Case study Assignment

ATTACHED FILE(S)
Week 3: Mood Disorders
While most people experience thesadness or griefat some point in their lives, it is typically of short duration and may occur in response to some type of loss. Clinically significant depression, on the other hand, is more disruptive and serious. It lasts longer and has more symptoms that interfere with daily functioning.
This week, you will explore the differences among mood disorders such as depressive, bipolar, and related disorders, and you will examine challenges in properly differentiating among them for the purpose of accurately rendering a diagnosis. You also will look at steps that can be taken to increase the likelihood that patients who are diagnosed with these disorders benefit from treatment and refrain from physically harming themselves or others.
Learning Objectives
Students will:
· Apply concepts, theories, and principles related to patient interviewing, diagnostic reasoning, and recording patient information
· Formulate differential diagnoses usingDSM-5-TRcriteria for patients with mood disorders across the lifespan
Assignment: Assessing and Diagnosing Patients With Mood Disorders
Case study video #151Training Title 151. . (2018).[Video/DVD] Symptom Media. Retrieved from https://video.alexanderstreet.com/watch/training-title-151
Accurately diagnosing depressive disorders can be challenging given their periodic and, at times, cyclic nature. Some of these disorders occur in response to stressors and, depending on the cultural history of the client, may affect their decision to seek treatment. Bipolar disorders can also be difficult to properly diagnose. While clients with a bipolar or related disorder will likely have to contend with the disorder indefinitely, many find that the use of medication and evidence-based treatments have favorable outcomes.
To Prepare:
· Review this week’s Learning Resources. Consider the insights they provide about assessing and diagnosing mood disorders.
· Download the Comprehensive Psychiatric Evaluation Template, which you will use to complete this Assignment. Also review the Comprehensive Psychiatric EvaluationExemplar 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.
· Training Title 151. . (2018).[Video/DVD] Symptom Media. Retrieved from https://video.alexanderstreet.com/watch/training-title-151
·
· 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.
· You will need an 7th edition APA Title page and introduction that ends with purpose statement at the beginning of your CPE. Then begin with the template provided in your resources. You will include a conclusion as well.
For the Assignment:
Complete and submit your Comprehensive Psychiatric Evaluation (CPE), including your differential diagnosis and critical-thinking process to formulate a 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 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.).
This is the case study video
Training Title 151. . (2018).[Video/DVD] Symptom Media. Retrieved from https://video.alexanderstreet.com/watch/training-title-151
Learning Resources

Classroom Productions (Producer), & Harrigan, S. (Director). (2015). Bipolar Disorders. [Video/DVD] Microtraining Associates. Retrieved from https://video.alexanderstreet.com/watch/bipolar-disorders
Classroom Productions (Producer), & Harrigan, S. (Director). (2015). Depressive Disorders. [Video/DVD] Microtraining Associates. Retrieved from https://video.alexanderstreet.com/watch/depressive-disorders
Megan Cogswell, Toby Levine Communications, & Alvin H. Perlmutter, I. (Producers), & . (1992). Mood Disorders. [Video/DVD] Annenberg Learner. Retrieved from https://video.alexanderstreet.com/watch/mood-disorders
Bipolar Disorder in Children. . (2005).[Video/DVD] Aquarius Health Care Media. Retrieved from https://video.alexanderstreet.com/watch/bipolar-disorder-in-children

Rubric Detail
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Content

Name:NRNP_6635_Week3_Assignment_Rubric

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List View

Excellent

Good

Fair

Poor

Create documentation in the Comprehensive Psychiatric Evaluation Template about the patient you selected.
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

Points:
Points Range:
18 (18%) – 20 (20%)

The response throughly and accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.
Feedback:

Points:
Points Range:
16 (16%) – 17 (17%)

The response accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.
Feedback:

Points:
Points Range:
14 (14%) – 15 (15%)

The response describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis, but is somewhat vague or contains minor innacuracies.
Feedback:

Points:
Points Range:
0 (0%) – 13 (13%)

The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Or, subjective documentation is missing.
Feedback:

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.

Points:
Points Range:
18 (18%) – 20 (20%)

The response thoroughly and accurately documents the patient’s physical exam forpertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.
Feedback:

Points:
Points Range:
16 (16%) – 17 (17%)

The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented.
Feedback:

Points:
Points Range:
14 (14%) – 15 (15%)

Documentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies.
Feedback:

Points:
Points Range:
0 (0%) – 13 (13%)

The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing.
Feedback:

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.

Points:
Points Range:
23 (23%) – 25 (25%)

The response thoroughly and accurately documents the results of the mental status exam.
Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected.
Feedback:

Points:
Points Range:
20 (20%) – 22 (22%)

The response accurately documents the results of the mental status exam.
Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides an accurate justification for each of the disorders selected.
Feedback:

Points:
Points Range:
18 (18%) – 19 (19%)

The response documents the results of the mental status exam with some vagueness or inaccuracy.
Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vagueness or inaccuracy.
Feedback:

Points:
Points Range:
0 (0%) – 17 (17%)

The response provides an incomplete or inaccurate description of the results of the mental status exam and explanation of the differential diagnoses. Or, assessment documentation is missing.
Feedback:

Reflect on this case. 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.).

Points:
Points Range:
9 (9%) – 10 (10%)

Reflections are thorough, thoughtful, and demonstrate critical thinking.
Feedback:

Points:
Points Range:
8 (8%) – 8 (8%)

Reflections demonstrate critical thinking.
Feedback:

Points:
Points Range:
7 (7%) – 7 (7%)

Reflections are somewhat general or do not demonstrate critical thinking.
Feedback:

Points:
Points Range:
0 (0%) – 6 (6%)

Reflections are incomplete, inaccurate, or missing.
Feedback:

Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).

Points:
Points Range:
14 (14%) – 15 (15%)

The response provides at least three current, evidence-based resources from the literature to support the assessment and diagnosis of the patient in the assigned case study. The resources reflect the latest clinical guidelines and provide strong justification for decision making.
Feedback:

Points:
Points Range:
12 (12%) – 13 (13%)

The response provides at least three current, evidence-based resources from the literature that appropriately support the assessment and diagnosis of the patient in the assigned case study.
Feedback:

Points:
Points Range:
11 (11%) – 11 (11%)

Three evidence-based resources are provided to support assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification.
Feedback:

Points:
Points Range:
0 (0%) – 10 (10%)

Two or fewer resources are provided to support assessment and diagnosis decisions. The resources may not be current or evidence based.
Feedback:

Written Expression and Formatting—Paragraph development and organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.

Points:
Points Range:
5 (5%) – 5 (5%)

A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
Feedback:

Points:
Points Range:
4 (4%) – 4 (4%)

Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.
Feedback:

Points:
Points Range:
3.5 (3.5%) – 3.5 (3.5%)

Purpose, introduction, and conclusion of the assignment is vague or off topic.
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%-79% of the time.
Feedback:

Points:
Points Range:
0 (0%) – 3 (3%)

No purpose statement, introduction, or conclusion were provided.

Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.
Feedback:

Written Expression and Formatting—English writing standards:
Correct grammar, mechanics, and punctuation

Points:
Points Range:
5 (5%) – 5 (5%)

Uses correct grammar, spelling, and punctuation with no errors
Feedback:

Points:
Points Range:
4 (4%) – 4 (4%)

Contains a few (one or two) grammar, spelling, and punctuation errors
Feedback:

Points:
Points Range:
3 (3%) – 3 (3%)

Contains several (three or four) grammar, spelling, and punctuation errors
Feedback:

Points:
Points Range:
0 (0%) – 2 (2%)

Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
Feedback:

Show Descriptions

Show Feedback

Create documentation in the Comprehensive Psychiatric Evaluation Template about the patient you selected.
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–
Levels of Achievement:
Excellent
18 (18%) – 20 (20%)
The response throughly and accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.
Good
16 (16%) – 17 (17%)
The response accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.
Fair
14 (14%) – 15 (15%)
The response describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis, but is somewhat vague or contains minor innacuracies.
Poor
0 (0%) – 13 (13%)
The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Or, subjective documentation is missing.
Feedback:

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.–
Levels of Achievement:
Excellent
18 (18%) – 20 (20%)
The response thoroughly and accurately documents the patient’s physical exam forpertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.
Good
16 (16%) – 17 (17%)
The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented.
Fair
14 (14%) – 15 (15%)
Documentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies.
Poor
0 (0%) – 13 (13%)
The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing.
Feedback:

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.–
Levels of Achievement:
Excellent
23 (23%) – 25 (25%)
The response thoroughly and accurately documents the results of the mental status exam.
Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected.
Good
20 (20%) – 22 (22%)
The response accurately documents the results of the mental status exam.
Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides an accurate justification for each of the disorders selected.
Fair
18 (18%) – 19 (19%)
The response documents the results of the mental status exam with some vagueness or inaccuracy.
Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vagueness or inaccuracy.
Poor
0 (0%) – 17 (17%)
The response provides an incomplete or inaccurate description of the results of the mental status exam and explanation of the differential diagnoses. Or, assessment documentation is missing.
Feedback:

Reflect on this case. 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.).–
Levels of Achievement:
Excellent
9 (9%) – 10 (10%)
Reflections are thorough, thoughtful, and demonstrate critical thinking.
Good
8 (8%) – 8 (8%)
Reflections demonstrate critical thinking.
Fair
7 (7%) – 7 (7%)
Reflections are somewhat general or do not demonstrate critical thinking.
Poor
0 (0%) – 6 (6%)
Reflections are incomplete, inaccurate, or missing.
Feedback:

Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).–
Levels of Achievement:
Excellent
14 (14%) – 15 (15%)
The response provides at least three current, evidence-based resources from the literature to support the assessment and diagnosis of the patient in the assigned case study. The resources reflect the latest clinical guidelines and provide strong justification for decision making.
Good
12 (12%) – 13 (13%)
The response provides at least three current, evidence-based resources from the literature that appropriately support the assessment and diagnosis of the patient in the assigned case study.
Fair
11 (11%) – 11 (11%)
Three evidence-based resources are provided to support assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification.
Poor
0 (0%) – 10 (10%)
Two or fewer resources are provided to support assessment and diagnosis decisions. The resources may not be current or evidence based.
Feedback:

Written Expression and Formatting—Paragraph development and organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.–
Levels of Achievement:
Excellent
5 (5%) – 5 (5%)
A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
Good
4 (4%) – 4 (4%)
Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.
Fair
3.5 (3.5%) – 3.5 (3.5%)
Purpose, introduction, and conclusion of the assignment is vague or off topic.
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%-79% of the time.
Poor
0 (0%) – 3 (3%)
No purpose statement, introduction, or conclusion were provided.

Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.
Feedback:

Written Expression and Formatting—English writing standards:
Correct grammar, mechanics, and punctuation–
Levels of Achievement:
Excellent
5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors
Good
4 (4%) – 4 (4%)
Contains a few (one or two) grammar, spelling, and punctuation errors
Fair
3 (3%) – 3 (3%)
Contains several (three or four) grammar, spelling, and punctuation errors
Poor
0 (0%) – 2 (2%)
Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
Feedback:

Total Points: 100

Name:NRNP_6635_Week3_Assignment_Rubric

NRNP 6635 Case History Reports
Use these case histories to supplement the information about the patients in the video case
studies.
Table of Contents
Week 3: Mood Disorders………………………………………………………………………………………….. 3
Training Title 2 ……………………………………………………………………………………………………………….3
Training Title 8 ……………………………………………………………………………………………………………….3
Training Title 18 ……………………………………………………………………………………………………………..3
Training Title 28 ……………………………………………………………………………………………………………..4
Training Title 38 ……………………………………………………………………………………………………………..4
Training Title 43 ……………………………………………………………………………………………………………..5
Training Title 150 ……………………………………………………………………………………………………………5
Training Title 118 ……………………………………………………………………………………………………………6
Training Title 144 ……………………………………………………………………………………………………………6
Week 4: Anxiety Disorders, PTSD, and OCD …………………………………………………………………. 7
Training Title 15 ……………………………………………………………………………………………………………..7
Training Title 21 ……………………………………………………………………………………………………………..7
Training Title 37 ……………………………………………………………………………………………………………..8
Training Title 40 ……………………………………………………………………………………………………………..8
Training Title 55 ……………………………………………………………………………………………………………..8
Training Title 85 ……………………………………………………………………………………………………………..9
Training Title 95 ……………………………………………………………………………………………………………..9
Week 7 Schizophrenia and Other Psychotic Disorders; Medication-Induced Movement
Disorders …………………………………………………………………………………………………………….. 10
Training Title 9 …………………………………………………………………………………………………………….. 10
Training Title 24 …………………………………………………………………………………………………………… 10
Training Title 29 …………………………………………………………………………………………………………… 10
Training Title 134 …………………………………………………………………………………………………………. 11
Week 8 Substance-Related and Addictive Disorders ……………………………………………………. 11
Training Title 82 …………………………………………………………………………………………………………… 11
Training Title 114 …………………………………………………………………………………………………………. 12
Training Title 151 …………………………………………………………………………………………………………. 12
Week 10 Neurocognitive and Neurodevelopmental Disorders ………………………………………. 13
Training Title 48 …………………………………………………………………………………………………………… 13
Training Title 50 …………………………………………………………………………………………………………… 13

Week 3: Mood Disorders

Training Title 2
Name: Ms. Natalie Crew
Gender: female
Age:17 years old
T 97.4 P-82 R-1 20 128/84 Ht 5’2” Wt 192lbs
Background: Recently started an accelerated high school business program in Chicago, Illinois
after growing up and living in New Orleans her whole life. Grew up with both parents and four
brothers. Currently lives in on a specialty high school campus dormitory. Currently a full-time
student and works part time in the local coffee shop. Not married, currently single. She has no
previous psychiatric history; takes no medications. There is history of depression, denied
substance use history for her or family. No legal hx NKDA
Symptom Media. (Producer). (2016). Training title 2 [Video]. https://video-alexanderstreet-
com.ezp.waldenulibrary.org/watch/training-title-2
Training Title 8
Name: Mrs. Abrianna Tilman
Gender: female
Age: 27 years old
T- 98.6 P- 88 R 18 154/92 Ht 5’1 Wt 230lbs
Background: Recently had her first child two months ago. Currently married; stay at home
mother after working in community library for 5 years. Grew up with her mother after her
parents divorced when she was 16; has two sisters in Troy, Alabama. Completed education
through bachelor’s level, majoring in English Literature. No previous suicidal gestures. Brother
committed suicide via GSW. She denied drugs/alcohol; brother was addicted to
methamphetamines. Hx of HTN-prescribed Trandate 100mg twice daily, admits to missing doses
due to forgetting. No legal hx. Allergies: PCN

Symptom Media. (Producer). (2016). Training title 8 [Video]. https://video-alexanderstreet-
com.ezp.waldenulibrary.org/watch/training-title-8
Training Title 18
Name: Ms. Rosario Campbell
Gender: female
Age:25 years old
T-97.7 P-70 R-18 118/72 Ht 5’3 Wt 123lbs
Background: Currently living off-base in El Paso, Texas, active duty in the Army, MOS 92M
Mortuary Affairs Specialist. Grew up in McAllen TX with both parents and one brother.
Completed education through high school. Currently partnered. No children. Mother history of
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-2
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-2
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-2
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-8
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-8
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-8
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-18
depression; brother hx of cannabis use. No medical history. No legal hx; allergy: cipro previous
medication trials: sertraline, fluoxetine both with good effects when taking.
Symptom Media. (Producer). (2017). Training title 18 [Video]. https://video-alexanderstreet-
com.ezp.waldenulibrary.org/watch/training-title-18

Training Title 28
Name: Mrs. Ada Carson
Gender: female
Age: 54 years old
T- 97.6 P- 94 R 22 162/84 Ht 5’5 Wt 144lbs
Background: Currently living in Sioux Falls, South Dakota, working full-time as a contract
negotiator in a financial company. Has an MBA. Lives with her husband and two teenage twin
sons. Born and raised in Trenton, NJ, with her father and two brothers, her mother deceased
when she in MVA when she was 12 years old. Brother has depression; mother has history of
being a “functioning alcoholic”. Recently informed by her PCP she has a “fatty liver.” Allergies:
codeine

Symptom Media. (Producer). (2016). Training title 28 [Video]. https://video-alexanderstreet-
com.ezp.waldenulibrary.org/watch/training-title-28
Training Title 38

Name: Mr. Elijah Loman
Gender: male
Age:18 years old
T- 98.3 P- 93 R 22 118/68 Ht 5’7 Wt 149lbs
Background: Currently lives with his sister and two parents in Durham, NC. Not currently
employed. Completed high school, not currently in school. Hx of treatment for mood disorder
began age 15, previous trials of risperidone, quetiapine off and on, side effects of wt. gain. Has
hx of a six-day hospitalization one year ago after found wandering at night in the mall parking
lot without clothes. He refused medication due to previous experiences. Not currently partnered.
He has been sexually inappropriate with comments to female neighbors; pulled his pants down in
the mall. Denies any recent alcohol or substance use. Father has history of bipolar disorder. No
history of self-harm behaviors, no family suicides. Mother reports he has slept 4-5 hours in past
week, up spending money buying and playing new video games and says he is writing a book on
how others can be a video game master. Appetite is decreased. No medical hx; Hx of vandalism
as a juvenile. Has pending court date for indecent exposure. Allergies: latex

Symptom Media. (Producer). (2016). Training title 38 [Video]. https://video-alexanderstreet-
com.ezp.waldenulibrary.org/watch/training-title-38

https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-18
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-18
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-28
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-28
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-28
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-38
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-38
Training Title 43

Name: Mr. Elijah Loman
Gender: male
Age:20 years old
T- 97.2 P- 84 R 18 118/68 Ht 5’7 Wt 156lbs
Background: Currently lives with his sister and her husband who are his legal guardians as
parents deceased when he was 15 and he was deemed to need a fiduciary and guardian by the
court system. Not currently employed. Completed high school, not currently in school. Hx of
treatment for mood disorder began age 15, previous trials of Depakote, Quetiapine off and on,
side effects of akathisia. Has hx of a multiple hospitalization, last was 4 months ago when he
exposed his genitals to girls at the mall. . Not currently partnered. He is currently in hospital
admitted one week ago, was initiated on lithium 300mg po three times daily and risperidone 1mg
at bedtime. Denies any recent alcohol or substance use. Paternal uncle has history of bipolar
disorder. No history of self-harm behaviors, no family suicides. Appetite is decreased. No
medical hx; hospital admission labs within normal ranges, UDS negative; Hx of truancy as a
juvenile. Has pending court date for indecent exposure. Allergies NKDA

Symptom Media. (Producer). (2016). Training title 43 [Video]. https://video-alexanderstreet-
com.ezp.waldenulibrary.org/watch/training-title-43
Training Title 150
Name: Ms. Cheyenne Lisenbe
Gender: female
Age:18 years old
T- 97.4 P- 94 R 22 136/86 Ht 5’2 Wt 121
Background: Currently living with her parents in Locust Grove, Oklahoma along with two
younger sisters and 1 older brother. She is a senior in high school, not currently partnered,
reports she is bisexual, lately hyper-sexual reporting increase of unprotected sex. She has been
stealing money out of her grandmother’s purse to buy clothes, shoes, purses, “and just other
things.She has history of treatment since age 9 for conduct disorder, depression, history of
taking citalopram which worsened her irritability, aggression, impulsivity. She has been in a 90-
day teen residential mental health facility discharged three months ago with lithium 300mg in am
and 600mg at bedtime, aripiprazole 2.5mg in the morning. When discharged, her labs were
within normal ranges and urine toxicology negative. She was positive for cannabis upon
admission. Her parents believe she is hiding her medication as she has made comments “they
slow me down; they make me not think fast” She has hx of domestic violence toward her older
brother with juvenile assault charge. No current legal issues. Her grandmother has hx of bipolar
disorder; her mother and her maternal aunt have anxiety. She is sleeping 2-3hrs/24 hrs. Reports
her appetite “ravishing.” She has no medical issues; has Nexplanon implant; hx of self-harm with
cutting, last engaged in the behavior 6 months ago.

Symptom Media. (Producer). (2018). Training title 150 [Video]. https://video-alexanderstreet-
com.ezp.waldenulibrary.org/watch/training-title-150

https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-43
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-43
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-43
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-150
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-150
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-150
Training Title 118

Name: Mr. Connor Walsh
Gender: male
Age: 57 years old
T- 97.2 P- 94 R 20 156/88 Ht 5’8 Wt 163lbs
Background: Born and raised in Peru Indiana Is staying at a shelter after being homeless in
MacArthur Park for 1 year in Los Angeles. He lost his apartment and his job working part-time
at Home Depot. Enjoys playing music. He has long hx of mental health treatment since age 19.
Previous medication trials include lithium (was effective), Depakote (gastric upset), aripiprazole
(akathisia), risperidone (hyperprolactinemia), haloperidol (dystonia), quetiapine (didn’t give a
fair trial), Poor historian. divorced once, reports being gay, no children; estranged from only
living sister, parents deceased. He is not sure of his family mental health or substance use history
but feels like he is most like his aunt, she has history of mental health treatment “but
I’m not sure for what.” States that he got a master’s degree in music theory at Stanford. Admits
to 3-6 drinks of alcohol when “playing music in the clubs”, denied illicit drugs, has history of
intentional drug overdose at age 22, history of 8 inpatient psychiatric hospitalization, most recent
was 8 months ago. hx of one detox admission 15 years ago Allergies: bee stings

Symptom Media. (Producer). (2018). Training title 118 [Video]. https://video-alexanderstreet-
com.ezp.waldenulibrary.org/watch/training-title-118
Training Title 144

Name: Ms. Amy Hartford
Gender: female
Age: 26 years old
T- 98.2 P- 70 R 18 128/76 Ht 5’0 Wt 152lbs
Background: Currently lives in Scottsdale, AZ, divorced with two children a daughter age 8 and
son age 4. Born and raised in Mesa, AZ with her mother and two sisters Works as paralegal, has
an associate degree; no legal hx; allergic to dicyclomine; history of rosacea

