Category: Disorders

People tend to change over time, no matter how stable they are in everyday life. Each year of life, a person goes through a certain stage of change depending on what information they received during this period or what kind of social interactions they had. Goals did not change significantly over time; rather, they took on clearer forms. For example, at first, the goals were knowledge in some fields of science. This goal without specifics is characteristic of an earlier age. Later, the goal evolves along with a persons personality and takes other forms, such as not just knowledge but a specific profession or direction.

Possible selves are a set of desirable or feared selves represented in the mind of a person, which are formed in the course of life practice and make it possible to discover the creative nature of the self, and on the other hand, the degree to which the self is socially determined and limited (Carrillo et al., 2019). It is a kind of self-knowledge that is especially sensitive to all changes. The instability of the environment does not cause changes in the stable part of the self-concept. However, it temporarily actualizes certain possible selves, which, in turn, will determine the current views of oneself. Acting as a cognitive form of a motive or goal, representing oneself in the target space, possible selves act as an incentive to one or anothers behavior (Aardema et al., 2018). Thus, they create a diffuse field of self-concept variability. Therefore, the concept of possible selves explains the variability of human behavior in different situations.

The possible selves that people can become are all potential developmental options for the individual to become another. According to Carrillo et al. (2019) thus, it could potentially be both the selves that a person wants to become in the future and the ones that they fear and do not want to become. The relationship between possible selves and how people create meaning can be viewed in terms of how each individual thinks about and interprets their possible future possibilities. If a person attaches great importance to whom they want to become and is aware of their possible selves, this can help them achieve results more successfully. It also works the other way around, and for example, if a person knows a particular person they do not want to become, then it will be easier for them to avoid that meaning.

References

Aardema, F., Moulding, R., Melli, G., Radomsky, A. S., Doron, G., Audet, J. S., & PurcellLalonde, M. (2018). The role of feared possible selves in obsessivecompulsive and related disorders: A comparative analysis of a core cognitive selfconstruct in clinical samples. Clinical psychology & psychotherapy, 25(1), e19-e29. Web.

Carrillo, A., Rubio-Aparicio, M., Molinari, G., Enrique, A., Sanchez-Meca, J., & Banos, R. M. (2019). Effects of the best possible self intervention: A systematic review and meta-analysis. PloS one, 14(9), e0222386. Web.

One of the more common problems in older adults is urinary incontinence. Various etiologies can impact urinary incontinence, including bladder infection and urinary retention. Urinary retention is the inability to voluntarily void urine can both acute and chronic. Acute urinary retention is an emergency that requires decompression of the bladder and identification of the underlying cause. Chronic urinary retention may be diagnosed by the presence of the following symptoms: obstructive symptoms, abdominal discomforts, and renal insufficiency (Martin et al., 2019).

Additionally, the disorder may cause agitation, disorientation, delirium, behavioral alterations, aggressiveness. The disorder is usually treated by draining the urine to avoid damages to the kidneys. Depending on the cause of the disorder, it can be treated pharmacologically using alpha-blocker, antibiotics, or 5-alpha reductase inhibitors (National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK], 2020).

Urinary retention can also be treated surgically by removing a part of the prostate, cystoscopy, laser therapy, and physical therapy (NIDDK, 2020). I would refer patients with the disorder to a physical therapist and surgery to decide on the most appropriate treatment plan.

The common symptoms of bladder infections are cloudy, bloody, or foul-smelling urine, pain or burning feeling during urination, frequent urination, and mild fever (Norman, 2016). The infections are usually diagnosed using blood tests. The common treatment of urinary tract infections is antibiotics. Non-pharmacological approaches include lifestyle changes to avoid bladder problems, such as drinking plenty of fluids, timely urination, and genital hygiene (Norman, 2016). Such patients are usually treated by family physicians, and no referrals are required (Norman, 2016).

References

Martin, J., Chandler, W., & Speakman, M. (2019). Investigating chronic urinary retention. BMJ, l4590. Web.

National Institute of Diabetes and Digestive and Kidney. (2020). Treatment of urinary retention. NIH. Web.

Norman, D. C. (2016). Clinical features of infection in older adults. Clinics in geriatric medicine, 32(3), 433-441.

Posttraumatic stress disorder (PTSD) is a serious mental health condition that needs treatment due to its potential negative implications. The symptoms include repeated reliving (nightmares, flashbacks, hallucinations), avoidance (avoiding people, places, and situations reminding the traumatic event), increased arousal (insomnia, anger outbursts, excessive emotions, difficulty concentrating), and negative mood (bad memories, blame) (American Psychiatric Association 271). Depending on the severity of the condition, the client can be recommended several treatment approaches.

The most effective strategies include cognitive behavioral therapy, cognitive processing therapy, prolonged exposure, and pharmacological therapies. Cognitive behavioral therapy has proved to be the most effective approach and is the first-hand intervention. This treatment approach entails a focus on feelings, thoughts, and behaviors, as well as the change of behavioral patterns (Watkins et al. 5). Prolonged exposure therapy encompasses activities aiming at teaching the client to approach the trauma-related memories and thoughts effectively. The patient gradually understands that these feelings and thoughts are not dangerous and can be managed effectively (Watkins et al. 3).

