Simulation 7 Flashcards
(34 cards)
As a psychiatric consultant for a county jail facility, you were called to evaluate an inmate for possible alcoholism and withdrawal symptoms. Tony was a 42-year-old advertising executive who was arrested for driving under the influence (DUI). His Highway Patrol-administered breathalyzer test estimated his blood alcohol level to be 0.09%—just slightly over the 0.08% limit in his state. He did not manage to produce bail, as the accident resulted in injuries and a commensurately high bond. He was contesting the arrest, and was incarcerated for some 36 hours. Jail staff noted that his hands seemed to be tremulous, and he presented as agitated, irritable, and moody. Concerned that his symptoms might escalate, you were called to evaluate his situation.
As a psychiatric consultant for a county jail facility, you were called to evaluate an inmate for possible alcoholism and withdrawal symptoms. Tony was a 42-year-old advertising executive who was arrested for driving under the influence (DUI). His Highway Patrol-administered breathalyzer test estimated his blood alcohol level to be 0.09%—just slightly over the 0.08% limit in his state. He did not manage to produce bail, as the accident resulted in injuries and a commensurately high bond. He was contesting the arrest, and was incarcerated for some 36 hours. Jail staff noted that his hands seemed to be tremulous, and he presented as agitated, irritable, and moody. Concerned that his symptoms might escalate, you were called to evaluate his situation.
What was Tony’s blood alcohol level according to the breathalyzer test?
0.09%
This is slightly over the 0.08% limit in his state.
How long was Tony incarcerated?
36 hours
What symptoms did jail staff observe in Tony?
Tremulous hands, agitation, irritability, moodiness
What is ‘essential tremor’?
A neurological disorder of unknown etiology that produces involuntary shaking, especially of the hands.
What was Tony’s claim regarding his alcohol consumption?
He insisted he is normally only a moderate drinker.
What key information is relevant for formulating a provisional DSM diagnosis?
- Medical history
- Employment history
- Alcohol abuse history
- Educational history
- Psychiatric history
- Substance abuse history
- Current prescription medications
- Legal history
What did Tony deny regarding his psychiatric history?
He denied any past psychiatric history or medications.
What medication did Tony occasionally use for anxiety?
Xanax (Alprazolam)
What did Tony’s wife report about his drinking habits?
He seemed to be drinking more than usual lately.
What is the definition of ‘moderate alcohol consumption’ according to the Dietary Guidelines?
Up to one drink per day for women and up to two drinks per day for men.
What could benzodiazepine withdrawal mimic?
Symptoms of alcohol withdrawal.
What was Tony’s initial diagnosis indicated by the cumulative information?
Illness, unspecified (R69)
What were the symptoms that indicated a deterioration in Tony’s condition?
- Increased tremulousness
- Sweating
- Tachycardia
- Agitation
- Confusion
- Anxiety
- Hallucinations
Which diagnosis was NOT indicated for Tony based on the information provided?
Alcohol Dependence with Withdrawal, unspecified (F10.239)
What are the criteria for substance use disorder?
Recurrent episodes of arrests or other maladaptive events secondary to substance use.
What was the most appropriate primary and secondary provisional diagnosis based on Tony’s condition?
- Alcohol Dependence with Withdrawal Delirium (F10.231)
- Alcohol Dependence with Alcohol-Induced Psychotic Disorder with Hallucinations (F10.951)
What is the diagnosis code for Alcohol Dependence with Alcohol-Induced Psychotic Disorder with Hallucinations?
F10.951
This diagnosis is made only when delusions or hallucinations are severe enough to warrant independent clinical attention.
Under what condition is Alcohol Dependence with Withdrawal Delirium diagnosed?
When cognitive symptoms exceed those usually associated with withdrawal syndrome
Symptoms must be severe enough to warrant independent clinical attention.
What are the criteria for diagnosing Alcohol Abuse, uncomplicated?
1) Signs of withdrawal
* 2) Increasing drinking
* 3) Impact on social/occupational/recreational activities
* 4) Continued use despite negative consequences
Only three criteria are required for diagnosis.
What is the primary diagnosis indicated for the client experiencing withdrawal symptoms?
Alcohol Withdrawal (F10.239)
Criterion A and five items from Criterion B must be met for this diagnosis.
What is the diagnosis code for Sedative, Hypnotic, or Anxiolytic Use, unspecified?
F13.90
There is insufficient evidence to warrant the application of this diagnosis.
Is Sedative, Hypnotic or Anxiolytic Dependence with Withdrawal Delirium indicated for the client?
No
There is insufficient evidence to apply this diagnosis.
What is required for the diagnosis of Brief Psychotic Disorder (F23)?
Psychotic symptoms must not be due to direct physiological effects of a substance or a general medical condition
In this case, alcohol explains the hallucinations.
