51 y.o M with h/o anxiety, depression, panic d/o, AUD, h/o PE on eliquis who
was transferred from OSA on a 5150 for DTS for SI with plan to either overdose
or crash his car into a lake in the setting of heavy alcohol intoxication.
Current presentation consistent with alcohol induced mood disorder, notable for
SI in the context of heavy drinking and resolution of SI with sobriety. Patient
seems to have an underlying anxiety disorder, likely social anxiety disorder,
notable for feeling anxious when talking to people and giving presentations that
hindered advancement in his career, which he tries to treat with alcohol. He
also has an unspecified depressive disorder, notable for amotivation and
hopelessness, but does not meet criteria for MDD at this time. There is no
concern for psychosis or mania given history.
Plan to admit to psychiatry to get patient’s anxiety and depression under
control prior to engagement with a substance use program given he has been
unsuccessful in such programs in the past due to his anxiety. Patient consented
to starting lexapro, as there is less chance of sexual dysfunction side effect
with this SSRI compared to his previous med, Paxil. Will also order gabapentin
PRN for anxiety/alcohol cravings, consider uptitrating and making standing.
Patient was given librium for alcohol withdrawal at the OSH and WLA ED. Will
contiue librium taper as detailed below. Consider discharging to the
Patient benefits from inpatient hospitalization for stabilization, medication
initiation, and appropriate disposition planning. Will continue LPS hold for DTS
given unable to gather collateral tonight to safety plan.
work (prefers 1:1 therapy rather than group therapy if available), and even
longer residential stay for substance use treatment and continued detox at the
. No withdrawal symptoms, just mild tremor, no hx of DT/sz confirmed.
Insightful into his drinking being a core issue, as well as anxiety and
depression. Denies current SI, plan, intent, or ideation. Doesn’t remember a lot
of what he said to his ex-wife or daughter when he was drunk and saying
everything. Has no recollection of the phrases from his 5150 hold but does admit
that this has happened before and he has been held a few times and hospitalized
briefly (he states 3-4 times). Patient again mentions that he would like to
leave once his hold expires but is open, especially since we are helping him
detox with librium taper and ativan, to stay for treatment and safer discharge
planning voluntarily and does understand that we may extend his hold if we are
concerned for him, but he could contest that if he disagrees and we would
advocate for him staying voluntarily since his SI is resolved, he did not have
any plan/act on a plan at this admission or historically (confirmed with
collateral), and is engaged with treatment. Communicate with RN staff to help
patient get access to his phone such that he can check emails regarding status
of declaration of bankruptcy, since financial stressor and housing issues are
the source of his anxiety right now. Patient ammenable to staying voluntarily
tomorrow and would be open to a DOM consult as well as outpatient mental health
treatment per our recommendations. Confirm he is ammenable to being on lexapro
5mg and will keep us updated if any SE.
Other notes about PPHX:
Med trials: paxil in the 90’s, anxiety was essentially treated (40mg) but then
stopped working a few decades later, had sexual side effects (ED). also tried
and failed celexa, venlafaxine, seroquel.
SHx: He notes that during that same time (2010-ish) when depression meds stopped
working, he began drinking heavily, business with brother (aerospace, describes
very interesting jobs such as helping folger coffee design their lids to
missile/defense work) was going well but then stopped going as well. job loss
early this year followed by evicion 1/1/21.
Fhx: some anxiety
– social anxiety that is crippling since childhood, didn’t like school or pursue
higher education despite being very bright (aerospace engineer, business with
brother), failed group therapy and AA multiple times, very nervous being on
inpatient unit, can’t sleep well
– depression: +amotivation, +anhedonia, +poor motivation, +low energy, +poor
concentration. Appetite is okay. Sleep is impaired due to alcohol use.
