Psychotherapy with Individuals Essay Paper
Week 10: Psychotherapy With Older Adults
According to the Institute of Medicine, more than 20% of the growing older adult population has a mental health disorder (IOM, 2012). In the past, many older adults avoided psychotherapy because of the associated social stigma, but with the growing acceptance of therapy and awareness of mental health issues, more of this population is seeking the help they need. In your role, as the psychiatric mental health nurse practitioner, you have the opportunity to help these older adult clients overcome challenges that may have plagued them for a lifetime.
This week, as you explore psychotherapy with older adults, you assess clients and consider the appropriateness of various therapeutic approaches. Psychotherapy with Individuals Essay Paper
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Learning Resources
Required Readings
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.
Chapter 18, “Psychotherapy With Older Adults” (pp. 625–660)
Chapter 20, “Termination and Outcome Evaluation” (pp. 693–712)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
McGuire, J. (2009). Ethical considerations when working with older adults in psychology. Ethics & Behavior, 19(2), 112–128. doi:10.1080/10508420902772702
Swift, J. K., & Greenberg, R. P. (2015). What is premature termination, and why does it occur? In Premature termination in psychotherapy: Strategies for engaging clients and improving outcomes (pp. 11–31). Washington, DC: American Psychological Association. doi:10.1037/14469-002
Document: Week 10 Case Study (PDF)
Discussion: Therapy with Older Adults
Clients who are older have often times been dealing with their mental health disorder their entire lives, whiles other disorders may be brought on through the aging process or the trauma of losing a lifelong partner. Treatment can be challenging for both the client and the therapist. For this Discussion, you will focus on therapeutic approaches for an older adult presented in a case study.
Learning Objectives
Students will:
Assess clients presenting with depression
Analyze therapeutic approaches for treating clients presenting with depression
Evaluate outcomes for clients presenting with depression
To prepare:·
Download and review the Week 10: Case Study from this week’s Learning Resources.
Review this week’s Learning Resources and reflect on the insights they provide.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the \”Post to Discussion Question\” link and then select \”Create Thread\” to complete your initial post. Remember, once you click Submit, you cannot delete or edit your own posts, and cannot post anonymously. Please check your post carefully before clicking Submit! Psychotherapy with Individuals Essay Paper
By Day 3
Post a treatment plan for the older adult client in the Week 10: Case Study found in this week’s Learning Resources. Be sure to address the following in your post:
Which diagnosis should be considered?
What is the DSM-V Coding for the diagnosis you are considering?
What is your rationale for the diagnosis? Be sure and link the client’s signs and symptoms to the DSM-V diagnostic criteria to support your diagnosis.
What tests or tools should be considered to help identify the correct diagnosis?
What differential diagnosis should be considered?
What Treatment Strategy would you recommend?
What treatment would you prescribe and what is the rationale?
Safety
Psychopharmacology
Diagnostic Tests
Psychotherapy
Psychoeducation
What standard guidelines would you use to treat or assess this patient?
Clinical Note: Is depression a normal part of aging?
Support your approach with evidence-based literature
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6640 Psychotherapy with Individuals
The case study involves a 69-year-old male who presents with complaints about depression and anxiety. The client further reports that anxiety and depression symptoms have been worsening because his father is dying. The client received psychotherapy for anxiety after he was diagnosed with prostate cancer and has been on several pharmacotherapy agents such as Effexor, Prozac, Zoloft Lexapro, and Duloxetine. Currently, he is taking Lorazepam 1 mg.
