Psychotherapy for the Advanced Practice Psychiatric Nurse Responses
Respond to these 3 discussion boards with 2 references eachMajor Chronic and Severe Mental Illnesses:1.Case Study: Dissociative DisorderMike, a 25-year-old African American soldier, is being treated in the hospital for a sudden behavioral change and periods of impaired recall. He is confused regarding her history and thinks he is in a different facility located 1000 miles away. Mike is generally agreeable and helpful throughout his time at the facility, but he would suddenly become uncooperative and hostile in some instances. Examination of his mental health revealed he was depressed after deployment, had [receding visual and derealization perceptual disorders.Diagnosis: Dissociative disorders ICD Code F44. 81Treatment:Dissociative disorder after the Dissociative Experiences Scale (DES) demonstrated a 50 percent score. Mike received fluoxetine (Prozac) 20 mg/PO/ twice daily for two weeks, an anti-anxiety medication that helps control the mental health symptoms linked to dissociative disorders.PlanThe plan is to have psychotherapy treatment. Based on Maslow's hierarchy, the patient has belonging needs. After deployment, he feels secluded from the general population. Thus, he needs an identity or a with which he can identify. Mike can benefit from a family therapy, as discussed in the works of Dallos and Draper (2015). Essentially, the authors conjecture that Family Systems Theory is best applicable in this case because it stresses connectedness and interactions that take place systematically (Dallos & Draper, 2015). These interactions can offer Mike the need for belonging.The labs ordered are (CMP, CBC, LDL, HDL, Triglycerides, HgA1C, EKG). Mike would undergo some physical examination, a psychiatric examination, and the DSM-5 assessment, as Subramanyam et al. (2020) recommended. Cultural considerations will be in the form of planning and management of the disorder through the help of his family and community. Other team members such as a social worker and a case manager can help in the examination process, identify community resources, and link the patient to these resources within their community. Also, a multidisciplinary team for Mike's case will help him cope with life stress as military personnel and help mitigate issues like apathy, hopelessness, anger, and sadness.ReferencesDallos, R., & Draper, R. (2015). An introduction to family therapy: Systemic theory and practice (4th ed.). McGraw-Hill Education.Subramanyam, A., Somaiya, M., Shankar, S., Nasirabadi, M., Shah, H., Paul, I., & Ghildiyal, R. (2020). Psychological interventions for dissociative disorders. Indian Journal of Psychiatry, 62(8), 280. https://doi.org/10.4103/psychiatry.indianjpsychiat...2.Major Depressive Disorder DiscussionChief complaint: Feeling guilty, worthless difficulties in concentrating at work and easily agitated. Further, she reports to have had episodes of sadness, hopelessness and restlessness accompanied with anxiety.History of presenting illness: Miss K.M is a 25-year-old female of Korean descent who reports to the outpatient clinic concerned over her mental health over the past few weeks. She is single with no children and has a fulltime job at the local municipality. Miss M reports to feeling guilty, worthless difficulties in concentrating at work and easily agitated. Further, she reports to have had episodes of sadness, hopelessness and restlessness accompanied with anxiety. This is the initial psychiatric evaluation consultation of her presenting symptoms. she co-shares an apartment with her friend and denies any past mental assessment, treatment or mental illness. She admits to be taking cocaine, marijuana and alcohol. She has no family history of mental problems or any social issues. She has never had any type of hallucinations or delusions. Besides, she reports to have had suicidal ideations long time ago.Diagnosis: Major Depressive DisorderMedication: Fluoxetine 20mg PO QD and Tofranil 75mg PO QDPreceptor’s planIn combination with the pharmaceutical medication, the preceptor concurred that psychotherapy can also be used to treat other specific symptoms. According to Mayo Clinic Staff (2018), different types of psychotherapies have shown massive improvement in the condition’s prognosis and wellness. such therapies suitable for our client include: cognitive behavioral, interpersonal, family, and occupational therapies. The therapies are discussed to the patient forming a therapeutic relationship for better ways to cope and solve the mental health problem. Besides, she will be able to regain her sense of