-military history: served in the army, persian gulf war, noncombat, ’88-92, no
– denies childhood trauma, neglect, or sexual/emotional abuse though concedes,
“there were ups and downs”
– ex wife, , patient cleared us to speak with her. Ex-wife clarifies
she is a nurse, knows patient very well, married from 1995-2005, has been in
contact with good relationship ever since, their extended families also in good
contact with both of them. Main challenges were alcohol use which she
understands, has helped him detox many times prior. Unfortunately, his
escalating use since around 2010-2013 meant that they had to part ways which has
been a very challenging thing for both of them.
– SOCIAL HISTORY/NATURE OF THIS EVENT OF SI: was texting wife that he just
wanted to die on the night that she called sherrif (texted her), drives truck
into lake, walk into freeway, and so forth. Family members have stopped
listening as this happens whenever he drinks. So far has never done it, but
family members also never know when he will do something. He also says some
hurtful things to family when drunk and ex-wife tells him “we’re not going to
see you until you’re sober”. Binge started on Friday (1/1/21), patient said “if
you don’t come see me I’ll take all my meds” and “am I so bad no one wants to
talk to me?” “I want to drive truck into lake”. Wife texting him, daughter
worried. Patient did not want suicide hotline to talk to him. Next step was to
do a welfare check. Sherrif then talked to family and evaluated patient which
took him to hospital. Per wife, this is usually how it goes, he drinks so much
no one will talk to him and then no one will talk to him anymore.
– SUICIDAL THOUGHTS: suicidal thoughts always come when he is bingeing on
alcohol, “not the first he has been on”
– DEPRESSION: mostly what patient describes, low motivation usually from
spiral/anxiety with worsening substance use.
– ANXIETY: anxiety is the major issue, has been anxious since childhood mostly
social, the alcohol helps to cope/self-medicating to tolerate anxiety,
depression in his 20-30’s, was stable and treated. Of note, patient spirals with
shame and embarassment when re-reading messages he sent while drunk. He has had
long standing anxiety ever since wife knows him, can get spiralled, embarassed.
Fails group therapy because he gets overhwhelmed listening to others’ problems
and hates sharing in front of groups to the point where he leaves. Has left AA
and other groups as a result.
– DEVELOPMENTAL/FORMATIVE HISTORY: very rough childhood growing up per wife,
mother had some emotional problems and took it out on the kids. Patient also has
a lot of guilt with not being involved in older child’s life (oldest daughter
from a previous relationship). Sensitive issue with him.
– SUICIDE ATTEMPTS: never per wife
– LETHAL MEANS: had shotgun when they were married but removed from house after
first hold. No knifes/opiates.
– ALCOHOL: drinking was heavy to begin with when they married 1 year of sobriety
around 4 years ago, major jump in drinking in 2013 which cause business started
to suffer. Also sober summer/thanksgiving-christmas, heavily drinking since
christmas eve with jack daniels bottles all over the place, over the last
weekend had to be out of his apartment due to the eviction, and he left
(beblow is an example of what is needed)
Case Conceptualization Paper
Description of Problem
Jasmine is a 36 year old Caucasian female who presents to the clinic for psychotherapy. She states she has a successful, well-paying career for the past several years as a consultant for McKinsey & Company. Even though she has worked for the same, flourishing company for over 5 years, she’s found herself worrying constantly about losing her job and being unable to provide for her 2 toddler children. This worry has been troubling her for the past 7 months since her colleague and best friend was laid off from the same job. Despite her best efforts, she has not been able to shake the negative thoughts. Ever since the worry started, Jasmine has found herself feeling restless, tired, and tense. She often paces in her office when she is alone. She has even experienced several embarrassing moments in meetings where she has lost track of what she was trying to say. And when she goes to bed at night, it is as if her brain would not shut off and consequently she has trouble sleeping. She finds herself mentally rehearsing all the worse-case scenarios regarding losing her job, including ending up homeless and her children taken away from her. She is now agreeable to help, including medication, if necessary. She denies any thought of wanting to harm herself or others; and denies any visual and auditory hallucinations. Jasmine has psychiatric history of Generalized Anxiety Disorder.
