Psychological Treatment Plan Analysis - Research Paper Example

?PSYCHOLOGY TREATMENT PLAN This paper reviews a treatment plan for a thirty five year old patient exhibiting symptoms of hopelessness, reduced energy, hypersomnia and feelings of worthlessness. Moreover, the patient runs the risk of committing suicides. These symptoms indicate that the patient is suffering from depression. Suicide attempts are at a high rate in relation to the general world populace. With the behaviors becoming complex issues, there are a number of preventive measures that can be utilized. There has been minimum research in the field to offer effective preventive measures, and thus it remains a problem in determining the best approach relevant to these scenarios. Consequently, there are a number of evidence-based practices, which include medication treatment and psychotherapy, which are essential in treating disorders such as depression. Psychotherapy and treatment are effective approaches relevant in the case of the thirty five year old patient. In the contemporary world, there have been tremendous attempts at identifying and developing evidence- based approaches in therapy. Even though many interventions exist, few have been proven to be effective through scientific methods and research. Currently, there is no known cure for depression disorder. However, appropriate treatment assists patients with behavioral change to gain a better means of controlling the symptoms and mood changes including patients with severe and chronic problems. The paper deals with the treatment of depression disorder for a patient with the chronic symptoms. Therefore, man effective long-term treatment plan is considered. The treatment plan incorporates psychotherapy and medication to ensure avoidance of a relapse and development of the symptoms. Introduction According to Clark, depression is very chronic a disease, which causes mood swing, lower activity levels, disturbed sleep, and idea of suicide and self-harm, lack of confidence and appetite (2013). Individuals with disabilities are at a risk of being affected by the disorder, which significantly affects the life of the individual as it is characterized by high mortality rate. Therefore, physician’s concern is imperative in determining how the patient will fair during the treatment. The treatment of depression must be based on the patient’s safety and thus incorporates psychiatric consultation which must be followed by evidence based assistance and treatment. Consequently, the treatment of the thirty five year old patient must incorporate a long-term management that includes continuous medication and psychotherapy (Connolly and Thase, 2011). The disorder is a mental problem, which incorporates unusual changes in behavior, thinking, mood, and energy as is apparent in the case of the patient. The treatment plan should incorporate the assistance of a physician and psychiatrist consultation. The physician with the assistance of the psychiatrist is important in ensuring the general safety and health of the patient. In dealing with the patient’s problem effectively, it is vital to understand the disease’s impact on health, its maintenance and management in the end (Connolly and Thase, 2011). Presentation and diagnosis There are various approaches, which are beneficial in the treatment of depression. These treatments include psychological therapies and pharmacological treatments. The therapies are effective in mild depression while the pharmacological treatment should be considered first in the cases of chronic and severe depression. Moreover, the two approaches could be combined for patients with modest to severe depressions (Connolly and Thase, 2011). A patient in the initial stages usually presents episodes of depression, and a careful analysis of the patient’s history is essential in understanding the symptoms. This is vital in the treatment plan as it ensures an appropriate diagnosis of the patient’s problem. Therefore, this incorporates the screening for past hypomanic as well as depression symptoms, which might be overlooked in other treatment approaches of the patient. Consequently, a “self report Mood Disorder” questionnaire is a necessary apparatus in the diagnosis of the patient’s problem. The evaluation must include the laboratory and historical information and data. This evaluation provides essential data and thus ensures an appropriate and safe medication treatment plan is formulated. Screening is a very essential approach in the detection of psychological distress as in the case of the patient. It is essential in identifying a patient who is suffering from depression. The PDHRA (Post Deployment Health Reassessment) and PDHA (Post Deployment Health Assessment) are effective self-report screens that can be utilized in providing data on the patient’s condition to determine the appropriate and effective treatment (Greenberg and Tesfazion, 2012). Therefore, screening will be helpful in the assessment of risks the patient is likely to cause to others and to herself. Moreover, it is helpful in determining the appropriate treatment, which assures safety of the patient (Greenberg and Tesfazion, 2012). Psychiatric Hospitalization is required in the case of severe depression as its symptoms include lack of confidence and tiredness. Therefore, the patient in this state displays agitation, intense irritability and impairments that might steer away the diagnosis of the patient’s problem during judgment and testing. Consequently, hospitalization provides an appropriate diagnostic approach. In the event of a mixed occurrence, the patient will be characterized by both depression and acts of self-harm like suicide. This is present in the case of the woman as mixed episodes are common with women