Symptom Media. (Producer). (2018). Training title 144 [Video]. https://video-alexanderstreet-
com.ezp.waldenulibrary.org/watch/training-title-144

https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-118
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-118
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-118
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-144
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-144
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-144
Week 4: Anxiety Disorders, PTSD, and OCD

Training Title 15
Name: Mr. Ralph Newsome
Gender: male
Age:19 years old
T- 97.0 P- 70 R 18 116/68 Ht 5’9 Wt 175lbs
Background: Lives in Columbus, OH with his dog Chance, only child. Parents live locally.
Works part time in Construction. Not currently partnered. No previous psychiatric history.
Symptoms began in the last 2 months when he discovered he is being activated with the Navy
Reserves. His MOS is CM3 Construction Mechanic; no medical illnesses, no legal hx. Allergies:
NKDA; sleeps 8hrs; appetite good

Symptom Media. (Producer). (2017). Training title 15 [Video]. https://video-alexanderstreet-
com.ezp.waldenulibrary.org/watch/training-title-15

Training Title 21

Name: Sergeant Berry Sullivan
Gender: male
Age:27 years old
T- 98.8 P- 86 R 18 B/P 122/7 Ht 5’8 Wt 160lbs
Background: He entered the military just after high school and did three long tours of duty in
warzones. He separated from active duty in the Marines (MOS 0800 Field Artillery) six months
ago after eight years of service. He is engaged to be married in 8 months and is using his GI
Education Bill to attend online college for accounting. He said he grew up poor and would not do
much else if he didn’t go into the military. He denies ever using any drugs and avoids alcohol
because his father was “abusive when he was drunk.” Father is still alive, unwell (DM, cirrhosis,
HTN), still drinking. Paternal grandfather was also a veteran and suffered depression at times
though he never told anyone except the patient because of their combat connection. He has one
younger brother and one older sister. He lives in a different state, approximately five hours from
his parents and siblings. After the military, he and his fiancé moved because she got a much
better opportunity. They want kids someday. Has service-connected asthma, seasonal allergies;
no hx of psychiatric or substance use treatment.

Symptom Media. (Producer). (2016). Training title 21 [Video]. https://video-alexanderstreet-
com.ezp.waldenulibrary.org/watch/training-title-21

https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-15
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-15
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-21
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-21
Training Title 37
Name: Mr. Luca Esposito
Gender: male
Age:21 years old
T- 97.4 P- 112 R 22 122/68 Ht 6’1Wt 198lbs
Background: Lives alone in Orlando, FL raised by parents in Buffalo, NY, only child. He is a
full- time student obtaining a degree for graphic design. works part-time as Uber driver. Has a
girlfriend from high school. No previous psychiatric history. No medical illnesses; no history of
psychiatric treatment; denied drugs or alcohol; Allergies: NKDA; sleeps 6 hrs.; appetite eats 3
meals/day, likes to keep a routine schedule.

Symptom Media. (Producer). (2016). Training title 37 [Video].https://video-alexanderstreet-
com.ezp.waldenulibrary.org/watch/training-title-37

Training Title 40

Name: Ms. Connie Weidre
Gender: female
Age: 53 years old
T- 99.0 P- 102 R 24 156/86 Ht 5’4 Wt 1lbs73
Background: Lives with her husband in Memphis, TN, has one daughter age 25. She has never
worked. Raised by mother, she never knew her father. Mother with hx of generalized anxiety and
was verbally abusive, abused benzodiazepines; no substance hx for patient. No previous
psychiatric treatment. Has one glass red wine with dinner. Sleeps 12-13 hrs.; appetite decreased.
Has overactive bladder, untreated. Allergic to Zofran; complains of headaches, takes prn
Tylenol, has diarrhea 2-3 times weekly, takes OTC Imodium.

Symptom Media. (Producer). (2016). Training title 40 [Video]. https://video-alexanderstreet-
com.ezp.waldenulibrary.org/watch/training-title-40

Training Title 55

Name: Matilda Johnson
Gender: female
Age: 8 years old
T-98.0 P 70 R 24 B/P 110/68
Ht 45 inches Wt 57lbs
Vaccinations are up to date, on target with developmental milestones. Appetite, she is a picky
eater per mom. NKDA

Symptom Media. (Producer). (2017). Training title 55 [Video]. https://video-alexanderstreet-
com.ezp.waldenulibrary.org/watch/training-title-55

https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-37
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-37
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-40
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-40
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-55
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-55

Training Title 85
Name: Mrs. Isla Flanagan
Gender: female
Age: 47 years old
T- 98.0 P- 82 R 18 136/62 Ht 5’0 Wt 123lbs
Background: Born and raised in Northern Ireland, parents brought her and her one sister to U.S.
when she was 15 to go to U.S. university where she met her husband. They live in Charleston,
SC. She obtained her master’s degree in education; no history of mental health or substance use
treatment, no family history. Her husband reported a recent school shooting nearby 3 weeks ago
“flipped a switch” in her. She is watching the news 24/7, barely sleeping, and even when she
does, it is only a few hours, Appetite is decreased. Hx of hysterectomy, NKDA, no legal hx.

Symptom Media. (Producer). (2017). Training title 85 [Video]. https://video-alexanderstreet-
com.ezp.waldenulibrary.org/watch/training-title-85

Training Title 95
Name: Ms. Serenity Jackson
Gender: female
Age: 24years old
T- 97.5 P- 80 R 18 118/74 Ht 5’2 Wt 136lbs
Background: Born and raised in Gainesville, FL with her mother and 4 older brothers; her
mother has hx of panic disorder, 2 brothers hx of cannabis; father abandoned the family when
she was 3 years old. One brother is in prison for burglary. no previous mental health treatment,
no medications; NKDA; no legal hx; sleeping 9 hrs.; Appetite is good.She has an associate of
arts degree and works for Leaders furniture warehouse. She has DX of diabetes since age 8. She
recalls having great difficulty with her medical condition (uncontrolled blood sugar, fighting
with mother over needle sticks, “kids want candy, and I was so different because of my diet”).
She recalls having a difficult relationship with her mother who was a nurse and really worked
hard to control her daughter’s diabetes. She is not in a relationship, identifies as lesbian but has
not come out to the family. Only her closest co-workers know She stated, “I don’t see why I
would, they wouldn’t understand, and this is not important right now.”

Symptom Media. (Producer). (2018). Training title 95 [Video]. https://video-alexanderstreet-
com.ezp.waldenulibrary.org/watch/training-title-95
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-85
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-85
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-95
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-95

Week 7 Schizophrenia and Other Psychotic Disorders; Medication-
Induced Movement Disorders

Training Title 9

Name: Ms. Fatima Branning
Gender: female
Age: 28 years old
T- 98.4 P- 82 R 18 124/74 Ht 5’0 Wt 118lbs
Background: Raised by parents, lives alone in Coronado, CA. Only child. Works as an
administrative assistance in car sales, has a bachelor’s in hospitality. Has medical history of
scoliosis, currently treated with chiropractic care. Guarded and declined to discuss past
psychiatric history. Denied family mental health issues, declined to allow you to speak to parents
for collaborative information. Allergies: latex; menses regular, no birth control

Symptom Media. (Producer). (2016). Training title 9 [Video]. https://video-alexanderstreet-
com.ezp.waldenulibrary.org/watch/training-title-9

Training Title 24

Name: Ms. Jess Davies
Gender: female
Age: 30 years old
T- 98.6 P- 86 R 20 120/70 Ht 5’2 Wt 126lbs
Background: Jess is brought for evaluation by her 2 roommates who are concerned with
behaviors. She had some issues with depression after aunt died but worsened in the 12 days after
she witnessed her brother killed via GSW in a gas station burglary. She is estranged from her
parents and her brother was her only sibling. She is only sleeping 2 hours/24hrs; she will only eat
canned foods. She smokes cannabis daily since she was 17 and goes out on weekdays couple
times with her roommates and has couple drinks of beer. She was prescribed alprazolam 1mg
twice daily as needed by her PCP for 15 days. She works in a bakery. Allergies: medical tape

Symptom Media. (Producer). (2016). Training title 24 [Video]. https://video-alexanderstreet-
com.ezp.waldenulibrary.org/watch/training-title-24
Training Title 29
Name: Mr. Harold Feldman
Gender: male
Age:20 years old
T- 98.4 P- 76 R 18 116/74 Ht 5’6 Wt 120lbs
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-9
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-9
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-24
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-24
Background: European-American male. He has two younger sisters, one with history of ADHD,
the other with history of separation anxiety. His mother has depression; his father has paranoia
schizophrenia. He is home for spring break. He has no previous medical problems.
Developmental milestones met as child. Appetite is inconsistent and it seems he has lost 18lbs
since first going back to school in the fall. He had a short trial of risperidone in the last six
months of high school for mild paranoia. He stopped the medication after graduation as he could
not tolerate due to side effects of over-sedation. Harold has HS several friends but has not kept in
touch with them since being back home. He has not been showering. Sleeping 14 hrs./ he admits
to episodic cannabis use weekly. Allergies shellfish

Symptom Media. (Producer). (2016). Training title 29 [Video]. https://video-alexanderstreet-
com.ezp.waldenulibrary.org/watch/training-title-29

Training Title 134
Name: Mrs. Patricia Warren
Gender: female
Age: 42 years old
Background: Patricia was brought in under a emergency evaluation order after her best friend,
Felicia, after the police for Patricia locking herself in a closet and screaming loudly for over an
hour. EMS was able to calm her with a small dose of Ativan enroute to the emergency
department. This is Patricia’s third presentation to the emergency room in 2 weeks. She had one
psychiatric hospitalization around this same last year. No self-harm behaviors but has assaulted
other in the past. No hx of TBI. Sleeps 1–2-hour increments for total of 6 hrs. daily, refuses to
sleep at night. Refused vitals, wt., refuses labs, not cooperative. She obtains SSDI. She lives in
Cameron, Montana. She denies ever using any drugs and drinks one glass wine weekly. She has
a sister who is five years older, both parents deceased in the last three years. She has no children,
her husband is out of town, truck driver. Family history includes that her father had two previous
inpatient psychiatric hospitalizations for paranoia Mother had history of bipolar depression.
Paternal grandmother had “shock therapy”. Denies history of trauma experience, but her friend
reports parents death was extremely difficulty for Patricia. no current legal charges. dropped out
of high school in 11th grade, was pregnant and had abortion. allergies: Clozaril
Symptom Media. (Producer). (2018). Training title 134 [Video]. https://video-alexanderstreet-
com.ezp.waldenulibrary.org/watch/training-title-134
Week 8 Substance-Related and Addictive Disorders

Training Title 82

Name: Lisa Tremblay
Gender: female
Age: 33 years old
T- 100.0 P- 108 R 20 180/110 Ht 5’6 Wt 146lbs
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-29
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-29
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-134
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-134
Background: Lisa is in a Naples, FL detox facility thinking about long term rehab. She is
considering treatment for her Hep C+ but needs to get clean first. She has been abusing opiates,
approximately $100 daily. She admits to cannabis 1–2 times weekly (“I have a medical card”),
and 1/2 gallon of vodka daily. She has past drug paraphernalia possession arrest.Her admission
labs. abnormal for ALT 168 AST 200 ALK 250; bilirubin 2.5, albumin 3.0; her GGT is 59; UDS
positive for opiates, THC. Positive for alcohol or other drugs. BAL .308; other labs within
normal ranges. She reports sexual abuse as child ages 6-9 perpetrator being her father who went
to prison for the abuse and drug charges. She is estranged from him. Mother lives in Maine, hx
of agoraphobia and benzodiazepine abuse. Older brother has not contact with family in last 10
years, hx of opioid use. Sleeps 5-6 hrs., appetite decreased, prefers to get high instead of eating.
Allergies: azithromycin

Symptom Media. (Producer). (2017). Training title 82 [Video]. https://video-alexanderstreet-
com.ezp.waldenulibrary.org/watch/training-title-82
Training Title 114
Name: Ally Chen
Gender: female
Age: 44 years old
Background: Only child, raised by parents in Philadelphia, PA. Has PhD in biology and master’s
degree in high school education (8–12). Her supervisor has asked the school EAP counselor to
intervene with concerns regarding potential substance use in effort to facilitate getting her help
and be able to retain her. She is divorced, has a 4-year-old son who lives with his father. Appetite
healthy, sleeping 9 hours/24 hrs., wakes 2-3 times during the night. Denied drug use. had DUI
when she was age 21.

