Psych NP Case Studies Essay
Each case study has to be completed
Cases:
MDD & Homelessness- You have been providing some pro bono care and services at a local drop-in veteran center. They have limited bed space for homeless veterans and have a rather extensive waiting list for services. You are asked by the social worker to help devise a group therapy program for a group of homeless veterans with mental health issues. Psych NP Case Studies Essay
Older adult & suicide- You are called to a local nursing home for consultation. You meet seventy-three-year-old female resident who has resided in the nursing facility for approximately six weeks. She was admitted to this facility following an acute CVA, and although involvement of her right side is minimal, staff report that she appears depressed, and a few evenings before your visit, made statements that she wanted to kill herself. One of the nursing assistants informs you that she only says that because she knows that when she is placed on suicide precautions, that her daughter will come to visit.
Marijuana and Schizoaffective disorder- You receiver referral to your outpatient clinic for a twenty-one-year-old Pakistani male, who reports that he was hearing voices, but that he is able to control the voices with marijuana. Despite his assertions, the referral that you receive comes from a local inpatient psychiatric unit. In reviewing the psychiatrist’s assessment during the client’s hospitalization, you learn that he has been hospitalized several times for worsening of psychosis secondary to cannabis use. You further learn from this assessment that the client will not accept the diagnosis of schizoaffective disorder, even though he meets all of the DSM-5 criteria for this disorder.
Questions to address in your main posting:
Discuss the process of diagnostic differentiation (be specific about what your assessment would include specific to the diagnoses provided)- how would you determine symptoms belonging to each condition and how would you work with symptom overlap?
Describe how the current setting in which the child lives would impact your care/treatment plan.
Discuss physical assessments you would make with the client- include a description of any referrals you would consider (and what is the rationale for those referrals?)
List laboratory testing and rationale for selected tests
Discuss concerns with existing pharmacotherapeutic approaches and
discuss any changes you would consider- include rationale for any changes you may suggest. Psych NP Case Studies Essay
Tell us about the psychotherapeutic approaches you would use with this client. Specifically, what psychotherapy will you use, and why? Will you make referrals for any type of specialized psychological testing? Will you refer the individual to group psychotherapy? Again, all responses should be evidence-based.
Included discussion of possible strengths and weaknesses of each client.
Describe discharge criteria-that is, what is it that the client must be able to successfully do, achieve, or complete, for you to discharge them from your current patient load?
Psych NP Case Studies
Older Adult & Suicide
The assessment will focus on the known risk factors for suicide in older adults. The risk factors for suicide in older adults include physical ailments, lack of social support, mental disorders like depression, losses, and suicide ideation. The client has various risk factors that include physical ailment due to an acute CVA; depression, lack of social support since she is in a nursing home and she indicates the desire to have her daughter visit; and the suicidal ideation where she constantly mentions she will kill herself.
The patient will be assessed for suicide ideation using tools such as the Interpersonal Needs Questionnaire and the Geriatric Suicide Ideation Scale, Geriatric Depression Scale to assess the patient’s depression severity. The Columbia Suicide Severity Rating Scale will be used to assess the patient’s risk of suicide. The client will be assessed for depression using the DSM-5 diagnostic criteria. It will also be important to assess if the stroke is the cause of depressive symptoms for this client.
The client has been staying in the nursing home facility for 6 weeks. Evidence shows that older adults living in nursing homes may have reduced quality of life, suffer from depression, and experience social isolation (Boland et al., 2017). Social isolation and lack/loss of independency are the factors that contribute to depression and reduced quality of life for individuals living in nursing homes. Therefore, this patient is likely to be experiencing symptoms of depression and suicide ideation because of the impact of being in a nursing home. It would thus be appropriate to ensure that social isolation is addressed in the client’s treatment plan. This client will further be assessed for hypothyroidism. This is because hypothyroidism is associated with depression.
It will be appropriate to conduct blood tests for this client. Blood tests would help examine if there are medical conditions such as thyroid or anemia problems that would be contributing to the depressive symptoms for this client.
Cognitive-behavioral therapy (CBT) would be appropriate for the client. CBT focuses to change the maladaptive thoughts into more positive thoughts. Secondly, CBT equips individuals with coping skills to deal with difficult events in their lives (Raue et al., 2017). Moreover, the efficacy of CBT for older adults with depression and acute health conditions has been demonstrated. A study conducted by Raue et al (2017) indicated that hospitalized older adults with depression demonstrated major improvements in depressive symptoms and physical functioning after undergoing 15 sessions of CBT.
The major weakness in the treatment of older adults is that aging is associated with cognitive impairment and this may interfere with the therapeutic process. The cognitive impairment may interfere with the client’s ability to understand the skills and knowledge taught during the CBT (Soleimani et al., 2018). Cognitive impairment may also interfere with the client’s ability to adhere to the treatment regimen. The possible strength is that the client may have the appropriate social support from the daughter.
A significant symptom remission including the risk for suicide should indicate the client’s readiness for discharge. The suicide risk for this client should be assessed and documented. Low risk for suicide is an indication that the client is ready for discharge. The protective factors for the client should be identified, including the available social support system for the client. It is important to engage the client in adaptive problem-solving to ensure that she has the skills to cope with challenging events. Finally, a suicide safety or crisis plan should be worked out and the client provided with a copy. Psych NP Case Studies Essay
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Marijuana and Schizoaffective Disorder
For this client, it would be appropriate to assess for Cannabis-Induced Psychotic Disorder (CIPD). According to the DSM-5 criteria, a CIPD diagnosis is given when an individual presents hallucinations and delusions following cannabis intoxication. The disturbance significantly impairs an individual’s functioning or causes significant distress (Pearson & Berry, 2019). Therefore, it would be important to assess the client for CIPD if the symptoms have been present for more than one month for the client.