in comparison with men. This is evident in the case study as the patients in this state are associated by symptoms such as a higher level of suicide risk. Therefore, the woman might be diagnosed with mixed episode as she has these symptoms as indicated in the case study. Consequently, if the patient is characterized by an amount of more than four episodes of attacks each year she will be diagnosed with rapid cycling, another type of the depression illness (Connolly and Thase, 2011). Even though in some instances, the depression disorder is less relentless in the elderly, the changes in mood are prone to occur at any moment. However, the treatment in the elderly is similar to adults; the administration of medications should be characterized by lower medication doses. This in turn alleviates the possibility of undesirable effects. Therefore, electro-conclusive therapy may be essential in the earlier phase of the treatment plan in the advancing age. Emergent and Urgent Care The patient must be assessed with immediate effect in the cases of severe depression, due to the patient’s psychosis and high suicide risks. Therefore, the family should seek the assistance of a psychiatrist as soon as possible. Moreover, the family should help by offering support to the patient. The urgent care must incorporate inpatient hospitalization and patient safety, while at the same time ensuring that there is no risk to self or others (Connolly and Thase, 2011). The thirty five year old patient requires social assistance and support from the family. Rapid medication is essential and appropriate if the patient suffers from mixed or manic episode, which are often typified agitated mode of behavior. Therefore, due to these conditions the family physician must immediately plan for the hospitalization of the patient and also the consultation of a psychiatrist keeping in mind the state laws that accompany patient hospitalization. Pharmacological management In the patient’s case, discontinuation of antidepressant medicinal treatment is highly advisable which must pave way for the administration of any antimanic medication (Balan et al,2013). Since the patient is not conversant with this type of treatment, lithium carbonate must be utilized as an antimanic agent. Consequently, lithium salts, carbamazepine, divalproex and SGAs (second-generation antipdychotics) can be used in the treatment, as FDA approves this medication in acute depression. For effective treatment, a combination of either divalproex or lithium with an SGA treatment is recommended. However, this combination often results in adverse effects for the patient. Olanzapine as an antimanic agent may result in glucose intolerance and weight gain and therefore must not be used as a first agent. Moreover, carbamazepine and sivalproex are related with neural tube fault and thus should be utilized in women who are expected to turn out to be pregnant. Divalproex also has significant effects in women like menstrual abnormalities while carbamazepine may lead to adverse blood dyscrasias. Therefore, for safety purposes a rational first line medication treatment must commence with lithium, SGA monotherapy or divalproex. Then olanzapine should be administered in the later stages of treatment and therefore should not be a first choice treatment especially in women. Maintenance Long-term medication is effective in the maintenance of normal non-depressed behavior after treatment. The utilization of lithium is appropriate in stabilizing the patient. Research indicates that it is effective as it assists sin the prevention of depressive and manic relapse. Moreover, a first-line of lithium treatment remedies the occurrence of suicide. In addition to this it is recommended to use divalproex as a second choice after lithium as a first line dose. Consequently, Lamotrigine is appropriate as research indicates that it can avoid the possibility of depressive setback especially for patients who are prone to depression. Currently, evidence indicates that an injectable risperidone preparation prevents relapses after treatment (Connolly and Thase, 2011). It should be considered in mind that sudden discontinuation of treatment especially of mood stabilizers can result in relapses even after a constant phase of remission. Therefore, it is vital for the patient to take caution and measures when stopping medication and thus should avoid abrupt discontinuation. Hence, the family physician must ensure slow discontinuation of medication to avoid a relapse (Connolly and Thase, 2011). Psychotherapy Psychosocial treatment like psychoeducation is also effective after early symptoms of relapse have been identified. Therefore, psychoeducation should be offered to the patient as an addition to the treatment plan of the patient. Family-based, cognitive-behavior, social rhythm and interpersonal therapies are example of psychotherapies which are beneficial as additions to the treatment plan to improve the efficacy of medication and management of the disorder (Clark, 2013). Counseling is an effective method for the treatment of depression disorder in people. Even though medical approach treatments are effective in some cases it is appropriate to utilize various forms psychotherapy especially cognitive-behavior and communication- focused therapy (Clark, 2013). CBT is considered as an effective method for depression. This is an evidence-based treatment, which will be beneficial to the patient (Steidtmann et al, 2013). This method addresses on the feelings, thoughts and behavior in dealing with the patient’s depression disorder. After the treatment process, the patient is re-engaged in previously enjoyed activities and responsibilities for instance hobbies, exercise and music. This is because the patient no