Reference no: EM133909292

Question

Juliette is a 75 year old woman who is a new patient recently referred to the PMHNP. She is seeking a refill for her lorazepam, which she has been taking for anxiety/poor sleep since her husband's death 10 years ago; she has two grown children who live in the area and several grandchildren. They see her fairly frequently. Her prescribed dose is 1 mg at bedtime, but she has been taking 2 mg at bedtime for the last 2 to 3 months due to poor sleep. She also takes a tablet during the day with glass of scotch for anxiety. Her other medications include candesartan and paroxetine for depression. Juliette is an established patient in the primary care clinic next door which is a shared practice with the PMHNP. The PMHNP reviews the EMR.

Juliette tells the PMHNP that she had an ED visit 2 months ago after a motor vehicle accident where she crashed her car into a parked car while driving home from the grocery store. She didn't sustain any injuries in the accident, but stated it "sure made her nervous." She received a refill for her lorazepam at that time. Finally, she fell at home 3 weeks ago after tripping while taking out the garbage. She did not present for assessment but thinks she sprained her wrist. She has been taking ibuprofen 2 to 3 times daily for pain and wants Tylenol with codeine (T3) and asks the PMHNP to prescribe it.

Given what you know from Juliette's brief history, what are the differential diagnoses? Give your rationales and pertinent DSM5 criteria.

What do you find to be the most concerning aspect of Juliette's case? Why?

From what you know of Juliette's mental health concerns, what tools might you consider using to complete a comprehensive mental health assessment? What is your rationale?

What non-pharmacological modalities will you use to address Juliette's diagnoses? Why?