Cognitive processing therapy involves training the client to modify the thoughts and beliefs related to the trauma. The patient develops a new understanding of trauma and related ideas (Watkins et al. 4). It is possible to use these treatment approaches separately, or a combination of these therapies can also be applied, depending on the symptoms.

If the client does not display improvement during the first weeks of treatment, or the symptoms are rather severe, it is possible to prescribe medications (sertraline, fluoxetine, and paroxetine) (Watkins et al. 6). Medication is also used if the symptoms have considerable adverse effects on the clients life. It is noteworthy that a considerable number of patients tend to prefer cognitive behavioral therapy to medication use.

Works Cited

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed., New School Library, 2013.

Watkins Laura E., et al. Treating PTSD: A Review of Evidence-Based Psychotherapy Interventions. Frontiers in Behavioral Neuroscience, vol. 12, 2018, pp. 1-9.

Introduction

A 43-year-old male with a 4-year history of various symptoms is diagnosed with complex regional pain syndrome (CRPS). CRPS is a neuropathic disorder characterized by chronic pain that commonly occurs after an injury and usually affects only one limb of the body. Although medical experts are not entirely certain what causes CRPS, more than 90 percent of cases involve a history of trauma or injury (Caffrey, 2019). In the course of treatment, the patient was prescribed several medications, which caused a reduction of pain together with insignificant side effects.

Analysis of Decision 1

At his first visit, the patient was prescribed amitriptyline 25 mg PO QHS and titrated upward by 25 mg each week to a maximum dose of 200 mg daily. Amitriptyline is a tricyclic antidepressant that is primarily used to treat depression and various pain syndromes, including neuropathic pain. It interferes with the chemical processes in the brain, increasing the neurotransmission of serotonin. Along with other tricyclic antidepressants, it is confirmed to be efficient in treating various neuropathic pain conditions and is recommended first-line (Moore et al., 2015). Its side effects primarily include cardiovascular problems, such as hypotension, syncope, hypertension, and tachycardia, and CNS symptoms, such as seizures, tremors, EOPS, drowsiness, fatigue, and headache (Sandoz, 2014). Other potential side effects are anticholinergic symptoms, such as hyperpyrexia, urinary retention, constipation, and dry mouth, skin rash, and gastrointestinal problems, such as nausea, vomiting, and anorexia (Sandoz, 2014). Overall, amitriptyline is an effective medication that is often prescribed in such cases.

After four weeks, the patient reported an improvement in pain and function and the side effect of being groggy in the morning. According to the study by Mago et al. (2018), 50 % of patients treated with antidepressants verbalized feelings of frustration or dissatisfaction with health care because of lack of efficacy and side effects. That is why it was important to address the patients concerns regarding his grogginess and need for additional pain control.

Analysis of Decision 2

At the patients second visit, it was decided to continue the current medication while taking the dose of 125 mg at bedtime and steadily increase it until the goal dose of 200 mg daily is achieved. The patient was asked to call the hospital in 3 days to tell them about his condition in the morning. It allowed the physician to evaluate the response to treatment without having to wait for the four-week checkup.

At the checkup, the patient reported improved pain control up to 4 out of 10 and feeling less groggy in the morning. His episodic cramping has decreased twice in the past month, and his mobility has improved to him being able to move around the apartment without crutches. However, the patient reported concerns about his slight weight gain since the start of the medication.

Analysis of Decision 3

At the third visit, the patient was advised to continue the current dose of amitriptyline of 125 mg per day and refer to a specialist who can consult him on eating habits and exercise. According to the research by Annesi (2020), exercise-induced mood improvements foster greater self-regulation and reduced emotional eating (p. 1). Physiotherapy and occupational therapy play an important role in the interdisciplinary treatment and rehabilitation of CRPS (Villa et al., 2016). The patients prognosis is positive, with his weight gain being an issue that can be easily addressed with the help of a specialist.

Conclusion

CRPS includes a complex array of symptoms and requires a multidisciplinary approach to treatment. With the pain being improved with medication, the patient began to heal holistically. The further treatment strategy needs to address the current concerns and reduce side effects, including weight gain. The treatment plan needs to include follow-up visits, medication management, compliance with schedule, evaluation of side effects, and additional treatment options. They can include dietary, exercise, and behavioral counseling, relaxation and mindfulness practice, and participation in support groups for people suffering from CRPS.

References

Annesi, J. (2020). Sequential changes advancing from exercise-induced psychological improvements to controlled eating and sustained weight loss: A treatment-focused causal chain model. The Permanente Journal, 24, 19.235. Web.

Caffrey, C. (2019). Complex regional pain syndrome (CRPS). In Salem Press Encyclopedia of Health. Salem Press.

Mago, R., Fagiolini, A., Weiller, E., & Weiss, C. (2018). Healthcare professionals perceptions on the emotional impact of having an inadequate response to antidepressant medications: Survey and prospective patient audit. Annals of General Psychiatry, 17. 

Moore, R., Derry, S., Aldington, D., Cole, P., & Wiffen, P. J. (2015). Amitriptyline for neuropathic pain in adults. Cochrane Database of Systematic Reviews, 7. Web.