longer involves herself with these activities due to the lack of interest in these activities (Binnie, 2012). On the other hand, the cognitive approach involves the identification of feelings and thoughts during therapy. This is vital, as the psychiatrist will be able to identify negative thinking and therefore work towards cognitive reformation of the patient’s way of thinking (Binnie, 2012). Family focused therapy seeks to help family members on strategies of coping with a loved one. It is essential as it prepares the families on how to handle and help the affected individual especially in new behaviors in their early stages (Connolly and Thase, 2011). Moreover, the therapy enhances communication and eases conflict in the family. Consequently, Interpersonal therapy is very beneficial to the patient as it assists the patient on how to improve her communication skills and thus contributes to improving relationships with others in the society (Puterbaugh, 2006). Consequently, it assists the patients on skills that assist in the management of daily activities and sleep routines to avoid manic attacks. Therefore, psychoanalysis is beneficial in terms of the patient’s improvement as it prepares and educates people about the prevalent disorder and its effective treatment. As a result this assists individuals to identify the symptoms of relapse in order for them to seek treatment before the patient gets worse (Puterbaugh, 2006). Ethical, legal, individual and socio-cultural implications According to Milton (2005), Ethics and legal measures incorporate a broad range of principles that guide physicians and medical officers in making decisions on how to assist patients. Physicians and psychotherapists must be keen in choosing the appropriate approach when dealing with patients. The main concern of practitioners is minimizing harm and ensuring safety by maximizing on the benefits, acting justly and respecting the patient’s autonomy (Steidtmann et al, 2013). When using the alternative methods of treatment harm to patients is considered a legal concern as it is unethical to provide medical assistance to patients without considering their health and safety. The principles of ethics are very important when dealing with patients with disorders, and the medical practitioners must ensure that superiority care is made available to all patients without prejudice. Consequently, they should operate with discretion by respecting the patient’s confidential information and privacy (Milton, 2005). Therapy is a widely utilized method for providing help to patients and therefore it is essential to give a consideration of restrictions of the method before the treatment commences. For instance, if the program requires additional services, the practitioners must ensure that the services are put in place to ensure maximum satisfaction of the client’s needs. Moreover, quality services incorporate clarification of the duties and rights of patients. The medical officers must uphold and monitor their vigor to perform with efficacy in order to provide quality services (Milton, 2005). The practitioners have a responsibility to all clients to offer protection when other officers are putting the patient’s into risks. Therefore, in cases of complaints the medical practitioners must ensure that they respond professionally to them. This will include remedy and measures to any harm done to the patients in order to prevent future cases. Conclusion and Recommendation The disorder is characterized by a burden of medication effects to the patient resulting health and safety risks. Therefore, the family physician must ensure that measures are put in place to monitor health risks that might endanger the patient in the process of medication. The treatment of the patient must be based on patient’s safety and therefore must incorporate psychiatric consultation as early in the treatment plan as possible. This should start in the evidence-based treatment into the maintenance period of the disorder. Effective management requires euthymia maintenance and continuing medication with the benefits of psychotherapy. In the case of the patient, the physician and family play a very important responsibility in the treatment plan on top of mitigating adverse effects that are associated with the disorder. References Balan, I. C., Moyers, T. B., & Lewis-Fernandez, R. (2013). Motivational Pharmacotherapy: Combining Motivational Interviewing and Antidepressant Therapy to Improve Treatment Adherence. Psychiatry, 76(3), 203-209. Binnie, J. (2012). Using Cognitive Behavioural Therapy with Complex Cases: Using the Therapeutic Relationship to Change Core Beliefs. Issues in Mental Health Nursing, 33, 480-485. Clark, D. M. (2013). Developing and Disseminating Effective Psychological Treatments: Science, Practice and Economics. Canadian Psychology, 54(1), 12-21. Connolly, K. R., & Thase, M. E. (2011). The Clinical Management of Depression Disorder: A Review of Evidence-Based Guidelines. Prim Care Companion CNS Disord, 13(4). Greenberg, J., & Tesfazion, A. A. (2012). Screening, Diagnosis, and Treatment of Depression.Military Medicine, 177(8), 60-66. Milton, M. (2005) The Ethics (or Not) of Evidence-Based Practice: Handbook of Professional and Ethical Practice for Psychologists, Counsellors and Psychotherapists. Hove:Brunner-Routledge.  Puterbaugh, D. T. (2006). Communication Counseling as Part of a Treatment Plan for Depression. Journal of Counseling & Development, 84, 373-380. Steidtmann, D., Manber, R., Blasey, C., Markowitz, J. C., Klein, D. N., Rothbaum, B. O., & Arnow, B. A. (2013). Detecting Critical Decision Points in Psychotherapy and Psychotherapy and Medication for Chronic Depression. Journal of Consulting and Clinical Psychology, 81(5), 783-792.   Read More