Description
Provide a response to discussion prompts that your colleagues provided in their video presentations. You may also provide additional information, alternative points of view, research to support treatment, or patient education strategies you might use with the relevant patient. To 3 separate students.
STUDENT 1 TOPIC AND PLEASE PROVIDE TWO SEPARATE RESPONSES WITH AT LEAST 3 PARAGRAPHS TO EACH WITH SCHOLARLY REFERENCE.
Example :
**Student 1 :
-Response 1 , Thank you Ms. Magalys for your video presentation, it was very informative. I believe …. … ….
.. .. … Continue for at least 2-3 paragraph . with Reference.
-Response 2, : Ms. Magalys I also believe and would like to add that to this diagnosis that . . .. . . . . .
. . . . . Continue 2-3 parapgraph with reference.
***Student 2 , with two separate responses and References
***Student 3, with two separate responses and References.
Respond to
Student 1: Ms. Magalys topic:
Question: What are treatment options for patients who have depression and show resistance to medications?
HPI: Patient, K.T., is a 31-year-old female who has come to the clinic for her first comprehensive psychiatric evaluation. Her primary complaint is that she feels depressed all the time, every day. She has been crying a lot, for a major part of the day, since her boyfriend’s death nine months ago. She has lost several beloved ones in her life and this life situation makes her angry. She also feels unmotivated for doing anything in her life. She reported that she has no desires to do out and socialize with anyone. She feels so sad that she wants to isolate herself, from both family and friends. Her lack of control over her mood makes her feel desperate and anxious. She has reported experiencing angry outbursts and wanting to be dead. However, presently she has no desire to kill herself. She feels hopeless, helpless, and unmotivated about everything. Reported sleeping difficulties and cannot sleep at night as she missed her boyfriend. Also mentioned reduced appetite, and less desire to eat meals. She even forgets if she has eaten or not. Her mother makes sure she eats something at every mealtime. She denied hallucination, delusion, and homicidal thoughts, at present.
Student 2, Ms. Daile Topic
Question: Should she be referred to group programs aimed to improve GAD?
Case : CC (chief complaint): “I feel worried about everything.
PI: Patient, L.G., is a 35-year-old female patient who is referred by her primary care provider
(PCP) for psychiatric evaluation. She mentioned feeling worried about everything and has
difficulty making decisions. She finds it difficult to control her worries. She persistently feels sad
and has feelings of crying all the time. She mentioned feeling blocked mentally which is why she
has concentration problems. She also experience muscle tension, irritability, and sleep
disturbances. She sometimes has headaches due to lack of sleep and increased workload. She
mentioned that she has been experiencing these symptoms for the past five to six months. She
mentioned that she recently experienced an increased intensity of feeling worried and had a
nervous breakdown. During nervous breakdown, she experienced chest tightness, increased heart
rate, tremors, and the sensation of choking. The recent breakdown greatly impacted her job as
she was given a leave for a week, which impacted her total salary. She reported experiencing
similar reactions to circumstances that she disliked leading to the development of feelings of
insecurity which in turn makes it difficult for her to make decisions. Her symptoms have
significantly affected her relations with her family and spouse and work area too. She denied
homicidal, delusional, or suicidal thoughts. Denied nightmares or flashbacks.
Student 3 . Mr. Matthew
Question: Understand the rationale supporting the provider’s preferred treatment plan, including pharmacological, nonpharmacological, and alternative therapies. ?
Case presentation
Chief Complaint
“Every day I feel so much anxiety.”
History of Present Illness
MS is a 59-year-old Caucasian male who is seeking treatment for his long-established diagnosis of bipolar I disorder and “intolerable” anxiety. He is currently prescribed Vraylar 1.5mg daily, propranolol 20mg TID, Klonopin 1mg BID, lithium 300mg BID, Seroquel 150mg QHS, and trazodone 50mg QHS. He was referred by an acute psychiatric hospital from which he was discharged yesterday to establish care with this outpatient psychiatric provider. He has only been hospitalized for psychiatric reasons twice: Once at age 25 for mania and associated delusions, and once three days ago for depression. After his first hospitalization, his mood was stable on a regimen that included 1500mg of lithium daily with his levels always being between 0.8 and 1.0; however, his anxiety was “always” present. Over the last few months, his new psychiatrist, to whom he was referred by his long-term, recently retired provider, attempted to wean him off lithium and start Vraylar. But on less than 600mg of lithium daily, the client experienced profound depression: Poor sleep, anhedonia, anergia, poor appetite, and psychomotor slowing resulted in his hospitalization. The client describes himself as “a worrier who gets into catastrophic thinking quickly.” According to the client, the duration/frequency of his anxiety has been constant since age 25. His depression is intermittent and rare; however, the severity and impact of his depression are high because it resulted in his most recent hospitalization. His anxiety is also severe, though not debilitating when managed with Klonopin. The only stressor causing his recent crisis was the medication changes his provider attempted.
Pharmacologic and Nonpharmacologic Intervention
Given that continued cocaine use can contribute to depressive, anxious, and otherwise dysphoric symptoms (Milivojevic et al., 2022), an essential part of the client’s treatment plan will be to encourage complete abstinence. This is especially important because the current literature has failed to show promise in psychotherapeutic intervention for those with bipolar disorder who continue to abuse drugs throughout treatment (Crowe et al., 2021). Therefore, the client must be persuaded to abstain from cocaine use, if he is not already sober. Once achieved, weekly cognitive behavioral therapy (CBT) sessions may be helpful to maintain remission of his substance use disorder, as well as to treat his ongoing depressive episodes and chronic anxiety.
For this client, a prudent approach to pharmacotherapy includes maintaining all of his current medication until he is sober from cocaine use. This approach is essential considering the fact that his most recent hospitalization for depression occurred when his provider attempted to reduce his lithium dosage. A safer approach is to encourage abstinence, maintain the current medication regimen, and introduce regular CBT until stability is achieved. If once stable and sober the client’s depressive and anxious presentation persists, medication can be gradually altered to manage his symptoms accordingly.
Alternative Therapy
Rather than an “alternative” to psychotherapy and pharmacotherapy, a 12-step program such as Narcotics Anonymous (NA) is likely to be instrumental as an adjunct to treatment as usual. Regular meetings with like-minded, sober individuals are likely to encourage the client and support him in his aim to remain sober from cocaine. In addition, 12-step philosophy and practices are rich with coping mechanisms, spirituality, and wisdom that is sure to provide the client with great experience, strength, and hope. As a psychiatric provider, it is critical to encourage this alternative therapeutic modality to be used as an adjunct to medication and psychotherapeutic treatment.