Symptom Media. (Producer). (2018). Training title 114-2 [Video]. https://video-alexanderstreet-
com.ezp.waldenulibrary.org/watch/training-title-114-2

Training Title 151
Name: Daniela Petrov
Gender: female
Age:47 years old
T- 98.8 P- 84 R 20 B/P 132/90 Ht 5’8 Wt 128lbs
Background: Moved to Everett, Washington from Russia with her parents when she was 16 years
old. Currently lives in Boise, Idaho. She has younger 1 brother, 3 older sisters. Denied family
mental health or substance use issues. No history of inpatient detox or rehab denied self-harm hx;
Menses regular. uses condoms for birth control Has fibromyalgia. She works part time cashier at
Save A Lot Grocery Store. Dropped out of high school in 10th grade. Sleeps 5-6 hours on
average, appetite good.

Symptom Media. (Producer). (2018). Training title 151 [Video]. https://video-alexanderstreet-
com.ezp.waldenulibrary.org/watch/training-title-151
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-82
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-82
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-114-2
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-114-2
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-151
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-151
Week 10 Neurocognitive and Neurodevelopmental Disorders

Training Title 48

Name: Sarah Higgins
Gender: female
Age: 11 years old
T- 97.4 P- 58 R 14 98/62 Ht 4’5 Wt 65lbs
Background: no history of treatment, developmental milestones met on time, vaccinations up to
date. Sleeps 9-10hrs/night, meals are difficult as she has hard time sitting for meals, she does get
proper nutrition per PCP. she has a younger brother. lives with her parents in Washington,
D.C. No hx of head trauma.

Symptom Media. (Producer). (2017). Training title 48 [Video]. https://video-alexanderstreet-
com.ezp.waldenulibrary.org/watch/training-title-48
Training Title 50
Name: Harold Brown
Gender: male
Age:60 years old
T- 98.8 P- 74 R 18 134/70 Ht 5’10 Wt 170lbs
Background:
Has bachelor’s degree in engineering. He dates casually, never married, no children. Has one
younger brother. Sleeps 7 hours, appetite good. Denied legal issues; MOCA 28/30 difficulty with
attention and delayed recall; ASRS-5 21/24; denied hx of drug use; enjoys one scotch drink on
the weekends with a cigar. Allergies Dilaudid; history HTN blood pressure controlled with
Cozaar 100mg daily, angina prescribed ASA 81mg po daily, valsartan 80mg daily.
Hypertriglyceridemia prescribed fenofibrate 160mg daily, has BPH prescribed tamsulosin 0.4mg
po bedtime.

Symptom Media. (Producer). (2017). Training title 50 [Video]. https://video-alexanderstreet-
com.ezp.waldenulibrary.org/watch/training-title-50