The second client needs to be assessed for other mental disorders, including substance abuse, Cannabis-Induced Psychotic Disorder, and psychosis. The client is from Pakistan, and thus this should be integrated into the client’s treatment plan. The client is an immigrant; evidence shows that nativity is a key significant factor associated with substance use disorders among immigrants in the US (Salas-Wright et al., 2014).
The client would undergo a CT scan to analyze if there are physical defects that may be causing the psychotic symptoms for this client (Bai et al., 2018). For both clients, there is no indication if they are using any current medications.
Motivational interviewing (MI), CBT, and contingency management (CM) will be used to treat Marijuana and Schizoaffective disorder. MI is a therapeutic counseling technique that focuses on resolving uncertainty and allows individuals to change and adopt better lifestyle choices such as stopping substance abuse through a self-actualization process (Schultz et al., 2015). CBT will be used to change the client’s belief system and thought proves, and subsequently lead to both emotional and behavioral changes. The contingency management will be used to reinforce the positive behaviors for the client, such as regarding the client for stopping to use marijuana (Schultz et al., 2015).
However, the psychosis may interfere with his ability to understand the treatment regimen (Clark et al., 2018).
A complete symptom remission, especially the psychotic symptoms should be an indication for the client’s readiness for discharge. Before discharge, it is important to educate the client about the possible triggers of marijuana use and how to avoid the triggers. During discharge, the client will be advised to seek support from local community support groups.
MDD & Homelessness
This client will be assessed for other mental disorders, substance abuse, and physical illness. This is because evidence indicates that the prevalence of mental disorders, physical illness, and addictions are significantly higher among homeless individuals. Substance abuse is a strong predictor of homelessness and common comorbidity in people with serious mental disorders (Mejia-Lancheros et al., 2020). Additionally, since post-traumatic stress disorder (PTSD) is common in veterans, this client will also be assessed for PTSD.
The current setting for the clients is homelessness. Homeless individuals are likely to experience feelings of isolation and withdrawal. Additionally, homelessness increases the risk of the individual abusing drugs or alcohol and the risk of mental health problems because of feelings of isolation (Marcal, 2018). Additionally, homeless people are exposed to cold and unhygienic conditions and thus more prone to ill health. It is necessary to conduct a comprehensive physical and mental health assessment for the homeless client because they are more prone to both physical and mental illnesses. Psych NP Case Studies Essay
A group- cognitive-behavioral therapy (group-CBT) would help the clients develop a more positive thinking pattern and equip them with skills to deal with challenging life situations such as homelessness (Raue et al., 2017). A group-CBT would allow the clients to share their experiences, encourage each other, and provide moral support to each other.
The aspect of homelessness and the unavailability of bed space for homeless veterans may hinder the process of effective care provision for the client. The homeless clients would be discharged after a safe housing has been identified and after complete remission of the depression symptoms.
References
Bai, Y., Yang, X., Zeng, Z., & Yang, H. (2018). A case report of schizoaffective disorder with ritualistic behaviors and catatonic stupor: successful treatment by risperidone and modified electroconvulsive therapy. BMC psychiatry, 18(1), 67.
Boland, L., Légaré, F., Perez, M. M. B., Menear, M., Garvelink, M. M., McIsaac, D. I., … & Stacey, D. (2017). Impact of home care versus alternative locations of care on elder health outcomes: an overview of systematic reviews. BMC geriatrics, 17(1), 20.
Clark, S. R., Schubert, K. O., Olagunju, A. T., Lyrtzis, E. A., & Baune, B. T. (2018). Cognitive and Functional Assessment of Psychosis Stratification Study (CoFAPSS): Rationale, Design, and Characteristics. Frontiers in psychiatry, 9, 662.
Marcal K. (2018). Timing of housing crises: Impacts on maternal depression. Social work in mental health, 16(3), 266–283. https://doi.org/10.1080/15332985.2017.1385565
Mejia-Lancheros, C., Lachaud, J., O’Campo, P., Wiens, K., Nisenbaum, R., Wang, R., … & Stergiopoulos, V. (2020). Trajectories and mental health-related predictors of perceived discrimination and stigma among homeless adults with mental illness. PloS one, 15(2), e0229385.
Pearson, N. T., & Berry, J. H. (2019). Cannabis and Psychosis Through the Lens of DSM-5. International journal of environmental research and public health, 16(21), 4149.
Raue, P. J., McGovern, A. R., Kiosses, D. N., & Sirey, J. A. (2017). Advances in Psychotherapy for Depressed Older Adults. Current psychiatry reports, 19(9), 57.
Salas-Wright, C, Vaughn G., Clark T, Terzis D & Córdova, D. (2014). Substance use disorders among first- and second- generation immigrant adults in the United States: evidence of an immigrant paradox? Journal of studies on alcohol and drugs, 75(6), 958–967.
Schultz, B. R., Rodriguez-Cabezas, L., Angres, D., & Smith, M. J. (2015). Treatment Strategies for Cannabis Use in Schizophrenia. Current Treatment Options in Psychiatry, 2(2), 168-181.
Soleimani, R., Shokrgozar, S., Fallahi, M., Kafi, H., & Kiani, M. (2018). An investigation into the prevalence of cognitive impairment and the performance of older adults in Guilan province. Journal of medicine and life, 11(3), 247–253.