The client’s vulnerabilities
Jasmine grew up with both parents in the house. She always felt she had to prove herself. Constantly seeking her father’s approval. She is the only child and always believed that her father wished he had a boy instead. She states “he always wanted me in sports and boyish activities. I never wanted to disappoint him which I guess created a lot of anxiety”. Jasmine states whenever she received praise from her daddy, her anxiety subsided. As she got older into her teens, education is more emphasized. Again, she wanted to please her parents so she spent less time with friends, and less time doing activity she enjoyed such as going out with friends. She states her parents were loving but she could not help but think they might not love her if she was not their “perfect” child. Jasmine was raised as a Christian Science which is the belief that prayers alone can cure all illnesses (mental or physical). They do not believe in labeling people with mental illness and/or taking psychiatric medication for extended period of time or even at all. She believes her mom suffered from anxiety but was never formally diagnosed. She remembers her mother worrying a lot and will talk about the same worse-case scenarios over and over. And when her mom was anxious, she had trouble concentrating and sleeping. Jasmine remembers when she was a senior in high school, her father lost his job as an administrator for a big company. As a result, her father became depressed. She states “he lost himself and I lost the strong father I knew”. She left for college and would drink alcohol to ease her anxiety. She never sought help. She did not want to be labeled as “crazy” and placed on medication for ‘crazy people” as sometimes she will often hear people say.
The client’s triggers
One of Jasmine’s colleagues at work, who happens to be her best friend was laid off “improper conduct” 7 months ago. She states no one saw it coming and it caught everyone by surprise. Since that particular incident, work has been more stressful. She feels as if all eyes are on her. She feels as though she has to work harder or else she would lose her job. Furthermore, because of her anxiety, she is not able to perform at a confident level resulting to performance anxiety. She has been drinking more caffeine than usual about 4 cups daily to stay awake. Consequently, the increase caffeine use result to jittery hands, palpitation and inability to get sound sleep. She then uses alcohol and over the counter sleep medication, Nyquil which does not help her stay asleep. Jasmine states she has decreased appetite and food seems unappealing. “I’m constantly worrying, thinking negative thoughts about losing my job, my kids and being homeless. And then I worry about my worries”.
Jasmine is afraid of success because she believes that “what goes up must come down. It is the rule of life”. She believes she is at the height of her career perhaps and now it is only a matter of time that she “drops” just like her best friend at work and others she believes has had the same fatal outcome. Jasmine believes there is “something wrong with me”. She feels like she can never get a break from her negative thought process. She states “I am flawed. It seems like I can never been happy or make others happy”. She states she has always felt this way since childhood believing that her father always wished she was a boy. She believes she suffers from low self-esteem. She has trouble developing close intimate relationship. For example, she states the reason why her 3 year old married failed was because it was easier to her not to connect fully to him than to connect and he see how really flawed she is. She believes he saw that “flaw” in her anyway. Jasmine believes “you have to be happy to be liked”. She believes having negative thoughts makes her “unlovable” and “nobody likes a worry wart”
The most central thoughts client is avoiding
Since her childhood, she has never felt that she was not good enough. She believed she was born the wrong sex because her father’s dream was to have a boy and her mother could not have more children. She constantly sought the approval of her father and others. She never fully was validated and therefore would worry a lot thinking others did not like her or see her as good enough. She remembers having to work extra hard at her current job. She states she has to struggle for everything in her life. And even she has to work extra hard to relate to others. She remembers having a decent childhood and her dad having success career, marriage until her father lost his job.
Social Anxiety Disorder
According to the DSM-5, (Diagnostic and Statistical Manual of Mental Disorders, fifth edition), there are a total of ten diagnostic criteria for Social Anxiety disorder:
The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.