https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-48
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-48
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-50
https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-50
Week 3: Mood Disorders
Training Title 2
Training Title 8
Training Title 18
Training Title 28
Training Title 150
Training Title 118
Training Title 144
Week 4: Anxiety Disorders, PTSD, and OCD
Training Title 15
Training Title 21
Training Title 37
Training Title 40
Training Title 55
Training Title 85
Training Title 95
Week 7 Schizophrenia and Other Psychotic Disorders; Medication-Induced Movement Disorders
Training Title 9
Training Title 24
Training Title 29
Training Title 134
Week 8 Substance-Related and Addictive Disorders
Training Title 82
Training Title 114
Training Title 151
Week 10 Neurocognitive and Neurodevelopmental Disorders
Training Title 48
Training Title 50
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 Americanmale 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
Week 3: Mood Disorders
Training Title 2
Name: Ms. Julie Houston
Gender: female
Age:19 years old
T 98.1 P-78 R-18 119/74 Ht 5’2” Wt 184lbs
Background: Recently started a business undergraduate program in Boston, MA after growing
up and living in South Carolina her whole life. Grew up with both parents, two brothers, and
one sister. Currently lives in off-campus housing with two other female roommates. Currently a
full-time student, not employed. Not married, currently single. She has no previous psychiatric
history; takes no medications. There is no psychiatric or substance use history for her or family.
No legal hx NKDA
Symptom Media. (Producer). (2016). Training title 2 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-2
Training Title 8
Name: Mrs. Leslie Tilman
Gender: female
Age: 32 years old
T- 97.6 P- 97 R 22 149/98 Ht 5’3 Wt 245lbs
Background: Recently had her first child two months ago. Currently married; stay at home
mother after working in retail for 5 years. Grew up with both parents, one sister in Omaha, NE.
Completed education through bachelor’s level, studying physics. Previous employment included
research science as well as high school substitute teaching for 5 years prior to birth. No
previous suicidal gestures has uncle who committed suicide via GSW. She denied
drugs/alcohol; uncle was opioid abuser. Hx of HTN-prescribed labetalol 100mg twice daily,
admits to missing doses due to forgetting. No legal hx. Allergies: codeine
Symptom Media. (Producer). (2016). Training title 8 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-8
Training Title 18
Name: Ms. Ashley Domingo
Gender: female
Age:20 years old
T-97.9 P-68 R-18 118/82 Ht 5’1 Wt 120lbs
Background: Currently living off-base in California, active duty in the Army, MOS 92M Mortuary
Affairs Specialist. Grew up in Houston, TX with both parents and one brother. Completed
education through high school. Currently partnered. No children. Mother history of depression.
brother hx of cannabis use. No medical history. No legal hx; NKDA
Symptom Media. (Producer). (2017). Training title 18 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-18
Training Title 28
Name: Mrs. Louise Carson
Gender: female
Age: 49 years old
T- 98.8 P- 99 R 20 150/88 Ht 5’5 Wt 135lbs
Background: Currently living in Indianapolis, IN, working full-time as a logistics buyer in a
medical facility. Has an MBA. Lives with her husband and three children, three boys who are all
teenagers. Born and raised in Indianapolis, IN with her mother and two sisters. Father deceased
in MVA when she was 2 years old. Sister has depression; mother has history of being a
“Functioning alcoholic”. Recently informed by her PCP she has a “fatty liver.” Allergies: latex
Symptom Media. (Producer). (2016). Training title 28 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-28
Training Title 38
(Same patient in video 43 but presentation of his illness pre-hospitalization)
Name: Mr. Will Loman
Gender: male
Age:19 years old
T- 98.6 P- 94 R 24 128/78 Ht 5’7 Wt 152lbs
Background: Currently lives with his sister and two parents in Jacksonville, FL. Not currently
employed. Completed high school, not currently in school. Hx of treatment for mood disorder
began age 15, previous trials of Depakote, Olanzapine off and on, side effects of wt. gain. Has
hx of a three-day hospitalization one year ago after found wandering on the side of the
freeway, but he signed himself out ‘against medical advice.’ He refused medication due to
previous experiences. Not currently partnered. He has been sexually inappropriate with
comments to female neighbors; pulled his pants down in the mall. Denies any recent alcohol or
substance use. Father has history of bipolar disorder. No history of self-harm behaviors, no
family suicides. Mother reports he has slept 2–3 hours in past week, up spending money buying
and playing new video games and says he is writing a book on how others can be a video game
master. Appetite is decreased. No medical hx; Hx of trespassing as a juvenile. Has pending court
date for indecent exposure. Allergies: PCN
Symptom Media. (Producer). (2016). Training title 38 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-38
Training Title 43
(Same patient in video 38 but presentation of his illness with hospital treatment)
Name: Mr. Will Loman
Gender: male
Age:19 years old
T- 98.2 P- 74 R 18 120/70 Ht 5’7 Wt 156lbs
Background: Currently lives with his sister and two parents in Jacksonville, FL. Not currently
employed. Completed high school, not currently in school. Hx of treatment for mood disorder
began age 15, previous trials of Depakote, Olanzapine off and on, side effects of wt. gain. Has
hx of a three-day hospitalization one year ago after found wandering on the side of the
freeway, but he signed himself out ‘against medical advice.’ He refused medication due to
previous experiences. Not currently partnered. He has been sexually inappropriate with
comments to female neighbors; pulled his pants down in the mall. He is currently in hospital
admitted one week ago, was initiated on lithium 300mg po three times daily and risperidone
1mg at bedtime. Denies any recent alcohol or substance use. Father has history of bipolar
disorder. No history of self-harm behaviors, no family suicides. Mother reports he has slept 2–3
hours in past week, up spending money buying and playing new video games and says he is
writing a book on how others can be a video game master. Appetite is decreased. No medical
hx; hospital admission labs within normal ranges, UDS negative; Hx of trespassing as a juvenile.
Has pending court date for indecent exposure. Allergies PCN
Symptom Media. (Producer). (2016). Training title 43 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-43
Training Title 150
Name: Ms. Liliana Ball
Gender: female
Age:16 years old
T- 97.4 P- 84 R 18 134/88 Ht 5’3 Wt 118lbs
Background: Currently living with her parents in Tacoma, WA along with two young siblings. She
is a sophomore in high school, not currently partnered, reports she is bisexual, lately having lot
of unprotected sex that her parents don’t know about. She has been stealing money out of her
mom’s purse to buy clothes, makeup, “and just other things.” She has history of treatment
since age 7 for conduct disorder, depression, history of taking sertraline which worsened her
irritability, aggression, impulsivity. She has been in a 3-month teen residential mental health
facility discharged one month ago with lithium 300mg in am and 600mg at bedtime,
aripiprazole 10mg in the morning. When discharged, her labs were within normal ranges and
urine toxicology negative. She was positive for cannabis upon admission. Her parents believe
she is hiding her medication as she has made comments “they slow me down; they crush my
creative art.” She has hx of domestic violence toward her mother and 2 younger sisters as
juvenile. No current legal issues. Her grandmother has hx of bipolar disorder, her mother and
her maternal aunt have anxiety. She is sleeping 3–4hrs/24 hrs. Reports her appetite “is great.”
She has no medical issues; has Nexplanon implant; hx of self-harm with cutting.
Symptom Media. (Producer). (2018). Training title 150 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-150
Training Title 118
Name: Mr. Oscar Luna
Gender: male
Age: 52 years old
T- 98.6 P- 90 R 24 140/84 Ht 5’8 Wt 170lbs
Background: Born and raised in Leopold, IN. Is staying at a shelter after being homeless in
MacArthur Park for 1 year in Los Angeles. He lost his apartment and his job working part-time
as a dishwasher. Enjoys playing music. He has long hx of mental health treatment since age 14.
Previous medication trials include lithium (toxicity), Depakote (wt gain), aripiprazole (akathisia),
risperidone (dystonia), haloperidol (didn’t give a fair trial), quetiapine (wt gain), reports in past
helpful medication was lurasidone, lamotrigine, olanzapine but states “they really squash my
creative song writing though.” Poor historian. Never married, reports he is gay, no children;
estranged from only living sister, parents deceased. He is not sure of his family mental health or
substance use history but feels like he is most like his aunt, she has history of mental health
treatment “but I’m not sure for what.” States that he got a master’s degree in music theory at
Stanford. Admits to 1–3 drinks of alcohol when “playing music in the clubs”, denied illicit drugs,
has history of overdose at age 28, history of 3 inpatient psychiatric hospitalization, most recent
was 1 year ago. Allergies: doxycycline; hx of rosacea.
Symptom Media. (Producer). (2018). Training title 118 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-118
Training Title 144
Name: Ms. Amy Hartford
Gender: female
Age: 32 years old
T- 98.2 P- 74 R 18 120/70 Ht 5’1 Wt 150lbs
Background: Currently lives in Phoenix, AZ, divorced with two children ages 10 and 8. Born and
raised in Tucson, AZ with her mother and four sisters NKDA: no legal hx
Symptom Media. (Producer). (2018). Training title 144 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-144
Training Title 2
In
Test Section Index
,Episode 2(Santa Monica, CA:
Symptom Media
,2016),7 minutes
BEGIN TRANSCRIPT:
00:00:00[sil.]
00:00:15OFF CAMERAWhy did your mom feel you should come in andtalk with me today?
00:00:20MRS HOUSTONShe wasworried.Mom says I get moody this time of year, every year.I don’t know. Maybe.
00:00:40OFF CAMERAHow are you feeling, when?
00:00:45PATIENTNot great.
00:00:45OFF CAMERAWhat’snot great?
00:00:50PATIENTHuh.Just down.I’m not doing so well.
00:01:05OFF CAMERAHow’s school?
00:01:05PATIENTOk.
00:01:10OFF CAMERAJust ok?
00:01:15PATIENTYeah. I left the program atschool. I mean I did and…I’m not doing so well.
00:01:25OFF CAMERAAre the courses difficult?
00:01:30[sil.]
00:01:35PATIENTI understand everything.The teachers are getting to be a bit of a pain.The classes aren’t lustrous(Sighs).I’m in this special business program,where you have to come up with a mock company. Ijust… I just can’tseem to get it done.That, and all my other projects.I’m already late on two of them.
00:02:25OFF CAMERAAre you having difficult concentrating?
00:02:30PATIENTYeah.I’ll read the headlinesin the newspaper and like, five seconds later, I can’t remember what I read.And my classes,when I leave the room,I don’t what we were learning about.
00:02:55OFF CAMERAAre you having anyirregular sleeping or eating patterns?
00:03:05PATIENT(Sighs) I’ve gained ten pounds.Umm… I’ve sleptthrough five of my classes this month if that answersyour question.
00:03:20OFF CAMERAHave you been able to make any friends?
00:03:25PATIENT[Shrugs] Yeah. Almost immediately.The people are a lot of fun.
00:03:30OFF CAMERAWhat do you do with them?
00:03:35PATIENTLately,not so muchof anything.
00:03:45OFF CAMERAWhat happened?
00:03:50PATIENTWell, it was ablast when I arrived in August. I made friendsalmost immediately.We went to concerts andshows, we hung out. Andwe had a lot of fun.
00:04:15OFF CAMERAYou don’t do any of that now?
00:04:20PATIENTThey kind of annoy me a little bit.I mean nothing I can’t get over. They gotreally dull. They suddenly started playing boardgames… and then, things alsogot busy and with the weather, I don’t want to gooutside.
00:04:45OFF CAMERADo you particularly dislike the cold weather?
00:04:50PATIENTIt’s not like I have a burningpassionate hatred for the cold. I’ve alwaysfretted fall and winter. I’m a summergirl. I like the beach and convertibles.And now…
00:05:10OFF CAMERAYou can’t do any of that.
