Diagnosis of Possible Anorexic

Geriatric The author of this report has been asked to review the results and history of a woman who has come for treatment. She is a woman with Irish descent and there are some fairly disturbing signs that can be seen through her medical history, her current results, what she is taking in terms of drugs and her list of diagnoses. Each of those factors, facts and diagnoses will be explored in terms of the implications, the likelihood of a problem and so forth.

While anorexia would be a pretty bad thing for this patient to have, it does indeed seem to be the most pressing and likely thing going on with this patient. Vitals Before getting to the primary and other diagnoses, there are a few things in the vitals and basic information that should be explored. First, the woman in question is a scant five feet tall and she weights one hundred fifty pounds.

This is clearly overweight for a woman of her height as she should be much closer to one hundred pounds than one hundred fifty unless she has outstanding muscle mass and very little fat. The rest of the vitals and history are not extremely concerning with a few exceptions. First, someone her age should absolutely have an influenza shot every year. Also, she should absolutely have a Pneumovax given her age and the fact that she had pneumonia fairly recently.

While her family history of health is pretty good up to and including the fact that her parents both lived into their 90's, pneumonia and similar disorders are something that should be kept away and prevented whenever and however possible. Her last tetanus being more than ten years ago also needs to be addressed. Her lack of the herpes zoster vaccine should be addressed as shingles is something else that should be addressed given her age.

This would go double if she did not have chickenpox as a child given that adults typically have a much rougher go of things when they get the virus in question. The last mammogram being only four years ago is fairly good news but she should keep those up given her age. However, it does not seem that there is a family history. However, she should have a colonoscopy to ensure that there are no issue.

Twelve years is a long time for someone her age to have gone without such a screening. She should also get a bone density screening even though none of the diagnoses that came up with today's tests and review suggest a problem with arthritis and so forth. She is also fairly clear of any sign of diabetes and the like despite the fact that she is overweight. Her heart beat sounds fine and her lungs are also good.

Her blood pressure is very good but her overall BMI is not great at all. However, she would fall under the class of "overweight" rather than "obese" unless or until she reaches a BMI of thirty or higher, per the CDC. She could stand to lose a few pounds but that is not the biggest problem here (CDC, 2015). The biggest problem, and the source of many of the diagnoses in her list, relate to her mental health. Diagnoses There are clearly some troubling signs when it comes to psychiatric health.

For example, her psych results in general are not a good sign and the fact that she behaved in the manner in which she did during the tests is fairly revealing. Also problematic is the fact that she "nibbles" when she eats and her ostensibly rampant insomnia. This would make anorexia the clear and obvious concern as her issues clearly center on both eating and mental issues in general. However, that might not be the only issue. One differential diagnosis that came up is hypothyroidism.

This is something that affects women in the patient's age group and it is easy to detect. While this would not seem to be the major issue for this patient, it could be the issue or at least a contributing factor (Mayo, 2015). Thus, a blood test to ensure the thyroid is operating properly should be done to rule this out as the major or a comorbid cause of problems for the patient.

Anemia is also something that should be screened for and such but there are not any overt signs that she is having such a problem. Even so, ruling out things that can easily be disproven is a wise idea (WebMD, 2015). Indeed, most of the issues that the patient does or potentially has center on mental problems. Indeed, two of the differential diagnoses are depression and bipolar disorder.

Bipolar would seem to be a leap but if she is indeed shifting on a dime from manic states to depressive states, it is something that should be checked. Also important to note are some of the secondary diagnoses such as anxiety. In the end, the author of this report does think that the problem here is a confluence of potential anorexia (or some other eating disorder) and the fact that she is overweight. Regardless, there is clearly a mental issue of some forth.

It is just a matter of which one it is and how protracted the problem is. Signs of this include the fact that she nibbles, as mentioned before, and her unwillingness to participate in the psychiatric exam. The latter behavior is a telltale sign that she is mentally ill or that she thinks she is and this should not be ignored under any circumstances.

Recommendations As noted above, the patient has some screenings and some vaccines that need to be caught up on but that is not the major issue and those screenings/vaccinations are by no means urgent as compared to the elephant in the room that could and should be dealt with. The patient needs to be referred to a psychiatrist and potentially a psychologist as well depending on what the former finds when doing a diagnosis.

The psychiatrist referred to should absolutely have history when it comes to dealing with patients that have eating disorders. The psychiatrist would be able to ascertain whether the patient has one or more of the mental health diagnoses listed in this case study such as anorexia, bipolar disorder, depression and anxiety. There is a very good possibility that more than one issue will exist at the same time. For example, it would seem at least somewhat likely that the patient will have anorexia and anxiety issues at the same time.

A peer reviewed article by Kaye et al. describes precisely this as it relates to both anorexia and bulimia (Kay et al., 2004). That all being said, there is an extremely high chance that the patient will resist going to the psychiatrist and thus it is important that any present family members hear the recommendation if at all possible. It should be stressed that there is nothing wrong with her as a person but it should also be said that there is.