Author Question: A patient who has been pacing rapidly for the past hour cannot immediately be located on the unit. ... (Read 89 times)

codyclark · **on:** Jul 19, 2018

A patient who has been pacing rapidly for the past hour cannot immediately be located on the unit. When he is found, he is in his closet, rocking back and forth rapidly and talking rapidly to himself.

When staff approach, he only seems to notice them momentarily, then leaves his room and begins running up and down the hallway. Which of the following interventions should be attempted at this point? a. I want you to breathe deeply as I do, in slowly, now hold it, now breathe out..
b. I have some medicine that will calm you; would you like it by pill or in a shot?
c. In a calm but direct voice say: Stop running. I will stay with you. Walk with me..
d. Gather a show of force and say: You need to come with us now to seclusion..

Question 2

A patient states, I feel detached and weird all the time. It's as though I'm looking at life through a cloudy window. Everything seems unreal. It really messes up things at work and school..

This presentation is most consistent with the DSM-IV-TR criteria for: a. depersonalization disorder.
b. body dysmorphic disorder.
c. dissociative amnesia.
d. malingering.

zacnyjessica · **Reply #1 on:** Jul 19, 2018

Answer to Question 1

C
The patient's behavior is consistent with a panic level of anxiety. Calm, brief, directive verbal instructions can help such patients gain control of overwhelming feelings and impulses. Patients experiencing panic-level anxiety are unable to focus and integrate new information into memory, making teaching likely to be ineffective until their anxiety is reduced. Antianxiety medications and seclusion would be a back-up intervention if verbal interventions fail. However, although providing an opportunity for the patient to participate in decisions about his care is usually desirable, asking the patient to choose the route of medication to be used at a time when understanding and decision making are impaired is not therapeutic. Seclusion could be interpreted as punishment or perceived as a threat, and in turn heighten his fear and panic; it should be reserved for situations when all other options have failed or no other intervention can provide acute safety needs.

Answer to Question 2

A
The DSM-IV-TR description of depersonalization disorder states that it involves a persistent or recurrent experience of feeling detached from and outside one's mental processes or body. Although reality testing is intact, the experience causes significant impairment in social or occupational functioning and distress to the individual. Body dysmorphic disorder involves preoccupation with a body part the individual believes to be distorted. Dissociative amnesia involves memory loss. Malingering is a conscious effort to deceive others, often for financial gain, by pretending to have physical symptoms.