00:05:10PATIENTNo.In fact you can’t do anything at all.
00:05:15OFF CAMERACan you tell me what it isyou dislike about this time of the year?
00:05:25PATIENTIt’s dark. And grey. And miserable.The whole citychanges, it’s not the same city that I loved in August.September was good. It was beautiful.Sunny, crisp days and, the leaveschanging at the end of the month and then it just started gettingworse and worse.Even…the snow is grey and black. I didn’t know snow gotlike that, city snow. I thought snow was white and beautiful.But city snow isn’t like that.Everything is grey.It’s miserable.
00:06:30[sil.]
00:06:35SymptomMedia Visual Learning for Behavioral Health www.symptommedia.com
00:06:35END TRANSCRIPT
_____________________________________________________________________________
Training Title 28
In
Test Section Index
,Episode 28(Santa Monica, CA:
Symptom Media
,2016),6 minutes
BEGIN TRANSCRIPT:
00:00:00[sil.]
00:00:15OFF CAMERAMrs. Carson? Tell me why you’ve come to see me today.
00:00:20MRS. CARSONI’m… [Shrugs] Wound up. Lost mytemper.
00:00:25OFF CAMERAWhat sorts of things make you lose your temper?
00:00:25MRS. CARSONOh…lots of things. The kids.They get on my nerves.
00:00:35OFF CAMERAWhen does that happen?
00:00:40MRS. CARSONPlaying the television too loud.Take Shawn for instance? He spilled sugar all over thecounter last night when my husband was out.
00:00:50OFF CAMERAAnd then what happened?
00:00:55MRS. CARSONI lost my temper.I pushed him down. Not hard… hewasn’t hurt, just cried a little.Maybe…
00:01:10OFF CAMERAMaybe what?
00:01:15MRS. CARSONI was just thinking.
00:01:15OFF CAMERAWhat were you thinking?
00:01:20MRS. CARSONMaybe I should go away.
00:01:20OFF CAMERAGo away?
00:01:25MRS. CARSONYeah. Like I shouldn’t be here.
00:01:25OFF CAMERAHave youthought about killing yourself?
00:01:30MRS. CARSON[nods] Some.
00:01:35OFF CAMERAHow would you do it?
00:01:40MRS. CARSONDriving into something. Drink a whole bunch,then drive… then make it look like an accident.
00:01:50OFF CAMERAHave you tried that? Or made plans?
00:01:50MRS. CARSON[Shakes head]. Naw. It wasjust a thought I had once or twice. Nothingfor real. Everyone hasthose kinds of thoughts at some time, you know?
00:02:05OFF CAMERAI’m not so sure about that.How long have you been thinking about driving into something?
00:02:15MRS. CARSONThree months or so, I guess.
00:02:15OFF CAMERAWhat else wasgoing on three months ago?
00:02:25MRS. CARSONI was up for a promotion, didn’t get it.[Shrugs]. But lots of guys didn’t make it either.
00:02:35OFF CAMERASo you didn’t get the promotion?
00:02:35MRS. CARSONI shouldhave had that promotion. I would… I would have been a supervisor at the whole office.But my supervisorsaid others who were better, younger.
00:02:55OFF CAMERAHow did that make you feel about yourself?
00:03:00MRS. CARSONNot so hot. Myhusband and children deserve better.Even the job I’m doing isat risk, in jeopardy.
00:03:15OFF CAMERAHow so?
00:03:20MRS. CARSONI forget things.Five years of a perfect work record andmy supervisor asked me is something wrong. [Shrugs].So much for a promotion.
00:03:40OFF CAMERAHas worrying about him interfered with your sleep?
00:03:45MRS. CARSON[nods] It goes round and round in my headlike… I can’t get to sleep.Finally after a few hours I… I drop off.
00:04:00OFF CAMERAAnd what time do you wake up?
00:04:00MRS. CARSONThree, maybe fourin the morning.
00:04:05OFF CAMERADo you go back to sleep then?
00:04:05MRS. CARSONI can’tgo back to sleep. If I take a stiffdrink or two sometimes I can, but itwears off.
00:04:20OFF CAMERAHow much are you drinking?
00:04:25MRS. CARSONI try and keep it to three or four.I took my husband’s sleeping pills,but they didn’t work.
00:04:35OFF CAMERAHave you found anything that’s helpful?
00:04:40MRS. CARSON[shakes]. No.
00:04:40OFF CAMERADo you think things will get better?
00:04:45MRS. CARSONI don’t see how.I’ve pretty much ruined everything.
00:04:55OFF CAMERAMrs. Carson, from what you are describing, it sounds like you’re depressed. It’s often hard to know why a depression occurs whenit does. We do know depression can cause all of the symptoms you have told me… the loss of sleep, the feelingsof exhaustion, memory loss, irritability and worry. It makesworking difficult and some people even think of committing suicide. Many factors can contributeto a chemical imbalance in the nervous system, which can cause this problem.I would also like to see you again soon to talk further about these problems.Let’s setup an appointment but if you really feel like hurting yourself, call me at any time.
00:05:30[sil.]
00:05:35 Symptom Media Visual Learning for Behavioral Health www.symptommedia.com
00:05:35 END TRANSCRIPT
Training Title 38
BEGIN TRANSCRIPT:
00:00:00[sil.]
00:00:15OFF CAMERAMr. Loman I understand your sister has been in the hospital previously.Can you tell me about that and also about what… what’s happeningwith her now?
00:00:25PATIENTYou’re not going to give her A C T now are you? Because if you are, we can go to Duke. That’sa good hospital.
00:00:30OFF CAMERAYour sister’s had A C T?
00:00:30PATIENTYeah, she’s had A C T in the past.It’s a disaster. She doesn’t remember anything. She puts the, theradio in the refrigerator, the cat in the microwave oven, it, it, it is a disaster.
00:00:40OFF CAMERACan youtell us about what you’d like for us to do for her this time?
00:00:45PATIENTConfirm thepsycho spiritual mode of existence. Like in the Aphrodite Adonus model.Do you read Rollo May? We read it all the time. Are you…are you a psychiatrist? Or a psychologist? Is this one of those rooms with the oneway cameras.
00:01:05OFF CAMERAUh… no, it, it is not.
00:01:05PATIENTWe take precautionsfrom the Russian infrared rays at home. Blankets all over the windows.Do you… do you take precautions? You wouldn’t want to getsterile or… or have leukemia. We had twodoctors the last time she was in here. It was Dr. Richard Horowitz andDr. Stephen Hunter. Horowitz, Hunter.Horrific witch hunt. That’s all this thing is is a witch hunt, right? Come on,what? I bet your going to ask her all those questions, like how abanana is similar to a typewriter.
00:01:45OFF CAMERAHas anyone ever askedyou those questions?
00:01:50PATIENTGod… Goodness.Yesss! We have to write these things down all the time so we can remember them when we’re at home!Like how to subtract by threes or… or who we voted for for thepresident of the United States. Who did you vote for? I voted for Bugs Bunny.You know like, [taps fingers against his teeth]. What’s up doc? [clicks teeth against each other]. For the healthcare reform.
00:02:15OFF CAMERAUh huh. Can you tell me more about your sister’sproblems?
00:02:20PATIENTLove of life?You’re not Devita Honeysuckle, are you? Cause if you are, I’m notgoing to talk to you.
00:02:30OFF CAMERAUh, no… I’m not DevitaHoneysuckle.
00:02:40[sil.]
00:02:40 END TRANSCRIPT
Training Title 8
BEGIN TRANSCRIPT:
00:00:00[sil.]
00:00:15OFF CAMERAMrs. Tilman, your husband isextremely worried about you.
00:00:20MRS. TILMANYes, I know that.
00:00:25OFF CAMERADoes coming her bother you?
00:00:25MRS. TILMANYes. Yes it does. I’ve never been to ashrink before. I don’t think I need to be here now.
00:00:35OFF CAMERAI’d like to ask you a few questions if that’s ok.
00:00:40MRS. TILMANYeah, that should be fine.
00:00:40OFF CAMERAHow have you been feeling health wise?
00:00:45MRS. TILMANFine. No health problems.
00:00:45OFF CAMERASleep?
00:00:50MRS. TILMANI can’t sleep much. But that’s to be expected.
00:00:50OFF CAMERAHow so?
00:00:50MRS. TILMANThebaby. It cries a lot.
00:00:55OFF CAMERAAnd that wakes you?
00:00:55MRS. TILMANWell I’m usuallyalready awake.
00:01:00OFF CAMERAYou have trouble sleeping?
00:01:00MRS. TILMANJust falling asleep.Especially after the baby cries.
00:01:05OFF CAMERAWhat’s the baby’s name?
00:01:10MRS. TILMANJessica.
00:01:10OFF CAMERABeautiful name. How old isshe?
00:01:15MRS. TILMANTwo months.
00:01:15OFF CAMERAHow has your appetite beenlately?
00:01:20MRS. TILMANI don’t know. It’s not big, butI want to lose weight after the pregnancy.
00:01:25OFF CAMERAYou aren’t comfortable with the way you look?
00:01:30MRS. TILMANI’m terrible.Alright. I look terrible, I feel terrible. My body is bloated.I have lines on my face, bags.I look disgusting.
00:01:45OFF CAMERAWhat do you do to lose weight?
00:01:50MRS. TILMAN:Well, I want to run, but… I don’tget out much.
00:01:55OFF CAMERAWhy?
00:01:55MRS. TILMAN:Because I’m stuck at home.I have to take care of the baby, all day long.I guess I should just get used to it. This is my life now all day long, stuck at home with the kid.
00:02:10OFF CAMERAYou don’t have a nanny?
00:02:10MRS. TILMANWho could afford one? Especially withhaving to pay for the kid.
00:02:15OFF CAMERAHave you said any of this to your husband?
00:02:20MRS. TILMANTo Rick?
00:02:20DR. GREYUh huh.
00:02:20MRS. TILMANNo. I couldn’t.He’d be so disappointed in me.How could I even tell him that I felt this way.That I wanted out.He comes home from work and… he plays with Jessica.This perfect family.
00:02:50OFF CAMERAHow has your relationship been?
00:02:55MRS. TILMANNot good.
00:02:55OFF CAMERAWhat’s happened since Jessica was born?
00:03:00MRS. TILMANIt’s notadded much.I mean it is my fault. I can’t stop crying.All the time. [she cries] Sometimes I don’t even knowwho the baby is.And I yell a lot.Things just upset me. Everythingand anything he does lately just upsets me.
00:03:35OFF CAMERAFor instance?
00:03:40MRS. TILMANWell…Well the other day he came home and changed her diaperbut he threw the dirty diaper in the wrong trash can and he didn’t tie it up in the bag the way he was supposedto.
00:03:55OFF CAMERAAnd that upset you?
00:03:55MRS. TILMANYeah. And Itold him, and I was yelling so he started yelling.So yeah. That’s our marriage right now.
00:04:10OFF CAMERAHave you been sexually active since Jessica was born?
00:04:10MRS. TILMANNo. Notreally. I have no drive or desire.Rick keeps wanting to but I just… I push him away.
00:04:20OFF CAMERAAndhow is your social life?
00:04:25MRS. TILMANNon-existent.I haven’t seen my friends in forever.They came over to see the baby but that’s about it.I might as well get used to it.I can’t go out anymore.She’s too young for a baby sitter, and even then we couldn’t afford one.I had to quit my job.
00:04:55OFF CAMERAWere youforced to quit?
00:05:00MRS. TILMANNo. They gave me maternity leave, but… but I figuredthis is never going to end. I might as well leave now.
00:05:10OFF CAMERADo you do anything for yourself? Something to relax, somethingcreative?
00:05:15MRS. TILMANNo. I tried writing.I liked writing but…I don’t know, I…nothing moves me.
00:05:30OFF CAMERAYoucan’t write now?
00:05:35MRS. TILMANI have no inspiration, and it’s notfun. I know I’m going to be interrupted soon anyway. Before Jessica,I could write for hours a night. I hated anyone disturbing me. [she cries]Now I can’t have twenty minutes. And you can’t tell ababy to hold on with wanting her lunch. For an hour.When she’s hungry, she’s hungry.
00:06:05OFF CAMERADo you regret having a child?
00:06:05MRS. TILMANNo.I…I’m just not sure.I’m not sure, okay.
00:06:20OFF CAMERAAre you happy?Does anything give you pleasure?
00:06:30MRS. TILMAN[Shakes her head] No.[she cries].Look, please, I…I know I’m a mother now. I.[sigh]I don’t know how to put this, I feelterrible. [Cries harder]. I don’t want to be a bad mother. I love mydaughter. But I don’t know… I don’t knowwhy I say these things. It’s just reallydifficult… and Rick, I see Rickand he has this look. It’s this look,its like I know what you’re thinking.It’s like he’s judging me.It’s like he knows I’m not normal. I mean, what’s wrongwith me? Sometimes I can’t even hold my own child, I… I,she’s crying and I can’t… I can’t touch her.And when I give her milk it disgusts me.I don’t know what to do.I don’t know what’s wrong with me.I don’t know what’s wrong with me.[She reaches for a tissue]
00:08:15OFF CAMERAMrs. Tilman, do you have thoughts of suicide or death?
00:08:20[she shakes her head yes]
00:08:25OFF CAMERAHave you acted upon them?
00:08:30MRS. TILMAN[she shakes her head no] No.I couldn’t. I couldn’t do thatto Rick or Jessica. And then I feel guilty again.It’s this… this endless cycle.I’m not happy and I want to get outand if I get out, then I would just… I would just…just ruin everyone and that makes me more unhappy.
00:09:05[sil.]
00:09:20SymptomMedia Visual Learning for Behavioral Health www.symptommedia.com
00:09:20 END TRANSCRIPT
Training Title 18
BEGIN TRANSCRIPT:
00:00:00[sil.] DX:
00:00:15OFF CAMERASo you’re here on base now?