Adjustment Disorder with anxiety DSM 5 criteria (Adjustment Disorder, 2019)
A. The development of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s).
B. These symptoms or behaviors are clinically significant, as evidenced by one or both of the following:
Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation.
Significant impairment in social, occupational, or other important areas of functioning.
C. The stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder.
D. The symptoms do not represent normal bereavement.
E. Once the stressor or its consequences have terminated, the symptoms do not persist for more than an additional 6 months.
Generalized Anxiety Disorder
Patient appears to have Generalized Anxiety Disorder (GAD) as evidenced by persistent excessive anxiety about many aspects of her life and having difficulty controlling her worrying for 8 months about losing her job and ability to care for her children. There is no specific threat present and it is disproportionate to the actual risk. She is anxious most of her waking hours. She has at least 3 of the symptoms associated with GAD affecting her physically and cognitively. She expresses somatic complaints such as restlessness, tense and fatigue. She experiences impaired concentration at work, her mind going blank and losing her train of thought. She has trouble falling sleeping because she is unable to shut her mind down at night ruminating on the worse as scenario of losing her job. As a result she is more fatigued than usual.
Her symptoms are not caused by a direct effect of a substance or another mental disorder or medical condition. Her symptoms cause significant social and occupational dysfunction.
Jasmine states she drinks beer to cope with her anxiety. She states it has been a habit to drink a minimal of one or two beers before going to bed. She states it worked for a while, at least she could sleep. But now, drinking is not working anymore and I don’t want to go to work drunk. She states she has tried to be responsible with her drinking. She never drinks in front of the kids and never let alcohol affect her job. She mentioned walking, doing some deep breathing activities, and guided imagery she discovered on the internet but does not find any of them beneficial anymore.
The most effective treatment approach combines psychotherapy and pharmacotherapy. Cognitive Behavioral Therapy (CBT) is the gold standard of psychotherapy and one of the most popular treatments for Generalized Anxiety Disorder (GAD). The overall goal is to frequency, intensity, and duration of the anxiety so that daily functioning is not impaired. With 12 weeks, there are numerous objectives alongside interventions developed to aid Jasmine in reducing or alleviating her anxiety. She will learn and implement coping skills that result in a reduction of anxiety and worry, and improved daily functioning. This will be achieved by teaching calming and relaxation skills such as applied relaxation, progressive muscle relaxation, cue-controlled relaxation; mindful breathing; biofeedback and how to discriminate better between relaxation and tension. With the advent of smartphone technology and the rising popularity of interactive applications, Jasmine can benefit from the electronic self-help options that deliver programs informed by evidence-based GAD treatment. There are also applications available with circumscribed, do-it-yourself anxiety-busting tools, like relaxation techniques and mindfulness meditation exercises. She will be taught how to apply these skills to her daily life. To measure progress, Jasmine will be assigned homework each session in which she will practice relaxation exercises daily, gradually applying them progressively from non-anxiety provoking to anxiety-provoking situations. The staff will then review and reinforce success while providing corrective feedback toward improvement.
Jasmine will learn and implement a strategy to limit the association between various environmental settings and worry, delaying the worry until a designated “worry time. She will be taught how to recognize, stop, and postpone worry to the agreed-upon worry time using skills such as thought stopping, relaxation, and redirecting attention. Jasmine will be encouraged to use this skill in daily life. The staff review and reinforce success while providing corrective feedback toward improvement. Jasmine will be able to verbalize an understanding of the role that cognitive biases play in excessive irrational worry and persistent anxiety symptoms. The staff will assist Jasmine in analyzing her worries by examining potential biases such as the probability of the negative expectation occurring, the real consequences of it occurring, her ability to control the outcome, the worst possible outcome, and her ability to accept it. Jasmine will be taught to identify, challenge, and replace biased, fearful self-talk with positive, realistic, and empowering self-talk. Staff will explore jasmine schema and self-talk that mediate her fear response; and assist her in challenging the biases; and replacing the distorted messages with reality-based alternatives and positive, realistic self-talk that will increase her self confidence in coping with irrational fears. Jasmine will be assigned a homework exercise in which she identifies fearful self-talk, identifies biases in the self-talk, generates alternatives, and tests through behavioral experiments.
