NRNP/PRAC 6645 Comprehensive Psychiatric Evaluation

Comprehensive Psychiatric Evaluation
Subjective:

CC (chief complaint): Feelings of pain due to her surgery and loneliness due to the fact
her daughters are tired of her presence around their lives.

HPI:

Madam P is an Iranian-born American citizen, approximately 40 years of age. She is the
mother of five children that is three girls and two boys. She immigrated from Iran 12 years ago
to America trying to bring one of her girls to get proper medical attention which she could not in
Iran. She has since been separated from her husband for the same number of years and has
refused to return to Iran despite her husband’s several letters and please, which she admitted to
never having read any.

Her pains are related to the fact that she has previously been operated on, on her feet now
at least two times. She cannot walk or run and mostly stays on her bed or chair and uses a
wheelchair for movement, which she doesn’t like. She also complains of feeling useless and
lonely, which she claims is due to the fact her children don’t need and/or value her no more. Her
daughter, who is here with her today, is representing the other four siblings in trying to justify
that they have not abandoned their mother but rather their mother is clingy and desperate for
attention by force.

Based on her current state of mind, she seems fine, with no obvious psychiatric issues.

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Past Psychiatric History:

 General Statement: the patient has been treated several times before today by various
psychiatrists for the same complaints of feeling useless and lonely.
 Caregivers (if applicable): she has five caregivers, her children who keep checking up on
her with two, the young boys, currently staying with her, same house. She also has two
dogs at the house, support dogs; this can be assumed.
 Hospitalizations: she has been hospitalized on two separate occasions, with both of them
involving surgical interventions on her feet.
 Medication trials: there have been no medication trials that have been mentioned being
done on her. It is assumed she is taking medications for her pain after the surgery, but this
was not mentioned. She, however, is currently engaging in family counseling to help
determine why there is so much chaos, as she described it, in her home involving her and
her children
 Psychotherapy or Previous Psychiatric Diagnosis: her current therapist has described her
as having issues with adjustment to her new state, after the surgeries and her children
leaving, and wanting more independence

Substance Current Use and History: Madam P has no recorded history of engaging in
substance use previously or at the moment.

Family Psychiatric/Substance Use History: she did not suggest any known family history of
psychiatric disturbances in the larger family. What could be determined is a history of sexual and
physical abuse from her husband towards her and some of her children

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My genogram is attached .

Psychosocial History:

Madam P was born and raised in Iran by her father and assumed mother even though this
was never mentioned. She has no know siblings based on the interview. She was then married off
to her husband at the tender age of 14 years by her parents. She did not choose her husband as is
their custom.

She was in the United States previously, and her first two children are American citizens.
Her other three were born in Iran. At some point, around 12 years before this day, one of her
older children has a medical condition, and she sought visas to get the proper medical care in the
USA but unfortunately, one was left behind during the visit. She lived with her four children for
ten years before the one remaining child joined them, and they have been together for the last
two years. She currently stays with her five children in the USA. She is also separated from her
husband even though they have never gone for legal divorce back in Iran, but she has no plans of
going back.

Based on the interview, she seems not to have finished her early education as she was
married off at an early age. Here in the USA, she worked as a caregiver, which is a semiskilled
work and doesn’t need proper tertiary training. She is also an animal person and has several dogs
in the house. Her current occupation is unemployed since she had a traumatic incident and has to
be operated on both of her legs. She is currently disabled, uses a wheelchair for movement. Her

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hobbies include shopping, as she mentioned enjoying doing this, especially with her daughters.
Her former husband was described as abusive both sexually and physically.

Madam P has been through several traumas in her life. She was married off at an early
age and to an abusive husband who used to physically and sexually abuse her now and then. She
left her little girl for over ten years with the same abusive man, and she felt every pain for the
same. Recently, she was operated on her legs on two successive occasions and currently is
disabled and complains of constant pain.
Medical History:

 Current Medications: Madam P is not on any recorded medications but rather using
family counseling to help sort her problems
 Allergies: Madam P has no known food and drug allergies.
 Reproductive Hx: She is 45 years old, still capable of having children but no reports of
having a man or pregnancy since her last husband back in Iran

Objective:

Diagnostic results: She has no recorded laboratory procedures done on her.

Assessment:

Mental Status Examination: Madam P is an Iranian-born American citizen,
approximately 40 years of age. She is the mother of five children that is three girls and two boys.
During the assessment, she looks alert and oriented in time and place. During the interview, it

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was evident that she was clingy and emotional. She was well-groomed and spoke, making
logical sentences. She is a disabled bit with no other noticeable injuries or conditions (Trevino et
al., 2021) .

Differential Diagnoses:

1. Dependent personality disorder
   She feels lonely and useless, but this cannot be her main diagnosis as she can do a lot of
   things but chooses not to and let her children do it for her
2. Specific phobias
   She is afraid of staying alone, but this is not the main diagnosis since she is not
   technically staying alone
3. Rejection sensitive dysphoria
   She seems very emotional and afraid of rejection even though she is not even actually
   rejected
   Post-traumatic stress disorder is my primary diagnosis as it is clear that she is traumatized
   by her past, marrying the wrong husband who made her life a living hell hence why she wants to
   control her children’s lives and decision to ensure they get the best life and partner (Fung & Lo,
   2016) .

Reflections:

Madam P got an appropriate treatment for her condition as with PTSD, there is not much
that can be done other than counseling to help the client adjust to the new surrounding and that
the past is gone and can’t affect the future unless she lets it (Costas-Muñiz et al., 2020) .

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Case Formulation and Treatment Plan:

Madam P needs to continue both family and group therapy to help her understand her daughters
better and her new environment better as she seems traumatized by her past and afraid of it
happening again. She was advised to engage in other activities to keep her busy and she agreed
to this. The session was meant to be a one-time psychiatric evaluation

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References

Costas-Muñiz, R., Torres-Blasco, N., Castro-Figueroa, E. M., González, C. J., Breitbart, W., &
Gany, F. (2020). Meaning-Centered Psychotherapy for Latino Patients with Advanced
Cancer: Cultural Adaptation Process. Https://Home.Liebertpub.Com/Jpm, 23(4), 489–497.
https://doi.org/10.1089/JPM.2019.0423
Fung, K., & Lo, T. (2016). An Integrative Clinical Approach to Cultural Competent
Psychotherapy. Journal of Contemporary Psychotherapy 2016 47:2, 47(2), 65–73.
https://doi.org/10.1007/S10879-016-9341-8
Trevino, A. Y., Tao, K. W., & Van Epps, J. J. (2021). Windows of cultural opportunity: A
thematic analysis of how cultural conversations occur in psychotherapy. Psychotherapy,
58(2), 263–274. https://doi.org/10.1037/PST0000360