satisfaction and control of life (Mayo Clinic Staff, 2018).Maslow’s hierarchy of needsIn psychologist Abraham Maslow’s hierarchy of human needs, he agued that failure to have any needs met at any stage of one’s life could lead to health issues specifically mental health issues and psychiatric illnesses (Henwood et al., 2016). During the weekly therapy treatment plan, the five various stages were addressed to enable the patient adjust to current difficulties, maintain a healthy lifestyle (nutrition wise and exercise), explore positive relationships and set realistic life goals.Nichol’s bookAccording to Nichols (2001), family systems, and behavior can be blended in a flexible way to offer therapeutic approach to presenting problems. I would use the Integrative family therapy approach to help Miss K.M the virtue of acceptance and general inherent need to always be open and engaging others to understand any occurrences. I believe the family remains to be the basic health influencer hence the need to have them be part of treatment and prevention of health problems.Labs to ordersSince scientists and researchers have not yet discovered any biological test for mental illnesses, I would request for the routine blood works, UECs, TFTs and urine analysis to rule out any medical conditions. Further, I could order for a baseline EKG to monitor the QTc levels. It is important to note that at some point, the patient may need to discontinue the drugs, reduce dosage or switch to another agent hence the need for weekly assessment of Miss K. M’s Q-T intervals to be less than 500 (AMITA Health, 2020).Cultural considerationsReligious, tradition and culture contribute significantly to prevalence, treatment and view of mental illnesses in the society (Jimenez, 2012). I would ensure complete understanding of Korean tradition, culture and the patient’s religion in relation to how they view mental illnesses and wellness. I would use the non-judgmental and incorporate all the ethical aspects in dealing with the patient’s condition to avoid discrimination or stereotypes in the society.Inter- and intra-professional collaborationPsychologistsPsychiatristsPsychiatric mental health nurse practitionerSocial workersOccupational therapists and rehabilitation workers ReferencesAMITA Health. (2020). Cardiac Monitoring and QTc Assessment Guidelines Revised 4/9/2020 2:58 PM. Amitahealth.org. Retrieved 26 July 2021, from https://www.amitahealth.org/assets/documents/covid-19-playbook/amita-covid-19-cardiac-monitoring-and-qtc-assessment-guidelines-4-9-2020rev-final.pdf.Henwood, B. F., Derejko, K. S., Couture, J., & Padgett, D. K. (2015). Maslow and mental health recovery: A comparative study of homeless programs for adults with serious mental illness. Administration and Policy in Mental Health and Mental Health Services Research, 42(2), 220-228.Jimenez, D. E., Bartels, S. J., Cardenas, V., Dhaliwal, S. S., & Alegría, M. (2012). Cultural beliefs and mental health treatment preferences of ethnically diverse older adult consumers in primary care. The American Journal of Geriatric Psychiatry, 20(6), 533-542.Mayo Clinic Staff. (2018). Depression (major depressive disorder) - Diagnosis and treatment - Mayo Clinic. Mayoclinic.org. Retrieved 26 July 2021, from https://www.mayoclinic.org/diseases-conditions/depression/diagnosis-treatment/drc-20356013.Nichols, W. C. (2001). Integrative family therapy. Journal of Psychotherapy Integration, 11(3), 289-312.3.SchizophreniaPatient is a single 21-year-old African American female who presents to an outpatient clinic today for follow up appointment for schizophrenia. The patient is unemployed and lives with friends.Chief CompliantPatient compliant of “experiencing auditory and visual hallucination”History of Present Illness:Patient states that she is interested in restarting her treatment for schizophrenia. She states that she has a history of depression. She reports that she is currently taking Zoloft 100mg for her depression. She reports no adverse reaction to medication, and she takes medication as prescribed. She reports that she feels lonely and stressed sometimes. She states that when she is not taking her medication for schizophrenia, she experiences auditory and visual hallucinations, and paranoia. She denies difficulties managing anger. Currently she rates her mood as 8 (10 is the best). She rates her anxiety as 2 (10 is the worst). She reports that she is sleeping well at night. She states that she gets about 8 hours of sleep at night. Denies suicide or homicide ideation. Denies smoking cigarettes, drinking of alcohol or using any illicit substance.DiagnosisF20.9 – SchizophreniaMedicationsZoloft 100mg orally once a day for depressionAbilify 15mg orally once daily for Schizophrenia managementPreceptor’s PlanPatient was encouraged to take medication as prescribed. Discussed side effect of antidepressant such sleepiness, drowsiness, feeling tired, skin rash, dizziness, insomnia, and nervousness. Patient was also educated on Abilify side effects such as nausea, headaches, constipation, anxiety, restlessness, insomnia, and dizziness. AIMS was completed with a score of zero. Discussed self-management of weight lost through heathy diet and exercise such as walking. Encourage to be active during the day to continue good night sleep. Patient refers to psychotherapy for stress management. Schedule follow up appointment in two weeks. Advise to go to the ER or call 911 if symptoms get worse.The patient was scheduled to return to the clinic in two weeks to reevaluate the effect of the medication (Abilify) and symptoms management. I agreed with my preceptor plan because our goal is for patient to have less episode and less depressed mood.Maslow’s Hierarchy of NeedsThe Maslow’s hierarchy of need for this patient include physiological needs (Food, water, rest, warmth), safety need, belongingness and love need (friend, relationship), and esteem need (feeling of accomplishment) (Henwood et al., 2015).Nichols BookBased on Nicholas book, this patient will benefit from individual and family psychoeducational therapy which is the process of teaching to enhance understanding of the disorder, provides information about medication adherence, develop approaches to detect new episode and identifies illness coping strategies (Nichols, 2013).LabsI will order metabolic labs to check for glucose level, electrolyte and fluid balance, kidney, and liver function. TSH, CBC, lipid panel, pregnancy test, and urinalysis to make sure alcohol or drug is not causing the symptoms. Magnetic resonance imaging (MRI) or computed tomography (CT scan), will help to rule out other problems like a brain tumor. The blood test will be rechecked every six months and as needed.cultural ConsiderationAfrican Americans shared cultural factors that play a role in helping define mental health and supporting well-being resiliency and healing. Part of this shared cultural experience family connections, values, expression through spirituality or music, reliance on community and religious networks are enriching and can be great sources of strength and support. However, another part of this shared experience is facing racism, discrimination and inequity that can significantly affect a person’s mental health (Peterson et al, 2019). Additionally, members of the Black community face structural challenges accessing the care and treatment they need. According to American Psychiatric Associations (2020) only one in three Black adults who need mental health care receive it. One study showed that 63% of Black people believe that a mental health condition is a sign of personal weakness. As a result, people may experience shame about having a mental illness and worry that they may be discriminated against due to their condition.Interdisciplinary CollaborationPsychotherapist - to help or assist patient with her thought and ways of dealing with stress.Social worker - will assist the patient with mentoring and reenforcing treatment.Registered Dietitian - Patient is obese; therefore, a registered dietitian will assist with heathy dietary intake.Primary Care Provider – to manage other disease condition and patient well being.Psychiatrist – to evaluate patient for mental treatment and symptom managementI will handle this patient differently by referring the patient to a social worker and dietitian since the patient is also worried about her weight. The social worker will assist the patient with financial assistance, job search, and housing.ReferencesAmerican Psychiatric Association. (2020). Working with African American/Black Patients. Working with Black Patients. https://www.psychiatry.org/psychiatrists/cultural-competency/education/best-practice-highlights/working-with-black-patients.Henwood, B. F., Derejko, K. S., Couture, J., & Padgett, D. K. (2015). Maslow and mental health recovery: a comparative study of homeless programs for adults with serious mental illness. Administration and policy in mental health, 42(2), 220–228. https://doi.org/10.1007/s10488-014-0542-8Nichols, M. P. (2013). Family therapy: concepts and methods (10th ed.). Pearson.Peterson, A., Bradshaw, W., & Roseborough, D. (2019). African Americans and Recovery from Severe Mental Illness. Social Work in Mental Health, 7(6), 602–622
