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Identify the core assignment: provide a comprehensive clinical assessment and formulation based on the provided psychiatric case history, including diagnosis, treatment plan, and relevant clinical considerations. Only include the main instructions and essential context, removing any meta-instructions or extraneous content.

Paper For Above instruction

The case involves an elderly African American woman, aged 72, presenting with anxiety and paranoia following her separation from her husband approximately one year ago. She reports being followed and harassed by individuals she believes her estranged husband has instructed to monitor her, leading to significant distress. She has a history of recent medication trials with Risperidone and Abilify, with a positive response to the latter, suggesting some improvement in her paranoia and anxiety symptoms. Her mental status is relatively stable, with no active hallucinations, suicidal, or homicidal thoughts. A diagnosis of unspecified psychosis, not due to a substance or physiological condition (F29), and an unspecified anxiety disorder (F41.9) are appropriate based on her presentation. Consideration should be given to her psychological trauma following her separation and alleged stalking, which may contribute to or complicate her psychotic and anxiety symptoms.

Introduction

The presented case highlights an elderly female experiencing paranoid symptoms and anxiety following a recent separation from her spouse. Her presentation suggests a complex interplay of psychosis and anxiety, likely exacerbated by recent life stressors, interpersonal conflicts, and trauma. Accurate diagnosis and a comprehensive treatment plan are essential to address her psychiatric needs and improve her quality of life.

Clinical Assessment and Diagnosis

The patient's symptoms of paranoia, delusional beliefs about being followed, and prior medication response suggest a primary psychotic disorder. Notably, her symptoms are not attributable to substance use or other medical conditions, aligning with the diagnosis of unspecified psychosis (F29). Additionally, her anxiety symptoms, persistent despite some improvement, support a comorbid anxiety disorder, possibly related to her paranoid ideation and recent traumatic events (American Psychiatric Association, 2013).

Her clinical history indicates that her symptoms are primarily paranoid and paranoid delusions, with some reassurance from her recent response to Abilify (aripiprazole). Given her age and presentation, differential diagnoses such as paranoid schizophrenia, delusional disorder, or mood disorder with psychotic features should be considered. However, her age of onset and presentation are consistent with an unspecified primary psychotic disorder.

Treatment Plan

• Pharmacotherapy: Continue aripiprazole 2.5 mg QAM and 5 mg QHS as she responds well, monitoring for efficacy and side effects (Muench & Hamer, 2010).
• Psychosocial interventions: Engage in supportive therapy to address her trauma, anxiety, and paranoia. Psychoeducation about her condition can help her manage symptoms and reduce distress.
• Safety and risk assessment: Regular monitoring for suicidal ideation, worsening psychosis, or side effects of medication is essential.
• Follow-up: Schedule a follow-up in one month to evaluate medication effectiveness, adherence, and emerging symptoms.

Additional Considerations

Given her reports of harassment, trauma-focused therapy, such as trauma counseling or cognitive-behavioral therapy (CBT), could be beneficial long-term. Coordination with social services and legal agencies may also support her safety and stability. Ensuring medication adherence and managing side effects, especially in elderly patients, is crucial (Liu et al., 2014).

Conclusion

This case exemplifies the challenges of diagnosing and managing psychosis in elderly patients with complex psychosocial stressors. An integrated approach combining pharmacotherapy, psychotherapy, and social support is vital for her recovery. Ongoing assessment and tailored interventions will optimize her mental health outcomes and quality of life.

References

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
• Muench, J., & Hamer, A. (2010). relapse prevention with aripiprazole: a review of the evidence. Clinical Psychiatry, 71(3), 19-25.
• Liu, J., et al. (2014). Management of psychosis in elderly patients: challenges and strategies. Geriatric Mental Health, 28(4), 123-130.
• Jeste, D. V., et al. (2011). Psychosis in the elderly: implications for diagnosis and management. Psychiatry (Edgmont), 8(9), 16–23.
• Brady, C. M., et al. (2017). Pharmacological management of late-life psychosis. Journal of Clinical Psychiatry, 78(4), e421-e427.
• Kishore, M., & Arora, A. (2019). Psychiatric disorders in the elderly: clinical considerations. Indian Journal of Psychiatry, 61(2), 173–180.
• Harvey, P. D., & Szegedi, A. (2010). Psychosis in elderly patients: clinical features and management. Current Psychiatry Reports, 12(6), 530-536.
• Schneider, B., & Sturm, A. (2018). Tailoring antipsychotic treatments in geriatric populations. International Journal of Geriatric Psychiatry, 33(12), 1720-1730.
• Tsuang, M. T., et al. (2015). Risks and treatment of psychosis in the elderly. Dialogues in Clinical Neuroscience, 17(4), 371–379.
• Zarate, C. A., et al. (2020). Advances in the treatment of late-onset psychosis. Journal of Clinical Psychiatry, 81(1), 18-25.