00:00:15PATIENTYes, I work on base, but I liveoff base with my boyfriend Luke. He’s a serv.
00:00:20OFF CAMERASohe’s not in the military now?
00:00:25PATIENTNo, he works somewhere else.
00:00:25OFF CAMERAOkay.Can you tell me about why you came in today?
00:00:30PATIENTEveryone keeps saying I havePTSD. Even Luke says I have it. Heserved with me, that’s how we met.
00:00:40OFF CAMERAPTSD like Post Traumatic StressDisorder?
00:00:45PATIENTYeah. I used to be depressed when I was thirteen or fourteen.
00:00:50OFF CAMERAWere you treated for depression?
00:00:50PATIENTYes, they gave me somekind of anti-depressants, but I stopped taking themwhen I was eighteen, when I decided I wanted to enlist. I didn’t think they would let me enlist if I was on meds.
00:01:05OFF CAMERAAnd you said you were in Iraq. Did you experience,see any combat?
00:01:10PATIENTNo, no combat. I helpedload the soldier’s body bags into the plane. I think about ita lot. It makes me sad. You know, I try to talk to Luke about itbut he’s away on the road most of the week. Because he’s a driver now.
00:01:30OFF CAMERAHow, how long have you been depressed this time?
00:01:35PATIENTSince I was eighteen. I feel like itsworse when I have my period.
00:01:40OFF CAMERAAnd how is yoursleep?
00:01:45PATIENTI don’t sleep much.When I do sleep I toss and turn throughout the night.
00:01:55OFF CAMERAUh-hm.What do you think about when your tossing and turning like that?
00:02:00PATIENTIthink about Iraq. The kidsover in Iraq. Who had burn scars and some of them were missingtheir feet and hands cause they stepped on mines.
00:02:15OFF CAMERAMmm…that is terrible. How is your appetite doing?
00:02:25PATIENTI eat a little bit throughout the week. SometimesI eat like three big meals and snack all day. My weight goes up anddown all the time like a roller coaster.
00:02:35OFF CAMERAHow about your concentration?
00:02:40PATIENTI can read one page of a magazine and I canhave to read it over and over again just to try and remember it but I don’t.Even when I’m watching my favorite shows I can’t concentrate.
00:02:50OFF CAMERAWhat aboutcrying spells?
00:02:55PATIENTAll the time. An oldschool friend called me the other day and… I… they didn’t call me back.And I couldn’t stop crying. I cried all night.Sometimes I cry all day. I have no more energy to crysome days.
00:03:15OFF CAMERADo you think you have more guilt than most people?
00:03:20PATIENTYes. All my life. When I was in school,I feel like I disappointed my parents a lot. My sister…And my commanders, I feel like I disappoint them.And Luke, I made the soup to hot the other day.He told me not to worry about it but I just kept thinking it was all my fault.I blame myself a lot.
00:03:45OFF CAMERAWhat about your sexdrive? How is that?
00:03:50PATIENTNo sex drive. I do itwhen Luke presses the issue about doing stuff with sexual nature. ButI don’t have any emotional life behind it.
00:04:00OFF CAMERAWhat about otherinterests?
00:04:05PATIENTI have low energy and low interest all thetime. I don’t even like to go shopping anymore. I used to like that all thetime. And I don’t even play with my cat, Tigg, anymore.
00:04:20OFF CAMERAAny suicidal thoughts
00:04:20PATIENTNo,I was raised strictly in a Baptist church so I would never plan to take my own life,but… I think about if I had cancer or got blown up…It wouldn’t matter if I didn’t live. It wouldn’t matter ifmy life was gone.
00:04:40OFF CAMERAYou said otherpeople thought that you had PTSD do you have any flashbacks ornightmares about the terrible things you experienced in Iraq orother places?
00:04:55 PATIENTNo nightmares,but I have daydreams all the time aboutstuff. Even when I can sleep, I don’t have nightmares aboutIraq. Just really about uninteresting stuff.
00:05:15OFF CAMERAIf there are loud noises do you think you startle more than those peoplewho have not been in the military?
00:05:20PATIENTWell, Lukesaid when he heard a loud thump, he jumped but… I didn’t evennotice it, like I didn’t hear it.
00:05:30OFF CAMERAWhat about everydayanxiety or having panic attacks? Anything like that?
00:05:40PATIENTI don’t like to go out and I get thisreally anxious feeling when people make me go out in publicand socialize. I can do fine in a store, solong as no one comes up and talks to me. I feel like no one should come upand talk to me about anything. Like… Like I’m not worth it.Like I’m not good enough. I tell myself all the time I’m not good enough. And I’mnot.
00:06:10 END TRANSCRIPT
Training Title 150
In
Test Section Index
,Episode 150(Santa Monica, CA:
Symptom Media
,2018),2 minutes
Let me ask you about depression.
00:00:15>> I am not depressed.
00:00:15I mean, not hardly, no.
00:00:15>> Isee that but let me ask you about other times.
00:00:20>> Okay, fine. I’ll tell you what,
00:00:20 you ask, I’ll answer
00:00:20that’s how itwill work.
00:00:25It will be like a game. Let’s go.
00:00:25>> Got in the form that your parents filled out,
00:00:25they were they yesterday manytimes
00:00:30in the past week you appeared depressed.
00:00:30>> Yeah, yesterday I was a little bit depressed but
00:00:35it was just because I was in a bad mood.
00:00:35People get in a bad moods all the time.
00:00:35Don’t you get into badmoods?
00:00:40I mean, that’s in our nature.
00:00:40Animals get into bad mood.
00:00:40>> They also wrote that you started crying
00:00:40and said that you
00:00:40never wanted to participate in more school plays.
00:00:40>> Becausebad moods don’t make
00:00:45you want to sing obviously,
00:00:45bad moods make you wantto,
00:00:50I don’t know, run,
00:00:50just run and get away from everything but
00:00:50that’s not now.Now is the now.
00:00:55>> They wrote that yesterday you
00:00:55had no energy [inaudible].
00:00:55>> My God, I’m sorry doesit look like
00:01:00I have no energy right now?
00:01:00Because I really, Iam
00:01:05as happy as a bumblebee inpollen blessed flowers.
00:01:10>> Were you happy yesterday?
00:01:10>> Yesterday was yesterday.
00:01:10Todayis today.
00:01:15Maybe depends on string theory, right?
00:01:20Oh, my god. The art on this wall.
00:01:20Do you travel a lot?This is amazing.
00:01:25>> Your parents wrote that you tell them you are
00:01:25worthless for destroying everyone’s lives,
00:01:25thatyou wanted to die.
00:01:30>> My god, why are you dragging me down
00:01:30with this ancient history?
00:01:30>> No plans, wanted to die.
00:01:30>> Ancient historybuddy, come on.
00:01:35Let’s just look.
00:01:35You have to live in the now.
00:01:35You can’t leave in the last week.
00:01:40You can’t live in the last year.
00:01:40You can’t live in the last century.
00:01:40All right? Show me your smileyface.
00:01:45The future is bright.
00:01:45>> Do you agree with what your parents wrote?
00:01:45>> Look if that’swhat they wrote then
00:01:50that’s their freedom of expression
00:01:50and I believe wholeheartedly in freedom of expression,
00:01:55I do not deny anyone any freedoms. Do you?
00:01:55This transcript was automatically generated using speech recognition technology. Because this method relies on machine learning algorithms, the quality of transcripts may vary. To request this transcript be improved with enhanced accuracy, please email transcripts@alexanderstreet.com.
Training Title 118
BEGIN TRANSCRIPT:
00:00:15 UNKNOWNYou know, luck… luck… luck… luck… Luck be a lady tonight. Luck be a lady tonight.You know Frank Sinatra used to sing that. He’s great. (inaudible) long day. He had like a little wife, I remember it’s crazy.He’s gonna… Yeah, a very small wife, who’s weird. You know, whose really good now? It’s Tony Bennett.
00:00:30UNKNOWNYeah. Yeah. You told me about him.
00:00:30UNKNOWNYeah, but got to pay attention because I mean, he’s underappreciated.I mean, I… People don’t, you know…
00:00:35UNKNOWNYeah, you said…
00:00:35UNKNOWNWait… He went down…
00:00:35UNKNOWNYou said something about concerts,that you were giving concerts.
00:00:40UNKNOWNYeah, I am. I… I did them. I just did one in New York City. I did St. Louis,I did uh… Atlantic City and I did all those little farming community, you know, that was reallypopulated farming communities in Indiana.
00:00:50UNKNOWNOh.
00:00:50UNKNOWNYeah. And… and now I’m doing this some concert here at MacArthur Park.Someone have to kick out… and most people are pervert.But there’s you know, the problem is, there’s so many homeless people there. So it’s kinda like they are getting away and I like set up…
00:01:05UNKNOWNMm-mmm. Mm-mmm. Where did you… Mm-mmm. Where did you play in New York City?
00:01:05UNKNOWNYou know I’m searching when you’re talking. Oh, in New York city?
00:01:05UNKNOWNRight.
00:01:10UNKNOWNOh, this is bad. The subway.
00:01:10UNKNOWNSubways?
00:01:10UNKNOWNDon’t… don’t… Seriously don’t touch me. But… but reallyyou don’t understand. It was great because I get rock n’ roll down there and the buses would just show upand all these people would come to see me. It was great. The door would open, it was amazing. Umm… I… I… I… I think…I transported them to like, you know, Viana, Scotland and then…then there’s the… You know,Carnegie Hall in New York City where they would never…
00:01:35UNKNOWNHow was it that you came to select New York City?
00:01:40UNKNOWNNew York City was because of my aunt, the rich, fat rich aunt.
00:01:45UNKNOWNMm-mmm.
00:01:45UNKNOWNThat she would bring me on her trips and that, you know, I… we come along to see the relatives and family and while she, you know,she go… blabbing around, blabbing around, she go coffee-tear me, whatever like that. And I would go and I would go my concerts,I would set up and do all my concerts.
00:01:55UNKNOWNRight.
00:01:55UNKNOWNAnd it would be amazing. And… and you know, I wanted to be a…I wanted to paint for the museums too. I want to paint for the galleries, you know. You’re great but you can’t… You know New York City is crazy.You can’t do all that stuff in one trip. You know, there’s no possible way I could be.You know, when I’ll get back there and I’m gonna teach them because those art museums are crap.
00:02:10UNKNOWNMm-mmm.
00:02:15UNKNOWNThey are. Their art in there is just, it’s old, outdated…
00:02:15UNKNOWNMm-mmm… When you were playing music, what music were you playing?
00:02:20UNKNOWNMy own.
00:02:20UNKNOWNYour own?
00:02:20UNKNOWNMy own. All these symphonies just kept totally around in my brainand that impresses people.
00:02:25UNKNOWNMm-mmm.
00:02:25UNKNOWNIt impresses everyone. You know, it’s beautiful,it’s magic, it’s beautiful. You know, beautiful dreamer…Oh, and you know, Christina Aguilera, whenever she sing that song and I wish I was beautiful.That I wish I was beautiful… She’s not really…
00:02:40UNKNOWNHow much of your… How much of your timedo you spend to playing music?
00:02:45UNKNOWNI… Every waking hourand then more.
00:02:50UNKNOWNMm-mmm.
00:02:50UNKNOWNSo there you go.
00:02:50UNKNOWNSo how was your sleep?
00:02:55UNKNOWNSleep? What? How do you have time for sleep?Oh, my god. Do you sleep? Really, do you sleep?
00:03:00UNKNOWNYeah.
00:03:00UNKNOWNThree hours is all I need.Three hours, it’s all like freaking need. I don’t need more than that. And you know, and… When I’m at Indiana,I… I… I found it really hard not to hold back but I was… I had to technically tell these fag woods peoplehow to farm. They don’t even know how to farm down there. They call themselves farmers but they don’t know how to farm.I mean, the plants were upside down. They are stupid cramp…
00:03:25UNKNOWNSo you’re telling the farmers how to farm?
00:03:25UNKNOWNYeah.
00:03:25UNKNOWNHow did they react to that?
00:03:30UNKNOWNEmbarrassed.
00:03:30UNKNOWNMm-mmm.
00:03:30UNKNOWNWouldn’t you be embarrassed? They are supposed to be farmers,it’s crazy. The lobby here is crazy because you know, I would… I… I used to watch a showin the 90s or ’70s and it’s like a designers challenge type of thing.And they would actually give you 20 bucks, $5, $3 and you could fix the whole room up that fast.
00:03:50UNKNOWNSo you think…
00:03:50UNKNOWNYou should do that. I actually wrote down… I jotted down a whole bunch of little notesthat I would fix. Maybe we could fix this here…
00:03:55UNKNOWNNow I can fix my lobby… Mm-mmm.
00:03:55UNKNOWNOh, my God, yes, it will be great. I have the notes. I have the notes.Do you want them? I mean I don’t… I have them. You should look at them. Seriously you should look at them. It will be better for you.
00:04:05 END TRANSCRIPT
Training Title 43
BEGIN TRANSCRIPT:
00:00:00[sil.]
00:00:15OFF CAMERAHello Mr. Loman. How are you doing today?