Sandoz (2014). Amitriptyline. Federal Drug Administration. 

Villa, M., Rittig-Rasmussen, B., Mikkelsen, L., & Poulsen, A. (2016). Complex regional pain syndrome. Manual Therapy, 26, 223230. Web.

The media is one of the most powerful tools in information dissemination. The different forms of media have played crucial roles in influencing public knowledge and perception regarding health information and literacy. Unfortunately, the media has negatively influenced the publics perception of mental health. Movies and television shows portray psychotic disorders in a stereotypical, superficial, and inaccurate fashion, with the focus on violence, hallucinations, and traumatic experiences being largely inaccurate.

The dominant portrayal of people with mental illness in audiovisual media focuses on violence and traumatic events. People with schizophrenia are often portrayed as violent individuals who are uncontrollable and unpredictable. An example of this stereotyping is Andre Lyons depiction as a violent and hallucinating person during bipolar episodes in the Television show Empire. In reality, these symptoms form a small fraction of the experiences of people with psychotic disorders. The inaccuracies of these portrayals are further normalized through recurrent themes in different films.

The negative media portrayal of individuals with psychotic illnesses has lasting, often detrimental impacts on the patients, local community members, family members, and the willingness of these groups to seek and remain in treatment. Research indicates that the distorted depiction of mentally ill individuals discourages health-seeking behavior and hinders their efforts and desire to seek treatment (Srivastava et al., 2018). People in the local communities develop stigma towards the mentally ill as they consume the violent portrayal of such people in the media. Moreover, presenting as a person with mental illness becomes increasingly feared, shunned, and ridiculed. The negative portrayal proves to be detrimental to society in the long term.

To conclude, films and television portray psychotic disorders superficially and stereotypically. Movies often depict people with mental illnesses as violent and unpredictable. Ultimately, the communities, families, and individuals affected by psychiatric disorders are negatively affected.

Reference

Srivastava, K., Chaudhury, S., Bhat, P., & Mujawar, S. (2018). Media and mental health. Industrial Psychiatry Journal, 27(1), 1. Web.

Co morbidity refers to the coexistence of a psychiatric disorder with a substance abuse disorder often resulting from self-treatment by the patient for instance using drugs to offset the emotional distress that comes with the psychiatric disorder. It may also occur when in reaction to substance abuse; a patient develops psychiatric disorder like panic or anxiety attacks (Daughters, Bornovalova, Correia, & Lejuez, 2009, p.5). The most common coexistence occurs with mood disorders such as depression and anxiety attacks where patients seek the euphoric or sedative effects of respective drugs such as heroin, marijuana and ecstasy or alcohol and narcotics respectively. Antisocial personality disorders and affective disorders can induce illicit drug use in teenagers both in an effort to cope, and as a way of rebellion. Patients with eating disorders commonly abuse amphetamine-containing diet pills, and may shift to other stimulants when they become dependent on these (Hasin, Muthen, & Grant, 1997, p. 34).

Post Traumatic Stress Disorders (PTSD) often result in alcohol abuse or are a result of such abuse that ended in the inebriation of patients or their assailants. Attention Deficit/ Hypersensitivity Disorder (AD/HD) patients commonly abuse tobacco, marijuana or other CNS stimulating drugs in a bid to cope or fit with their peers. Such adolescents often have learning disabilities that weigh them down and induce drug use. Nevertheless, no matter the cause or reason for co morbidity, it is detrimental to treatment processes as it confounds physicians and therapists as to the extent of the conditions. If detected, both the SUD and the psychiatric disorder need to be treated simultaneously for the patient to be said to have received optimal treatment (Hasin, Muthen, & Grant, 1997, p. 30).

The DSM-IV-TR diagnostic criterion for substance abuse requires a pattern of destructive consumption tendencies by the adolescent that result in clinically significant impairment or distress. By impairment, this criterion refers to an inability to meet major role obligations, leading to reduced functioning in one or more major areas of life, risk-taking behavior, an increase in the likelihood of legal problems due to possession, and exposure to hazardous situations (Daughters, Bornovalova, Correia, & Lejuez, 2009, p. 9). This model also treats substance abuse as a residual category which can only be met in the absence of dependence. Patients with this diagnosis are therefore prone to be found on the wrong side of the law, or may be suicidal or even pose a danger to others around them. Consequently, they usually remain restrained or placed into inpatient facilities for treatment. These patients include juvenile delinquents.

