Case Of Sampling Date October Identifying Demographics

Case Ofsampaguitaintake Date October Xxxxidentifyingdemographic Data

Case Ofsampaguitaintake Date October Xxxxidentifyingdemographic Data

CASE of SAMPAGUITA Intake Date: October xxxx IDENTIFYING/DEMOGRAPHIC DATA: Sampaguita is a 29-year-old female from the Philippines. She is employed as a nurse at a local hospital. She lives by herself in an apartment close to where she works. CHIEF COMPLAINT/PRESENTING PROBLEM: Sampaguita was referred to treatment by her primary care physician. HISTORY OF PRESENT ILLNESS: Sampaguita had unusual and dramatic presentation of symptoms that defy any conventional medical understanding. When other symptoms resolved new emergence of other unusual symptoms would present themselves. Her primary care physician then referred her for therapy. PAST PSYCHIATRIC HISTORY: Sampaguita presented in the ER 5 years ago after an overdose. Sampaguita reported that she has had repeated overdoses and has slashed her wrist several times since she was 16 years old. SUBSTANCE USE HISTORY: Sampaguita reports use of many different drugs. She does not obtain them from the street but sneaks them from the hospital that she works at. It was suspected that the use of these drugs were to promote illness at noted in the PCP notes. PAST MEDICAL HISTORY: The report from her primary care indicated Sampaguita was always eager to undergo procedures or testing or to recount symptoms. She was reluctant to give access to collateral sources of information (i.e., refusing to sign releases of information or to give contact information for doctors). Since her parents are in the medical field the physician was able to obtain a release form for the parents. There was an extensive medical history including multiple drug allergies. She seemed to have the ability to forecast unusual progression of symptoms or unusual response to treatment. Sampaguita was very angry about the referral and wondered why her PCP was abandoning her. FAMILY HISTORY INCLUDING MEDICAL AND PSYCHIATRIC: Sampaguita’s parents integrated from the Philippines when she was 2 years old. Both parents are doctors and very successful. Sampaguita has two younger sisters, 27 and 25 years old. The three girls were raised by different nannies throughout their lives since their parents were very busy building the radiologist business. There were several different nannies since several were found to be abusive. The parents were rarely around and paid very little attention to the three girls. There were 3 or 4 times that Sampaguita ended up being hospitalized when she was very young. She found hospital workers (e.g., doctors, nurses, and hospital workers) to be loving and caring and never wanted to leave the hospital to return home. CURRENT FAMILY ISSUES AND DYNAMICS: Sampaguita’s parents are very concerned about Sampaguita’s illnesses since they do not see any present illness. In one of Sampaguita hospitalizations she was found to be carrying a list of symptoms of several disorders in her handbag. Her parents did believe that Sampaguita was able to simulate, induce, and aggravate her illnesses. The parents report Sampaguita being very moody since she was a teenager and always causing havoc in the family. Sampaguita has been in several relationships and is promiscuous but they are always short term and very volatile. There were several times she told her partners she was pregnant which never turned out to be true. MENTAL STATUS EXAM: Sampaguita is a well dressed 29-year-old who looks younger than her stated age. There were no perceptual disturbances noted. She was very cooperative in the intake, describing all her physical symptoms that did not look apparent to the social worker. Her mental state was normal. Sampaguita has a very poor self-image or sense of self. She was oriented to time, place, and person.

Paper For Above instruction

In this paper, I will critically analyze the psychiatric case of Sampaguita, a 29-year-old Filipino woman presenting complex mental health issues characterized by somatic complaints, possible psychodynamic factors, and trauma history. The case highlights diagnostic challenges and therapeutic considerations that merit a thorough exploration of her psychosocial background, symptomatology, and treatment strategies rooted in evidence-based mental health practices.

Introduction

Sampaguita’s case exemplifies the multifaceted nature of psychiatric diagnosis, especially when symptoms are atypical and resistant to conventional treatment approaches. Her history of recurrent somatic complaints, numerous hospitalizations during childhood, substance misuse, and familial dynamics suggests a possible underlying personality disorder, somatoform disorder, or factitious disorder. Understanding these complexities necessitates a multidimensional analysis incorporating developmental, biological, psychological, and social perspectives.

Developmental and Family Background

Sampaguita’s early childhood was marked by emotional deprivation and neglect, primarily due to her parents’ busy professional lives and the inconsistent caregiving from multiple nannies. The trauma of frequent hospitalizations as a child, where she experienced affection and care, likely contributed to her current health-seeking behavior and attachment to hospital environments. Her family’s medical background and affluent status may also influence her health perceptions and help-seeking patterns. Her history of hospital admissions at a young age could be indicative of early development of somatic symptom presentation or a form of psychogenic illness, rooted in unmet emotional needs and attachment disruptions.

Symptomatology and Diagnostic Considerations

Sampaguita’s presentation involves persistent physical complaints, a pattern of drug misuse, and manipulative behaviors such as carrying symptom lists and expressing anger about her treatment. The absence of perceptual disturbances and her cooperative mental status may initially suggest somatoform disorder, particularly somatic symptom disorder. However, her history of feigning or inducing symptoms to gain medical attention could also point towards factitious disorder or malingering. Differential diagnosis would include borderline personality disorder with histrionic features, given her volatile relationships and labile mood, as well as possible substance use disorder complicating her clinical picture.

The family’s assertion that she can simulate and induce illnesses suggests the importance of considering factitious disorder imposed on self (Munchausen syndrome). Her expressed anger toward her primary care physician and her eagerness for medical procedures might further support this hypothesis. It is also essential to evaluate her mood, cognition, and personality functioning comprehensively to formulate an accurate diagnosis.

Treatment Implications

Effectively addressing Sampaguita’s complex presentation requires an integrated treatment plan that may include psychotherapy, pharmacotherapy, and family interventions. Psychotherapeutic approaches such as dialectical behavior therapy (DBT) or mentalization-based therapy could be beneficial in managing mood instability and relational difficulties. Addressing underlying trauma, emotional regulation, and establishing trust are pivotal. Moreover, coordination with medical providers is crucial to prevent unnecessary procedures and to manage her somatic complaints appropriately.

Conclusion

Sampaguita’s case underscores the importance of a comprehensive biopsychosocial approach in psychiatric assessment and treatment. Her past trauma, family dynamics, personality structure, and symptom patterns necessitate a nuanced, patient-centered strategy that prioritizes validation, psychoeducation, and safety. Future interventions should focus on building a therapeutic alliance, exploring the roots of her illness behaviors, and promoting adaptive coping strategies to improve her overall functioning and quality of life.

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