Other Modality of therapy will explored such as Acceptance and Commitment Therapy (ACT) which is another present- and problem-focused talk therapy used to treat GAD. Although similar to CBT, the goal of ACT is to reduce the struggle to control anxious thoughts or uncomfortable sensations and increase involvement in meaningful activities that align with chosen life value. Psychodynamic psychotherapy, also known as insight-oriented therapy is another modality that can be explored. It is based on the idea that thoughts and emotions that are outside of our consciousness (i.e., outside of our awareness) can lead to internal conflict and manifest as anxiety. Psychopharmacology works will with psychotherapy. Jasmine is agreeable to medication and will be prescribed Lexapro 10 mg daily. Lexapro is a SSRI. SSRI stands for Selective Serotonin Reuptake Inhibitor. SSRI antidepressants are a type of antidepressant that work by increasing levels of serotonin within the brain. Serotonin is a neurotransmitter that is often referred to as the “feel good hormone”. It carries messages between brain cells and contributes to well-being, good mood, appetite, as well as helping to regulate the body’s sleep-wake cycle and internal clock. SSRIs increase levels of serotonin in the brain by preventing the reuptake of serotonin by nerves. Having more serotonin available in the nerve synapse means that it can transmit messages easier (Fookes, 2018). Jasmine will return weekly for treatment assessment and effectiveness.
Adjustment Disorders (2019). Traumadissociation.com. Retrieved from:
American Psychiatric Association. (2013). Social Anxiety Disorder. Diagnostic and Statistical
Manual of Mental Disorders. (5th Edition). Washington, DC.
Generalized Anxiety Disorder Treatment (2019). Retrieved from:
Fookes, C. (2018). Selective Serotonin reuptake inhibitor. Retrieved from:
SAMPLE TREATMENT PLAN ANXIETY. Retrieved from
Why Choose Us
Top quality papers
We always make sure that writers follow all your instructions precisely. You can choose your academic level: high school, college/university or professional, and we will assign a writer who has a respective degree.
Professional academic writers
We have hired a team of professional writers experienced in academic and business writing. Most of them are native speakers and PhD holders able to take care of any assignment you need help with.
If you feel that we missed something, send the order for a free revision. You will have 10 days to send the order for revision after you receive the final paper. You can either do it on your own after signing in to your personal account or by contacting our support.
All papers are always delivered on time. In case we need more time to master your paper, we may contact you regarding the deadline extension. In case you cannot provide us with more time, a 100% refund is guaranteed.
Original & confidential
We use several checkers to make sure all papers are plagiarism-free and do not share them with third parties.
24/7 Customer Support
Our support agents are available 24 hours a day 7 days a week and committed to providing you with the best customer experience. Get in touch whenever you need any assistance.
Try it now!
How it works?
Follow these simple steps to get your paper done
Place your order
Fill in the order form and provide all details of your assignment.
Proceed with the payment
Choose the payment system that suits you most.
Receive the final file
Once your paper is ready, we will email it to you.
No need to work on your paper at night. Sleep tight, we will cover your back. We offer all kinds of writing services.
You are welcome to choose your academic level and the type of your paper. Our academic experts will gladly help you with essays, case studies, research papers and other assignments.
Admission help & business writing
You can be positive that we will be here 24/7 to help you get accepted to the Master’s program at the TOP-universities or help you get a well-paid position.
Editing your paper
Our academic writers and editors will help you submit a well-structured and organized paper just on time. We will ensure that your final paper is of the highest quality and absolutely free of mistakes.
Editing your paper
Our academic writers and editors will help you submit a well-structured and organized paper just on time. We will ensure that your final paper is of the highest quality and absolutely free of mistakes.