ALEXANDRA KATSAROS
Alexandra Katsaros: An iHuman Case Review
Subjective
Chief Complaint
“I was feeling overwhelmed”
HPI
Alexandra is a 22-year
... [Show More] old female who presented to the emergency department by
her ex-boyfriend after a witnessed consummation of alcohol, alprazolam, and
acetaminophen with diphenhydramine. The couple had been having an argument
regarding their recent breakup. Prior to ingesting the medications, she had be
smoking marijuana, drinking beer as well as hard liquor. Afterwards, she went
home and had the fight. Initially, she ingested four acetaminophen with
diphenhydramine followed by two 1 mg alprazolam in an attempt to go to sleep.
Alexandra denies wanting to harm herself and suicidal ideations. She denies
homicidal ideations. States she is overwhelmed due to the stressful breakup due to
not having separate living accommodations. Alexandra also reports symptoms of
anxiety, insomnia, headaches, poor concentration, and muscle tension. The poor
concentration has affected two other areas of her live, school and work. She has a
valid prescribed for alprazolam for insomnia as needed.
Past Medical History
Hypothyroidism
Psychiatric History
Previous depression in high school with no psychopharmacologic support.
Possible undiagnosed ADHD based on instructor observation. Denies physical,
verbal, or sexual abuse. Avoiding social life. No family psychiatric history.
Surgical History
None
Obstetric History
G0P0
Family History
No significant family history.
Social History
Status: Community college student taking basic health science classes. Works in
an art gallery 5 hours per week.
Lives with mom and two sisters.
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ALEXANDRA KATSAROS
Religion: Catholic
Alcohol: Drinks a few beers a few nights per week.
Sexual activity: Not disclosed.
Denies illicit drug use.
Hospitalizations
None
Medications
Prescription: Xanax-PRN insomnia; Synthroid- daily hypothyroidism
OTC: None
Herbal or Complementary: None
Allergies
No known allergies
Preventative Health
Immunizations up to date
ROS negative with exception of
What is noted in the HPI
Objective
VITALS
P-72; R-20; BP 120/80; BMI- 20.5 kg/mS
Physical Exam within normal limits except
Charcoal stained mouth due to gastric lavage.
Diagnostic Tests
CBC, CMP, thyroid function tests, urine drug screen, urine hCG, blood alcohol
concentration (BAC), and acetaminophen (APAP) blood, salicylate all normal
except
UDS: POSITIVE for BENZOS
BAC: POSITIVE 164 MG/DL= 1.64 %, which is more than twice the
legal limit
Mental Status Exam
Appearance
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ALEXANDRA KATSAROS
Unkept appearance. Charcoal stained mouth. Thinning hair.
Manner and Approach
Interpersonal Characteristics and Approach to Evaluation:
Cooperative, restless
Eye Contact: Direct, looks away at times
Speech:
Expression: Spontaneous
Comprehension: Normal
Speech Form: Normal
Paraphasias: None
Recall and Memory: Intact for recent and remote
Motor: Hypoactive
Orientation, Alertness, And Thought Processes
Orientation: person and place, time; presidents- Not assessed
Alertness: Alert
Coherence: Coherence and easy to understand
Thought Processes:
Content: Worries about relationship situation and living situation
Risk: None
Hallucinations and Delusions
Judgment and Insight: Good
Intellectual Ability: Roughly average
Attention and Speed: Normal
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ALEXANDRA KATSAROS
Impulse Control:
Intrapersonal: Ego syntonic
Delusions: None
Mood and Affect
Mood or how they feel most days: Euthymic
Affect or how they felt in a given moment: Full, Broad and
congruent with mood
Rapport: Easy to establish
Facial and Emotional Expressions: Alert
Suicidal and Homicidal Ideation: Denies
Risk for Violence: None
Response to Failure on Test Items: Unassessed
Impulsivity: Low
Anxiety: None noted on exam
PHQ2/ PHQ9 (Appendix A)
PHQ 2: POSITIVE
PHQ 9: Score = 7 indicative of mild depression
Trouble falling asleep (2), trouble concentrating on
things (2) more than half days- 4
Poor appetite (1), feeling bad about yourself (1), and
fidgety/ restless (1) for several days- 3
GAD-7 (Appendix B)
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ALEXANDRA KATSAROS
Score = 9 indicative of mild anxiety disorder
Feeling nervous, anxious (2); not able to stop worrying (2): over half
the days-4
Worrying too much about different things (1); trouble relaxing (1);
being so restless that it’s hard to sit still (1); becomes easily irritable
(1); feeling afraid as if something awful is going to happen (1): for
several days-5
AUDIT (Appendix C)
Score approximate a 9 indicative of possible harmful or hazardous
drinking
Someone having concerns about drinking (4)
Drinking 2-3 times per week (3)
Typical days of drink 3 or 4 (1), Feeling guilty about drinking (1)
Six or more drinks on one occasion (0), Unable to stop drinking
(0), Failed to complete tasks due to drinking (0), Needed a morning
drink to get going after heavy drinking (0), Unable to remember
what happened the night before (0), injured self or others (0).
Assessment
Adjustment disorder with anxiety and conduct disturbance
Diagnostic Criteria:
Development of emotional of behavioral symptoms in response to an
identifiable stressor within 3 months of onset of stressor with one or both of the
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ALEXANDRA KATSAROS
following distress that is out of proportion to the severity or intensity of the
stressor or significant impairment in social, occupational, or other important areas
of functioning; stress-related disturbance not meeting criteria for another mental
disorder or exacerbation; does not represent normal bereavement; once the stressor
or its consequences are terminated the symptoms do not persist more than 6
months. There is both emotional and a disturbance of conduct present (American
Psychiatric Association, 2013; O’Donnell, Agathos, Metcalf, Gibson, & Lau,
2019; & Zelviene & Kazlauskas, 2018).
Differential Diagnosis
Adjustment disorder with anxiety and conduct disturbance F43.25
Acute stress disorder F43.0
Major depressive disorder F33.1
Social Anxiety disorder F40.11
Alcohol use disorder F10.9
Benzodiazepine use disorder F13.2
Borderline personality disorder F60.3
Obstacle for treatment: Patient has a may not recognize adjustment
disorder as an issue. Doesn’t think drinking is not really a concern
because she only drinks 2-3 times a week. She perceives that she
was just trying to get some sleep and that this combination of drugs
and alcohol is not an issue. [Show Less]