The treatment facility I identified and contacted is the White Deer Run, York Pennsylvania Treatment Facility. They use various treatment modalities depending on the nature and condition of individual patients. For instance, In-Patient Non Hospital Detoxification is used to assist patients cope with withdrawal symptoms of drug abuse, In-Patient Residential CD Rehabilitation is a customized procedure that is adapted to suit each individual adolescent patients needs. It is features services such as juvenile probation and Youth recreational facilities. Their Mental Health Residential Treatment program caters for adolescents with serious behavioral disorders, emotional disturbances and mental illnesses. Its objective is to stabilize these conditions at the level of the first diagnosis and provide patients with the necessary fortification, and health climate needed for survival in the community. Finally, they also offer outpatient individual, group and family therapy with the aim of preventing stress to affected individuals while supporting the treatment process of the patient. Other therapies are: Reiki; used in treating chronic pain, abuse, and emotion-oriented syndromes; EMDR therapy is used to reduce symptoms that are associated with trauma, psychodrama ranging from social atoms to full dramas; art therapy as an expressive medium for intrapersonal conflict and trauma; and relaxation therapy. All these programs and more range from detox to aftercare. Recently, they introduced the 12-Steps program, which encourages patients to join AA/NA support groups. Their philosophy is that each patient should receive unique treatment, suitable for the condition of their chemical dependency and mental status. They also believe in promoting the autonomy of each patient and providing them with the rewards and gratification of living a drug-free lifestyle. The staff at White Deer Run is multicultural and mostly bilingual to cater for the multiethnic populace of its clients. They are also qualified and licensed to treat the various conditions that are referred to the facility. The amount of time spent at the facility ranges from a few days to months or even years depending on the intensity of the condition, as do the charges. These are dependent on both the treatment procedures to be applied and the duration of stay. In my opinion, this is a very competent facility and it appears to serve the needs of both its population and the general community.

References

Daughters S., Bornovalova, M., Correia, C., & Lejuez, C. (2009). Psychoactive Substance Use Disorders: Drugs. M. Hersen, S. M. Turner, & D. Beidel. Adult psychopathology and diagnosis: Fifth edition. Hoboken, NJ: Wiley.

Hasin, D., Muthen, B., & Grant, B.(1997). The dimensionality of DSM-IV alcohol abuse and dependence factor analysis in a clinical sample. Vrasti, R., ed. Alcoholism, New Research Perspectives. Gottingen, Germany: Hogrefe and Hubner.

Presenting Problem

Nadia Qadiri is seeking psychotherapy due to her apparent anxious mood and debilitating headaches. The headaches and anxious mood have increased and become more frequent within the last several months. Nadias presenting problems made her body extremely infirm and weak and had no physical medical explanation, which necessitated professional help. The patient first discovered the symptoms of anxiety when she was a student. She was always worried about her academic status and maintaining the charade of perfectionism. Nadias debilitating headaches started after moving to the United States and giving birth to her two daughters.

Brief History

Nadia is fifty-two years old, and she migrated to the United States from Pakistan at twenty-two. Nadia was the third child in a family of four children. Nadias mother was a homemaker, while her father worked as a steamfitter. Her family often lived in a large Pakistan city in a neighborhood of the lower middle class. As opposed to her siblings, Nadia was an exceptional and bright student. She excelled in her elementary school and entrance examinations, which earned her a place in a prestigious high school known for academic excellence. Nadia was serious with her studies and often received the highest grades. However, she was constantly worried about the maintenance of her academic excellence. Nadia appeared to be self-confident, but she was an imposter internally. She had a critical attitude towards people who could not score high grades; nonetheless, she hated criticism. She had few friends, whom she distrusted and worried about how they were motivated to ruin her reputation.

Nadia was fourteen when her distant relative inappropriately touched her. She remained silent about the incident and talked to her mother without revealing all details. As a result of the incident, Naida became wary of men, leading to a deep distrust of mens intentions. Her cynicism towards men made her accept the offer of a prearranged marriage. She became married to Javed, whom she loved but did not trust him to take care of her financially. She attended a two-year college program in Pakistan and arrived in the United States, where she worked in a grocery store on a part-time basis prior to her childrens birth. She was constantly stressed by her husbands siblings, who were disrespectful and controlling about her familys matters. Nadias family does not have a history of any addiction or mental health.

Overview of Symptoms

Nadia shows signs of anxiety, feelings of inadequacy, and debilitating headaches. She worries a lot about multiple things. Nadia is worried and concerned about how to maintain her academic status. She often appears to be self-confident, but she is concerned about being an imposter. Nadia preferred to work alone while studying to increase her feelings of being in control and reduce anxiety. Additionally, she continuously worries about her daughters being in different locations and their safety. Nadia has felt inadequate and worthless about many things after and before her marriage. For instance, she told her husband that she has low self-esteem and faces constant stress. Nadia often thinks that she is not a good mother and wife. She believed that she could not provide care to her daughters. Nadia has debilitating headaches which are not attributed to physical causes. Furthermore, she feels irritable even when she tries to be positive.

Nadia has experienced sleep disturbances and often feels lonely and sad. She denies her husband sex because she believes sex is only meant for procreation. Her mood has deteriorated, and she experiences aggravated patterns of social isolation. Few activities give her pleasure; however, she enjoys her phone conversations with her parents. Nadias capability to organize and plan daily tasks in her life and family has reduced. She feels she has lost the energy that she once had to care for her daughters. She believes she will soon have a nervous breakdown or experience an episode.

