CASE HISTORY FOR HUS 308 SPRING 2024 Adriana Grande IDENTIFICATION: The patient is a 28-year-old, single, white female in amonogamous relationship, residing with her boyfriend. She experienced aseizure-like episode while at her primary care physician's office, and wasbrought to the Emergency Department by EMS shortly thereafter. She isseen for the psychiatric evaluation while hospitalized on a medical floor bythe consult liaison psychiatric nurse practitioner. CHIEF COMPLAINT: "I feel sick to my stomach and my anxiety andflashbacks are so bad that my whole body starts shaking and then I blackout." HISTORY OF CHIEF COMPLAINT: The following information wasobtained from an interview with the patient, an interview with her family, areview of her medical records, and collateral information from the medical Staff. PAST PSYCHIATRIC HISTORY: The patient was voluntarilyhospitalized in January 2015 for suicidal ideation. She denies a history ofactual suicide attempts. Posthospitalization, she started seeing a psychiatriston an outpatient basis with a diagnosis of bipolar II disorder and posttraumatic stress disorder (PTSD) secondary to sexual abuse. The client was violently raped as she entered college at age 19. She had also had multiple outpatient treatments at trauma specialty facilities. HISTORY OF DRUG OR ALCOHOL ABUSE: Reports cannabis andheroin use starting at age 20 to manage her PTSD symptoms, and alcohol. Cannabis: The patient reports that she smokes one to three marihuana cigarettes approximately 3 times per week, with the last use 1 day before admission. Heroin: The client had some short periods of remission, the last was during Spring 2022. However, her symptoms of PTSD intensified and she picked up heroin again in Summer 2023. Alcohol: The client stated that she drinks mostly alone at home, vodka or wine, sometimes every day when she does not work. Her live-in boyfriend does not drink. She had attended several inpatient treatment facilities and intensive outpatient (IOP) programs for her polysubstance abuse with the last admission 2 years ago. FAMILY HISTORY: The patient reports an unremarkable familyupbringing. She is the oldest of three girls. Her mother, sisters, aunts and grandmother have anxiety and depression. She currently liveswith her boyfriend of 2 years in an apartment and she is unemployed. She reports he is very supportive and does not abuse drugs or alcohol, he is also the only breadwinner. PERSONAL HISTORYPerinatal: Uncomplicated pregnancy and vaginal birth. Indicates that hermother did not use drugs or alcohol during her pregnancy. She wasbreastfed for approximately 6 months and then formula fed.Childhood: The patient achieved all developmental milestones withinappropriate time frames. No history of harmful behaviors to self, otherindividuals, or cruelty to animals. No reported history of head banging, rocking behavior, attachmentissues, separation anxiety, gender identity issues, sleep disturbancesincluding nightmares, or bed wetting. No report of any academic or socialissues. Learning disabilities or Child Study team evaluations were denied. Adolescence: The patient reports always having low self- esteem.Indicates that she was "always hard on myself," but despite this reportindicated that she was able to establish close relationships throughoutschool. She denies any binging, purging, or restricting her caloric intake tothe point where she was severely underweight. She denied issues regardingher body image, bullying, or a history of abuse. She was involved in soccerand field hockey. She was sexually active at age 17. Adulthood: The patient is currently unemployed. Denies service in themilitary. Denies any prior arrests or legal issues. The patient completed highschool and some college, but dropped out because it became too much financially and emotionally." She has worked in retail as a sales associateand as a waitress at several different restaurants. She reports difficultyholding a job due to her hospitalizations and low frustration tolerance. Shereports Catholicism as her faith, although she is not active in the church andsees herself as more of a spiritual person than traditionally religious. TRAUMA/ABUSE HISTORY: The patient reports that she was raped atage 19, after which she reports being severely depressed and isolatingherself. Her family reports she would often stare off into space in themiddle of a conversation, and it would be difficult to snap her out of it. About several weeks after the severe sexual abuse, she started experiencingflashbacks, nightmares, and hypervigilance. She was unable to concentrateand began illicit drug use to cope with her anxiety and fear. The drugshelped her escape the anxiety triggered by the traumatic memories.