55>> Like what? 

00:11:00>> Stimulants? 

00:11:00>> Like power drinks if I need to stay up? 

00:11:05>> Sure 

00:11:05>> Caffeine, I drink a lot of coffee. 

00:11:10I don’t know if cigarettes, 

00:11:10do they count as stimulants? 

00:11:10>> Yeah. 

00:11:10>> Yeah, I’m trying to cut back. 

00:11:15Two packs a day. 

00:11:15>> Ritalin, Dexedrine? 

00:11:20>> Oh, stimulants? 

00:11:20>> Right 

00:11:20>> Oh, yeah. Not a lot. 

00:11:25Like hardly ever. 

00:11:25I mean, if Zano and I are down for whatever reason, 

00:11:30or sluggish from smoking pot, 

00:11:35or just like if I need to get back up again. 

00:11:35Yeah, Adderall, just 20 helps. 

00:11:40>> Do you ever take prescription medications 

00:11:40that are not prescribed for you? 

00:11:45>> Well, are you kidding me? 

00:11:45Why would I do that? 

00:11:50I told you I don’t like medications in the first place. 

00:11:50>> Klonopin, Ativan, Xanax? 

00:11:55>> Those? 

00:11:55>> Yeah. 

00:12:00>> Yeah, if my anxiety is acting up, 

00:12:05if my meditation isn’t working? 

00:12:10Yeah, a couple Xana bars, 

00:12:10but not a lot. 

00:12:10>> How often would you estimate that is? 

00:12:15>> I don’t know. 

00:12:20Two? I don’t know. 

00:12:20I need like a freaking calendar to keep up with 

00:12:25all your questions, Doc, God. 

00:12:25>> So in the past, 

00:12:30who prescribed the oxycodone for you? 

00:12:30>> No one yet. Zano he 

00:12:35takes them because he’s got shoulder and back problems, 

00:12:40and I tried one and it really works. 

00:12:45To be honest it works fantastic. 

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