Diagnostic Formulation with Rationale

Based on her symptoms, Nadia has a major depressive disorder with anxious distress. Nadias symptoms satisfy the diagnostic criteria for major depressive disorder. A patient must experience at least loss of pleasure or interest or depressed mood to be diagnosed with major depressive disorder (American Psychiatric Association, 2013). According to Nadias symptoms, Nadia has a depressed mood and a loss of interest and pleasure. Additionally, Nadia has decreased appetite almost every day since she has based her eating habits on a starvation concept. Nadia also experiences a loss of energy, making her feel like she cannot care for her daughters. Furthermore, Nadia has become indecisive, as evidenced by her daughter wanting the parents to meet the daughters partner. Another possible diagnosis can be generalized anxiety disorder because Nadia faces excessive worry and anxiety associated with irritability, sleep disturbance, and restlessness. Furthermore, Nadia finds it hard to manage her worry.

Recommended Interventions

Nadia should seek psychotherapy to help with her major depressive disorder. Some types of psychotherapy, such as interpersonal therapy, cognitive behavioral therapy, or brain stimulation therapies, can be effective for treating depression. Face-to-face sessions with a therapist can help Nadia talk about her condition and learn how to cope. Medications can also be used to relieve depression symptoms. Such drugs for depression treatment can include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). The follow-up program will involve the counselor constantly monitoring their patients after treatment is offered to assess psychiatric symptoms changes, prevent relapses, and alter medication regimens if it is required (Giannelli, 2020). Nadia can join support groups that are based in her community since they can offer social support. In addition, Nadia can join online communities for mutual support from people around the world.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5^th ed.). American Psychiatric Pub.

Giannelli, F. R. (2020). Major depressive disorder. Journal of the American Academy of Physician Assistants, 33(4), 1920. Web.

Introduction

Substance use disorder during pregnancy is a significant public health concern that puts mothers and infants lives and well-being at risk. According to Peltier et al. (2022), women with previous mental health issues are at a higher risk of experiencing substance use disorder. Therefore, healthcare professionals should implement evidence-based interventions to minimize the prevalence of substance use disorder in this population. The plan proposed in this presentation seeks to enhance the quality of substance use disorder management in pregnant women by implementing a holistic approach following clinical guidelines.

Intended Change

The quality improvement goal for the proposed intervention with pregnant women with substance use disorder is to reduce the frequency of substance intake by the target audience by 10% within six months. To measure the change in the population, a self-reported survey will be conducted before and after the intervention with pregnant patients with substance use disorder to compare the change in the reported frequency of substance use. In addition, self-reflection on the interventions effectiveness over the implementation period will be conducted to collect qualitative measurements of the change.

A List of Required Outcomes

To achieve the quality improvement goal of the whole intervention, the following list of outcomes should be followed. Firstly, among the whole population of patients, the ones with substance use disorder should be identified through assessment and monitoring (Queensland Clinical Guidelines, 2021). Secondly, since women with substance use disorder are commonly triggered to abuse substances due to a history of previous mental illness, such underlying mental illnesses should be diagnosed (Peltier et al., 2022). Thirdly, the identified underlying mental illnesses should be treated; fourthly, patients with substance use disorder should be educated and counseled on the implications of their addiction (Queensland Clinical Guidelines, 2021). Finally, it is necessary to provide patients with community support through the establishment of proper collaborations.

Team Members Responsibilities

The responsible stakeholders for the presented intended outcomes include the nursing staff, therapists, and community-based non-profit facilities for substance use disorder treatment. In particular, the nursing staff will be responsible for patient assessment, mental illness diagnosis, and referral to therapy (Volkow, 2020). Therapists will be responsible for mental illness treatment, patient education, and disorder management skills development (Magill et al., 2019). Finally, the engaged community-based non-profit organization will be responsible for establishing community support, empowerment of patients, and the provision of resources for disorder management (Alsuhaibani et al., 2021).

Required Actions for Outcomes

In particular, the nurses will prepare communication strategies and plan the monitoring process to identify pregnant patients with substance use disorder. The nurses will formulate assessment strategies to diagnose underlying mental illnesses and develop a test for SUD diagnosis. Furthermore, nurses should research appropriate pharmacology and contact therapists to treat underlying mental illnesses. To educate and counsel patients on SUD implications, therapists will develop educational materials and schedule group and individual therapy sessions. Finally, to provide patients with community support, the project manager will contact community non-profits and arrange to fund the project.

To ensure that the project outcomes are achieved in a timely and appropriate manner, specific milestones should be established. In particular, it is planned that the results of the task achievement will be checked once a month, as well as the reports on the completed tasks will be submitted by the team members on a weekly and monthly basis according to the agreed schedule of the project. As for the supplies and equipment required for the project implementation, they will include computers and software for medical record processing, educational materials handouts, and survey sheets.

Project Time Frame

The overall duration of the planned quality improvement plan is six months, during which the patients will undergo educational and therapy-based interventions to eliminate substance use disorder via mental health treatment. During month 1, patient enrollment should be completed; a setback that might complicate this stage is the lack of individuals consenting to participate. During months 1 and 2, the diagnosis and assessment of the mental health of the patients with substance abuse will be conducted. The setback at this stage might be related to the complexity of mental health cases. During months 3 and 4, patient education and therapy sessions will take place. The setbacks at this stage might be related to patient withdrawal or internal disruption of the project plan. During month 5, community-based support groups will be initiated; during month 6, the team will conduct evaluation and reflection.