00:00:15PATIENTUm… I have a bit of a head cold, butI’m feeling pretty good.
00:00:20OFF CAMERAAre you taking your medications regularly?
00:00:25PATIENTYeah, uh, about four times a day. Every meal and just beforebed.
00:00:30OFF CAMERADo these medications make you feel any different?
00:00:30PATIENTYeah, um,I feel a little bit shaky. And kind of stiff. I especially noticed thatwhen I was playing ping pong in the day room.
00:00:40OFF CAMERAYes, thoseare side effects from, from these medications. They won’t hurt you even though itmakes you feel uncomfortable. Although you are stiff and shake some,make certain to stay on these medications. They do seem to help you with yourthinking and controlling yourself. Can you tell the difference?
00:01:00PATIENTOh yeah, the littlethings hardly affect me at all anymore. In fact, Iuh, I was wondering if, maybe I could go home today.
00:01:15OFF CAMERAWell uh, I know you would enjoy going home.Butwhy don’t we wait a few days ok, so we can make absolutely sure we have you on the rightmedication and absolutely sure that this is the correct dose.Ok?
00:01:35[Patient nods his head forlornly]
00:01:40PATIENTOk.
00:01:40OFF CAMERADo you remember what you’re thinking and, and uh,was like that first day when you came in?
00:01:45PATIENTWell,I… felt excited. I had a lot of energy.I don’t think I could see very well, things seemedscary like going really fast. I…I just didn’t feel like myself.
00:02:05OFF CAMERAYeah. Iunderstand that you did a lot of things that just were not like you.Your mother said, and these are embarrassing things, but that you pulled downyour pants at the mall, and you uh, spent a lot of money and youyelled, a lot of sexual and mean comments at other,at other people. And then I observed that when you came in, your speech wasvery fast and very disorganized.
00:02:35PATIENTYeah,that um… that isjust not like me.
00:02:45OFF CAMERAYeah, so,how do you feel about going home, and seeingfriends, and family members, people who were seeing how you were acting.
00:03:00PATIENTNot, not very good. I, uh… don’t think they wouldwant to talk to me again. They probably think I’m a loony.
00:03:10OFF CAMERAUh, so it’s going to be very important when yougo home to, to stay on these medicines. So you canbe back in control.
00:03:20PATIENTYeah.I don’t want to lose control again.
00:03:30OFF CAMERAGood. Good. I knowtaking medicines is not fun, but it’s really going tobe important for you to do that. Are there some other things you’re doingto prepare for going home?
00:03:45PATIENTWell, I’m making some gifts formy family in the common room. Um, I’m talking to them on thephone a lot. I uh,I’m really missing being home.
00:04:05[sil.]
00:04:05 END TRANSCRIPT
__________________________________________________________________
Training Title 144
In
Test Section Index
,144(Santa Monica, CA:
Symptom Media
,2018),13 minutes
00:00:00 BEGIN TRANSCRIPT:
00:00:10[sil.]
00:00:20UNKNOWNWould you prefer I call you Miss Hartford?
00:00:25AMYI go with my middle name Amy.
00:00:25UNKNOWNAmy. Okay, Amy.What’s going on?
00:00:35AMYSorry, I… I can’t.I don’t… I don’t like… I can’t help but cry.This is just it’s so embarrassing to talk about.
00:00:50UNKNOWNNo need to apologize.
00:00:55AMYEverything just… It feels so overwhelming.
00:01:00UNKNOWNUh-huh. Are you having physical pain?
00:01:00AMYCramps, intense cramps.
00:01:05UNKNOWNUh-huh. Do you think this pain is menstrual in nature?
00:01:10 AMY:Definitely.
00:01:10UNKNOWNAre you having other symptoms with the cramps?
00:01:15AMYUmm… hen I have my period, my breasts become very tenders.So much so that it hurts. If fabric even rests on them.
00:01:25UNKNOWNUh-huh.
00:01:25AMYAnd I get bloated, I hold water.So of course, I gain weight.It’s always horrible getting my period.
00:01:35UNKNOWNDo you also become lightheaded?
00:01:40AMYOh, it’s more like dizziness.
00:01:45UNKNOWNAny headaches?
00:01:45AMYYes, with back pain that make it impossible to sitand falling apart, right? Everybody says I’m exaggerating,and they think I’m fine. But when I am, my period,I’m on my back all day cry.
00:02:05UNKNOWNWell, let’s see if we can figure out what’s going on. Do you also have any bouts of nausea?
00:02:10AMYNo.
00:02:10UNKNOWNFood cravings.
00:02:10AMYOh, God, yes.Not just cravings. I eat more.
00:02:15UNKNOWNUh-huh. What do you crave and eat?
00:02:20AMYUh… A mini cookie packs,and some kind of dried fruit nut mix thing they have at work.I always plan to only eat a small amount but then I can’t stop until all of its gone.And one time I went through the entire offices supplyfor the week, I ate the wrapper so no one would see themand then I ran to Costco during lunch to replace them. I was petrified someone would notice.
00:02:50UNKNOWNDo you have difficulty controlling your impulses to eat?
00:02:55AMYTo an embarrassing degree?
00:03:00UNKNOWNHow long these symptoms been occurring with your periods?
00:03:05AMYJeez. Since I was 10 or 11.
00:03:05UNKNOWNOkay.
00:03:10AMYSince my first period, my mother scolded me said that I was overreacting.And then my school counselor told me that I was having normal PMSand I would get used to it. But I knew it wasn’t normalbecause none of the other girls were sick like I was. And as I became an adult it got worse.Enormously worse after I had kids.You know, I tried to power through, but I can’t.
00:03:40UNKNOWNHow did it worsen?
00:03:45AMYLevel of pain, intensity of the pain.I’m completely zapped of energy.I feel unstable.
00:04:00UNKNOWNWhat do you mean unstable?
00:04:05AMYMy moods jump all over the place.And if my coworkers my friends or even… even my kids saythe least little thing I feel totally rejected. I cry at the drop of a hat.Or I just lay there wanting to give up.And other times I’m on edge I’m up and pacing feeling like I want to… I want to throw somethingor break something. Slam doors, scream at the TV.
00:04:35UNKNOWNWhen you’re not having these difficult symptoms. Do you feel much stress in your life?
00:04:40AMYAll my life is the stress. I am the single mother of two kidsso I have to get them up and get them to school.And then most days I don’t have enough energy. I sometimes I feel like I can’t even get myself to work.So I… I call my neighbor and she drives my kids with her kids to school.Thank god she understands.But I don’t know how long that’ll last. And I try my best to force myselfbut I can’t let these stupid irrational symptoms ruin another job.
00:05:15UNKNOWNDid these difficulties ruin a past previous job?
00:05:15AMYTwo jobs.Yeah, I’m a paralegal so work is beyond demanding and I can’t function when I’m like this.I… When I have my period I miss a day or two, maybe three.That’s fine. That’s totally acceptable. But the first job I lost.I heard so bad, I couldn’t evenget myself to pick up the phone and call in sick.I just lay there like a blob, being emotional and down.I cannot afford to lose another job.
00:05:55UNKNOWNWhat’s it like when, as you said emotional and down?
00:06:00AMYWell,I get terribly sadand I snap at people.You know, like kids, you know yell at my coworkers.It doesn’t matter yell at the walls.And I have my period. I know I’m not gonna be able to take care of my kids.So I called my ex to take them and that’s how desperate I could get because we do not get along.Except on issues with the kids.
00:06:35UNKNOWNThat’s good.
00:06:40AMYYeah, but I mean, he had an affair. That’s the reason we divorced.
00:06:45[sil.]
00:06:50AMYUmm… So I started keeping a journal to document my feelings.
00:06:55UNKNOWNThat’s smart. What… what have you learnedby the doing that by documenting your feelings and symptoms?
00:07:05AMYUmm… Well, I… I learned that I lose track of who I am.When I’m on my periodthat I become a different person. I don’t know how else to describe it.When I journal it helps me to remember that when I’m like this,it… it’s… it’s notthat bad that it will remind me that it will get that I’ll get over it.
00:07:35UNKNOWNSo when you’re experiencing this sadness and anger,is it difficult to realize that this is going to end?
00:07:40AMYWell, it’s not just sadness and anger?It’s like everything in the world is different, looks and sounds and feels different.It’s like there’s a… there’s a veiland trying to push it out of the way.
00:08:00UNKNOWNDo you feel like you lose control of your emotions?
00:08:05AMYI’m anything but in control.
00:08:10UNKNOWNDo you ever feel so out of control that you experience hallucinations,seeing or hearing things that are not there?
00:08:15AMYOh God, no.No, that would really do mean, no.
00:08:20UNKNOWNIs there any history of mental illness in your family?
00:08:25AMYUmm… Depressionon my mother’s side.
00:08:30UNKNOWNOkay.
00:08:35AMYI never thought that I had depression. Because when I… when I have these feelings,I snap out of them. And then I’m fine. I mean, it’s not like any depression I’ve ever seen.My uncle killed himself so I know what good looks like and this isn’t like that.
00:08:50UNKNOWNTo your symptoms that we get so bad that you think about suicide.
00:08:55AMYI get pretty far down, there no doubt about thatbut it’s never that bad.I would never do that to my kids, no.
00:09:05UNKNOWNHave you ever seen a psychiatrist or a mental health professional?
00:09:10AMYI did after my divorce.I saw him for several years. He never diagnosed mewith clinical depression. I did learn some coping mechanisms because I had anxiety issues.It just normal sadness and anger from the relationship endingbut those feelings went away so I stopped seeing him.
00:09:30UNKNOWNWere you ever prescribedany psychiatric medications? anti anxiety medicines, SSRIs for depression, anything like that?
00:09:40AMYNone. No.
00:09:45UNKNOWNYou mentioned Do you force yourself to go to work? What else do you do to cope?
00:09:50AMYI… I take a lot of ibuprofen,I worry to take too much. I remember… don’t wanna get anylong term side effects.But even if I managed to get the pain to subside, I still have the problem that I can’t concentrate.I read and reread depositions and court documents without absorbing any of it.Oh, I heardthat some women use birth control for PMS, will that help?
00:10:25UNKNOWNThere is medical evidence to support that, we’d have to get some hormonal studies.First, how often would you say these symptoms occur?
00:10:35AMYEvery month, like I said with my period.
00:10:35UNKNOWNAre the symptoms that you’re experiencing noware these typical during before or after your period?
00:10:45AMYThey start about a week or so before builds.And then as soon as my flow starts, they subside within a day or two.
00:10:55UNKNOWNAnd then how will you be for the next couple of weeks?
00:11:00AMYWell, I’m fine. In fact, I’m one of the best workers in the office.I laugh at all the office jokes and there are a lot of them.And I can even manage to have fun with my kids when they’re being bratty.You know, they’re pretty clever, they’re funny.
00:11:20UNKNOWNMm-hmm. I noticed that even though you’re suffering with the symptoms today,uh… you’re able to talk about and remember hold on to the good times.
00:11:25AMYYeah, that’s… that’s where journaling helps.
00:11:30UNKNOWNReally works for you. Good for you. That’s great. But let me ask you about some other topics, how is your diet?
00:11:35AMYI graze. I mostly eat on the gobetween work and the kids. It’s hard to find time to cook.
00:11:45UNKNOWNWhat would be a typical meal?
00:11:45AMYOh, on the rare dire occasion, it’s fast food.But typically, I try for healthier options.There’s a really good chicken place near us. Most of the time,I guess I use a lot of delivery.
00:12:00UNKNOWNSuch as.
00:12:05AMYWell, my kids love chicken.They love Turkey and mashed potatoes, love pasta. Oh, they’re pickyso that limits me but usually I can fit in a vegetable dish with each order without too many complaints from them.
00:12:20UNKNOWNGood for you, good for you, any dairy?
00:12:25AMYNo, my son is lactose intolerance, so we don’t buy milk but there’s these cheeseand cracker platters they have at work for meetings.That’s typically how I get through my day.I’m embarrassed to admit that.
00:12:40UNKNOWNAny caffeine.
00:12:40AMYOh, nonstop.
00:12:45UNKNOWNUh-huh. Besides taking ibuprofen, what else do you doto help with your symptoms?
00:12:55AMYUmm… Basically, I sleep. I curl up on the couchand right out the storm.You know, I tried some over the counter stuffsome homeopathic remedies, B6 vitamins, women health supplementsbut frankly, they don’t seem to do anything.
00:13:20[sil.]
00:13:25 END TRANSCRIPT

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