week 13 journal

27-year-old male presents to the clinic complaining of excessive worrying about  multiple issues. He reports feeling uncomfortable, easily fatigued, having trouble  concentrating, sleep disturbance, muscle tension, and irritability, having a feeling  of “panic attack”.  Diagnosed with ADHD as an adolescent, currently on Ritalin 5  mg Po daily, but feeling that his mental illness is getting worse day by day. History  of anxiety, depression Hep C, PTSD.  His main complaint is vague pain all over his  body requesting prescription for Oxycontin or Percocet.  Referred by a worried  friend to the clinic.    General appearance appropriate eye contact.  Engaged in interview.  Linear  thought process.  voiced that he is taking recreational drugs, is a heavy smoker  but denied drinking at this time.  Previously drinking 2 pints of vodka per day.  VS  with BP slightly elevated and HR on 50’s. toxicology screen done to know if he is  other drugs before prescribing any more medications and avoid any drug-to-  drug interactions. Urine came back positive for benzodiazepine and Fentanyl  presumption.   Although pain is defined as a subjective experience upon observations patient  did not show any acute sign of pain.  Question if he has drug seeking behavior.   Became very irritated when asked why he is looking for opioid pain medication  prescription. This behavior signals that she has developed a dependence to  substances, which is the “physiological adaptation” over time to the drug (Stahl,  2017).  On the other hand, we must consider that SUDs and other psychiatric and  medical diseases occur comorbidly.   We can cite depression, anxiety, attention-  deficit hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), and  antisocial disorders amongst others (National institutes of health, 2020).  Therefore, his panic attack feeling may be a precursor to him seeking more  medication to self-medicate  His attitude towards substance use was discussed, willingness or readiness to  change was assessed.  For management of his generalized muscle pain, he was  recommended physical therapy, considering his drug abuse state, it would be  safer to treat his pain with non-opioids (Trasolini, McKnight & Dorr, 2018).  Therefore, he was advised to take over the counter Tylenol 975 mg every 6 hours.   To manage his anxiety and lack of sleep, sertraline 25mg PO and increase it to 50  mg maximum as needed.   Sertraline is a selective serotonin reuptake inhibitor  (SSRIs) and has less serious side effects and low chances of an overdose,  including a lack of abuse potential (Stahl, 2017).  We also offer addiction counseling, and, in the event, he wanted to give it a try,  the importance of having supports in place to fight addiction.  He reported he  has friends in recovery and just needs “to pick the 1000lb” phone and call them.   We also explained resources available like rapid recovery coach in case things  become unbearable for him.  He willingly took the contact number.     Agreed with the plan as documented  Will continue  Ritalin 5 mg daily  Gabapentin 800 mg tab  Wellbutrin 150 mg every 12 hrs.  Referral for Physical therapy to manage generalized muscle pain  Referral to addiction clinic   References  National Institutes of health. (2020, April). National institute on Drug Abuse. The  Connection Between Substance Use Disorders and Mental Illness.  https://www.drugabuse.gov/publications/research-reports/common-  comorbidities-substance-use-disorders/part-1-connection-between-  substance-use-disorders-mental-illness  Stahl, S. M. (2017). Stahl’s essential psychopharmacology: Neuroscientific basis  and practical applications (4th ed.). Cambridge University Press.   Trasolini, N. A., McKnight, B. M., & Dorr, L. D. (2018). The opioid crisis and the  orthopedic surgeon. The Journal of arthroplasty, 33(11), 3379-3382.