Risk Management Plan

The risks that the project team might face when implementing the intervention include internal and external ones. In particular, the lack of funds might be addressed via additional fundraising campaigns. The lack of participating patients at the intended hospital will be addressed by broadening the scope of patients to include additional medical facilities for pregnant. Finally, in the case of the disruption of stakeholder cooperation, new entities will be engaged to complete the project.

Budget and Roles

The planned project entails a budget of approximately $16,000, which entails personnel $12,000 and equipment $4,000. The roles distributed among the team members will include the following. Nurses will perform as educators and facilitators; therapists will perform as treatment specialists and educators; community counsels will be support group managers.

Progress Tracking

To monitor the completion of tasks according to the schedule, an electronic record will be created to enable team members to see the online schedule of the project and send their weekly and monthly reports on time. Twice a month, the project team will meet to discuss the success and drawbacks of the project to make adjustments. In case of challenges and possible difficulties, the issues will be addressed individually through team cooperation.

Evidence-Based Model

The evidence-based model selected as the core of the intervention is cognitive-behavioral therapy (CBT). According to Vujanovic et al. (2020), CBT is one of the most effective approaches to the treatment of substance abuse in combination with mental health issues. For that matter, the model will be used as the educational framework and therapy interventions to help pregnant women with substance use disorder acquire effective coping skills and behavioral patterns to reduce addiction.

Conclusion

The evaluation plan for the project involves the submission of team members qualitative and quantitative data provided at specific times. In particular, patient data on enrollment should be provided by nurses by the end of month 1. The formative assessment of therapy sessions will be conducted by therapists every week. The summative assessment of therapy will be conducted upon completion of the project. Support group feedback will be submitted by group facilitators every week. Finally, the patient data post-intervention will be submitted by nurses by the end of month 6.

References

Alsuhaibani, R., Smith, D. C., Lowrie, R., Aljhani, S., & Paudyal, V. (2021). Scope, quality and inclusivity of international clinical guidelines on mental health and substance abuse in relation to dual diagnosis, social and community outcomes: a systematic review. BMC Psychiatry, 21(1), 1-23.

Magill, M., Ray, L., Kiluk, B., Hoadley, A., Bernstein, M., Tonigan, J. S., & Carroll, K. (2019). A meta-analysis of cognitive-behavioral therapy for alcohol or other drug use disorders: Treatment efficacy by contrast condition. Journal of Consulting and Clinical Psychology, 87(12), 1-25.

Peltier, M. R., Roberts, W., Verplaetse, T. L., Burke, C., Zakiniaeiz, Y., Moore, K., & McKee, S. A. (2022). Licit and illicit drug use across trimesters in pregnant women endorsing past-year substance use: Results from National Survey on Drug Use and Health (20092019). Archives of Womens Mental Health, 25(4), 819-827.

Volkow, N. D. (2020). Personalizing the treatment of substance use disorders. American Journal of Psychiatry, 177(2), 113-116.

Vujanovic, A. A., Smith, L. J., Green, C., Lane, S. D., & Schmitz, J. M. (2020). Mindfulness as a predictor of cognitive-behavioral therapy outcomes in inner-city adults with posttraumatic stress and substance dependence. Addictive Behaviors, 104, 106283.

Queensland Clinical Guidelines. (2021). Perinatal substance use: Maternal. Web.

Behaviour

T. has a depression. It is evidenced by decreased inability of the mood state as well as poor ability to identify triggers and respond to them properly. T. claims to be sad and acting not like me. T. noted that she no longer engages in or performs activities that she once found enjoyable. The client lacks energy and is worn out, unhappy, and melancholy. T. stated that she occasionally feels numb and that her days are not filled with much joy.

Intervention

To reduce the symptoms as well as to improve the behaviour, T. will participate in the Intensive In-Home program by utilizing the positive coping skills. Coping mechanisms, when employed effectively, can lessen depressive symptoms and enhance well-being (Al-Shannaq and Aldalaykeh, 2021). Depending on the coping technique, they can be applied consistently every day to gradually elevate mood or during a trying time to squelch negative thoughts. The Coping Skills: Depression worksheet outlines four methods for reducing depressive symptoms that have been proven effective in the study. These methods include mindfulness training, social support, positive journaling, and behavioral activation (Al-Shannaq and Aldalaykeh, 2021). We advise practicing these skills during sessions and planning when to apply them most effectively. Create a strategy for clients to practice at home after that. This handout is an excellent resource for serving as a reminder at the home of the fundamentals of each technique.

Response

The utilization of coping skills have resulted in increased positive energy as well the increased interests and participation in activities.

Plan

Success in opening up during counseling Step Down Plan Criteria:

1. Must meet at least 50% of established goal criteria.
2. Must meet the 50% goal criteria consistently over the next authorization period.
3. The goal must be revised, and interventions enhanced to support T.s needs.
4. Authorization Units must be titrated based on T.s needs.

Reference

Al-Shannaq, Y., Mohammad, A. A., & Aldalaykeh, M. (2021). Depression, coping skills, and quality of life among Jordanian adults during the initial outbreak of COVID-19 pandemic: cross sectional study. Heliyon, 7(4), e06873.

