Solved: COMPREHENSIVE PSYCHIATRIC EVALUATION NOTE AND PATIENT CASE PRESENTATION, PART 2

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Instructions

A patient for whom you conducted psychotherapy for an impulse control or conduct disorder, 

Create a Comprehensive Psychiatric Evaluation Note on this patient using the template.

Be creative and add informations

Assignment

B.F. is a 38 year old male presents with symptoms of ADHD, Impulse behavior, Anxiety and Major Depressive Disorder. B.F. presents via in-person for today’s session. Met for sixty minutes. B.F. reports that he has been having “panic attacks” Monday through Thursday, but not on Fridays or the weekends. B.F. reports the negative thoughts come first followed by a “trigger”, and then the physical symptoms of “tingling, worrying, and mood shifts” manifest after that. B.F. reports that he feels his work is a contributing factor to his anxiety attacks. B.F. reports he uses the gym to release energy and start to feel better. B.F. reports that these anxiety feelings usually last “a couple of hours” and then subside. B.F. reports he also feels his self-esteem starts to decline while this is happening. B.F. reports he realizes now that some of his triggers may be from past childhood traumas. 

The psychotherapeutic interventions utilized in the session included: Begin working on Strengths. B.F. will continue taking medications as prescribed and report any issues. He will continue with weekly sessions.

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