Paper - Case of Allison

In the case of Allison she will be getting discharged. She has come for therapy for her health and mental health.  The therapist has diagnosed her with anxiety. A couple of weeks later she tried to commit suicide. She informed her friend that she is ready to go. She tried to over dose on medication. She then got diagnosed with depression because the death of her parents. After getting assistance, she has then improved. It is time for her discharge papers. In this paper, it will discuss her health baseline, goals, reevaluation, and outpatient references.

                                Discharged Summary

INITIAL ASSESSMENT

History:     Allison seeks assistance with treatment but does not want to respond. As Allison describes her concerns it seems as though she is suffering from anxiety. Her issues are often happening and it happens few times a week. Once her mood occurs it will last for a few hours in a day. Her appetite is not regular. She describes she has social problems. Wishes to be dead are expressed but suicidal ideas or intentions are convincingly denied.

Mental Status: Allison is down, slightly outgoing, unkempt, and hopeless.  She displays language that is usual in amount, volume, and speech and is clear and impulsive. Communication skills are together.   Symptoms of anxiety are present.  Allison continues to look at walls and head is down while talking. Her talking starts to appear decelerated by anxiety mood. Facial appearance and over-all conduct reveal anxiety mood.

Diagnoses: 300.02 Generalized Anxiety Disorder

 Discharge Status: Allison has denies that she has been having problems or symptoms. Her feelings has improved and eventful. There has not been any side effects recently as shown. She has not signs of anxiety since she tried to commit suicide. She later got diagnosed with depression which she has little signs of as of now. Her voice discloses no irregularities of degree, volume and enunciation and her communication skills are unbroken. She persuasively rejects suicidal thoughts. She has no homicidal thoughts or intentions. She has signs of psychotic development.  Her conduct is not strange and there are no signs that visions or misunderstandings are present.  She is not showing any signs of a thought disorder.  

Discharge Diagnosis: Major Depressive Disorder, Single, Moderate 296.22 (Active)

Medication Instructions:  Allison was instructed to take prescriptions as prescribed and was told about possible side effects.

Consent:  Allison was counseled concerning the dangers and benefits of treatment.

Other Instructions:  Follow through with safety plan at home as discoursed

Emergency Contact:  Phone: 1-800-CRISIS

Allison has sustained a healthy baseline with her improvement from the beginning of sessions. She had a downfall where she wanted to commit suicide but she has not been having thoughts of suicidal after. She has improved with her anxiety while she was trying to harm herself. Then she was diagnosed with depression. She has overcome her problems.