Introduction

The patient, Tegan, a retired college professor of social studies, used to be an active and outgoing old lady before developing severe mental health issues after being involved in a train accident. This inciting event, like any crisis, happened unexpectedly and caused significant physical and emotional trauma to this woman. Before the incident, Tegan could describe herself as a person with a wide social circle and who enjoyed life. However, the problem arose suddenly when the subway she was on struck a stationary train, resulting in multiple passengers being injured. The patient herself was seriously injured since she had a ligamental tear in her left knee as well as a concussion. After spending six hours in the Emergency Department while undergoing a radiologic examination, she observed various cases of people suffering, which initially caused acute anxious symptoms that transformed into post-traumatic stress disorder (PTSD). Research and clinical practice show that exposure to cognitive-behavior therapy (CBT) is effective in treating PTSD (Bryant et al., 2018). Tegan underwent exposure therapy for her psychiatric condition, leading to the successful subsidence of her symptoms and returning her to normal life.

Clinical Expression

PTSD is a debilitating mental health state that develops after a person experiences a traumatic event. Clinically, PTSD diagnosis is established based on two major criteria. Firstly, a patient must experience or witness a sexual assault, the death of a loved one, grave danger to ones life, or severe physical injury (Bryant, 2019). Secondly, there should be symptoms from all four clusters listed in the diagnostic manual (Bryant, 2019). The first cluster comprises distressing memories, flashbacks, nightmares, and prolonged psychological disturbance (Bryant, 2019). The second cluster is characterized by active avoidance of triggers that induce trauma (Bryant, 2019). Thirdly, an individual should either have constant negative thoughts or an inability to remember some elements of the traumatic event (Bryant, 2019). Lastly, a person should present with angry and reckless behavior or excessive irritability (Bryant, 2019). If left untreated, PTSD has multiple adverse consequences for a persons life, causing marital discord, physical illness, absenteeism, and unemployment (Difede et al., 2022). Therefore, adequate and timely intervention is vital not only for the benefit of an individual but also for preventing substantial economic losses to the country due to damage to the workforce.

Symptomology, Precipitating, and Perpetuating Factors

The clinical presentation and symptomatology of PTSD vary depending on the circumstances to which a patient was exposed. In the case of Tegan, her symptoms included flashbacks and memories about the train accident and the time spent in the Emergency Room, avoidance of trips and medical procedures, fearfulness, sleeping problems, and nightmares. Additionally, she became anxious, isolated, disoriented, and terrified to return to her usual mode of living for the past five months; hence, she was diagnosed with PTSD. The primary determinants of PTSD development for an individual are death in the family, physical injury, destruction of property, female gender, older age, lack of social support, and low educational level (Baral & Bhagavati, 2019). The patient seems to have a good education and a strong support circle, but she possesses some of the other listed risk factors. The precipitating event was that she received a physical injury during the accident and spent a prolonged time in an emotionally intense place. The major perpetuating factor is her bruised knee, which requires surgical intervention. Since being in a hospital trigger negative memory, Tegan refuses to receive medical assistance for this problem.

A critical aspect that is often underestimated in PTSD is the role of an individuals physiology in the development of this disorder. Specifically, it is essential to discuss and explore the role of inflammation and metabolic factors. The reason why these components of the human organism are believed to play an important role in PTSD is that not all people exposed to severe accidents develop this condition. Indeed, in about 60% of individuals, traumatic symptoms resolve over time without any intervention (Khan et al., 2018, p. 2). It appears that people with an increased serum concentration of pro-inflammatory cytokines like tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) are at greater risk for developing PTSD (Kim et al., 2020). Research shows that people with more severe post-traumatic symptoms had higher levels of IL-6 and TNF-alpha (Kim et al., 2020). Moreover, it was found that elevated cortisol concentration may make a person more vulnerable to PTSD development (Speer et al., 2019). Although not mentioned in this patients case, it might be worth implementing anti-inflammatory treatment for Tegan since the level of pro-inflammatory markers and oxidative stress rises at an older age.

Therapeutic Model Appraisal

The treatment proposed to the patient is exposure CBT, which can be classified into two categories: imaginal and in vivo. The cognitive part of the therapy should help the patient start perceiving her situation more neutrally. The behavioral therapy incorporating the abovementioned imaginal and in vivo approaches will change Tegans neurocircuitry by continuous re-exposure to the old narrative but under safe circumstances (Cox et al., 2020). The method of prolonged exposure was developed based on the emotional processing theory. It states that any robust traumatic event that leads to PTSD alters brain structures, making a person hyper-aware of all triggering factors and causing avoidance, fear, and anger (Gramlich et al., 2021). The principles of reimagining ones negative emotions and traumatizing situations cause desensitization and inhibit fearful mechanisms in the brain (Gramlich et al., 2021). However, the main problem of this treatment modality is the risk of dropout due to the patients inability to tolerate the exposure to traumatic memories (Lewis, Roberts, Gibson, et al., 2020). Thus, the therapists goal is to acknowledge the patients feelings and constantly reassure them that the symptoms will subside in case of treatment adherence.

Another equally effective approach for PTSD treatment is called eye movement desensitization and reprocessing (EMDR). The aim of EMDR is to change how traumatic memory is perceived by a person and make it less intense and vivid (Khan et al., 2018). In fact, some researchers claim that EMDRs effectiveness is significantly higher in terms of reducing symptomatology compared to CBT (Khan et al., 2018; Mavranezouli et al., 2020). Still, both are recommended for combined use, especially in severe cases when the functioning of a patient is tremendously damaged. Technological advancement allowed to implement virtual reality and web-based therapy to enhance exposure therapy and make it more accessible (Kothgassner et al., 2019; McLean et al., 2020; McLean et al., 2021; Reger et al., 2019). Apparently, studies demonstrated the efficacy of all these approaches, but at the same time, every PTSD patient requires an individualized approach and a unique choice of therapy.

Administered Techniques

Tegan received imagined and in vivo exposure therapies for her PTSD that allowed to reduce the severity of her symptoms. The former was conducted for one month and was divided into 12 sessions, accounting for three sessions per week, which is a reasonable and justifiable amount considering the severity of Tegans state. The imagined therapy requires a person to record ones traumatic experience in detail and then listen to the recordings for a certain period of time. This approach allows to alter specific brain structures responsible for fear responses, the amygdala and insula, reducing PTSD symptomatology (Zhu et al., 2018). It is crucial because this psychiatric disorder weakens the connection between the prefrontal cortex and the amygdala, which makes people have unrealistic fears in situations that may not be dangerous (Zhu et al., 2018). Indeed, Zhu et al. (2018) state, reduced amygdala-hippocampus & connectivity and increased amygdala-insula connectivity in PTSD, which may reflect enhanced attention to threat and biased memory for adverse events (p. 975). After that, the in vivo exposure part involved the patient restarting her daily activities, visiting public places, and using the subway again.

Effectiveness of Intervention

After intense exposure therapy, Tegan started to return to everyday life, became less anxious and fearful, as well as agreed to her knee surgery that she had been refusing for months and which went well. Indeed, numerous studies have proven the efficacy of prolonged exposure therapy, and it is considered one of the most powerful methods for reducing PTSD symptoms (Peterson et al., 2020; Vermes et al., 2020). It involves psychoeducation about peoples typical reactions to trauma, relaxed breathing practices, imaginal exposure, and real-world or in vivo exposure (Peterson et al., 2020). These techniques are intended to reduce the intensity of traumatic memories and to alleviate somatization symptoms as well as other mental health illnesses that sometimes are present in PTSD cases (Nesterko et al., 2020). Psychotherapists should be mindful of the choice of methodology because what works for one patient may not apply to another person due to their background differences (Lewis, Roberts, Andrew, et al., 2020). Overall, the method of prolonged imagined and in vivo exposure worked for this patient during a relatively short period of time.

The prolonged exposure therapy is likely effective due to the fact that it employs knowledge about classical conditioning. Based on the understanding of the latter, exposing a person to an aversive stimulus in combination with a neutral idea or situation may make the negative experience feel less dangerous (Vermes et al., 2020). In fact, Tegans PTSD was successfully resolved because behavioral therapy coupled with cognitive therapy helped her understand that the traumatic event that happened to her is a normal part of life. Furthermore, listening to the recordings about her unpleasant experiences helped her realize that they were not as dramatic as she believed. This approach was efficacious because the woman remained compliant with treatment and was eager to return to everyday life. Additionally, Tegan had supportive friends and was well educated, which are known as protective factors from developing PTSD and can be assumed to be vital elements of her mental recovery.

The treatment would be much more complicated if the patient were a depressed and physically unhealthy woman before the accident. The therapy could take longer or might fail if Tegan had an elevated level of pro-inflammatory cytokines and cortisol. In that case, she would require additional therapy for other mental health issues and treatment for possible chronic illnesses, which could shift the patients focus on her fears again. Fortunately, in this case, Tegan had the chance to focus mainly on her primary mental health issue and then seek medical help for her injured knee. Moreover, if the patient could not leave her house, it would require the use of web-based and virtual reality approaches to make exposure therapy as realistic as possible and ensure this patients issue is resolved.

Conclusion

Tegans PTSD was caused by a train accident in which the patient was unwillingly and unexpectedly involved, which caused quite severe physical and emotional injury to the woman in this case study. It appears that the major problem was induced by the fact that the patient spent six hours in the Emergency Room, where she saw traumatic pictures of human suffering. Furthermore, Tegan got a concussion and tore one of the ligaments in the left knee. Since her symptoms of PTSD worsened to the point that the patient tried to avoid social circumstances that caused her trauma and refused to undergo surgical repair of the knee, a therapists help was needed. The psychotherapist, experienced in PTSD, suggested that Tegan undergo prolonged exposure therapy to rewire her brain to view traumatic events as less dramatic and restore her normal functioning. Indeed, the exposure method was proven effective for substantially improving PTSD symptoms since it involved negative learning and desensitization. Overall, the therapy helped the patient eliminate her fears and return to her normal and active life as it was before the inciting incident.

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