The possible diagnosis for this patient is major depressive disorder (MDD) and generalized anxiety disorder. MDD in this client is manifested by symptoms such as lack of interest to interact with the family, tiredness, sleep difficulties, feeling guilty, and concentration difficulties while reading. These symptoms have interfered with his ability to work, as he no longer goes to work at the nursing home. According to the DSM-V criteria, symptoms of major depressive disorder include social withdrawal, weight changes, sleep difficulties, concentration problems, feeling worthless and hopeless, fatigue, feeling guilty, sad mood, and suicidal feelings (Hasin et al., 2018). The depressive symptoms impair an individual’s ability to function normally. The client manifests the majority of MDD symptoms that have interfered with his ability to work at the nursing home. GAD in older adults can be diagnosed when an individual has excessive worry or anxiety for more than six months. Other symptoms that should be present include restlessness, concentration difficulties, sleep disruption, or fatigue (Balsamo et al., 2018). The client manifests excessive anxiety, fatigue, concentration problems, restlessness, and sleep difficulties. Psychotherapy with Individuals Essay Paper
The treatment strategy for the patient will consist of a combination of both pharmacotherapy and psychotherapy. For psychotherapy treatment, cognitive-behavioral therapy (CBT) will be used. CBT is normally the first-line psychotherapy in the treatment of GAD in the elderly (Stavestrand et al., 2019). CBT is also effective in treating MDD in the elderly. The CBT is used to teach patients to interpret how situations affect one’s mood, feelings, and behaviors and thus aims to change the maladaptive thinking pattern, into a more positive thinking pattern (Stavestrand et al., 2019). Additionally, through CBT, the patient will be taught coping skills on how to handle difficult situations such as the one he is facing about the father.
The recommended antidepressant for this client is Escitalopram. Escitalopram is an SSRI that is effective in older patients to treat major depression and generalized anxiety disorder. Escitalopram works by elevating the amount of serotonin in the brain and thus improves the mood and feelings. In selecting antidepressants, the guidelines recommend that the medication should be selected according to the lowest risk of medication-medication interactions, safety profile, and the best side effect profile.
According to the Clinical Practice Guidelines for Management of Depression in Elderly by Indian Psychiatric Society (IPS), when selecting an antidepressant for an elderly, it is important to consider the type of depression, the earlier response, the safety profile, side effects, and the risk of interactions with other medications (Avasthi & Grover, 2018). Antidepressants in the elderly should be initiated at half of the typical adult dose, and then titrated upwards depending on the side effects, clinical response, and if the maximum dose has been achieved (Avasthi & Grover, 2018).
Even though depression is common among the elderly, it is not a typical characteristic of aging. Depression is a clinical issue that should be addressed. The prevalence of depression is high among the geriatric population due to factors such as having lost a spouse, presence of chronic disease, and social isolation (Mirkena et al., 2018). The client in this study is a widower, was diagnosed with prostate cancer, and is on the verge of losing his father, his only social support. All these factors predispose him to depression disorder. Psychotherapy with Individuals Essay Paper
References
Avasthi, A., & Grover, S. (2018). Clinical Practice Guidelines for Management of Depression in the Elderly. Indian journal of psychiatry, 60(Suppl 3), S341–S362. https://doi.org/10.4103/0019-5545.224474.
Balsamo, M., Cataldi, F., Carlucci, L., & Fairfield, B. (2018). Assessment of anxiety in older adults: a review of self-report measures. Clinical interventions in aging, 13, 573–593. https://doi.org/10.2147/CIA.S114100.
Hasin, D. S., Sarvet, A. L., Meyers, J. L., Saha, T. D., Ruan, W. J., Stohl, M., & Grant, B. F. (2018). Epidemiology of adult DSM-5 major depressive disorder and its specifiers in the United States. JAMA Psychiatry, 75(4), 336-346.
Mirkena, Y., Reta, M. M., Haile, K., Nassir, Z., & Sisay, M. M. (2018). Prevalence of depression and associated factors among older adults at ambo town, Oromia region, Ethiopia. BMC psychiatry, 18(1), 338. https://doi.org/10.1186/s12888-018-1911-8.
Stavestrand, S. H., Sirevåg, K., Nordhus, I. H., Sjøbø, T., Endal, T. B., Nordahl, H. M., … & Andersson, E. (2019). Physical exercise augmented cognitive behavior therapy for older adults with a generalized anxiety disorder (PEXACOG): study protocol for a randomized controlled trial. Trials, 20(1), 1-14.
NURS 6640: Psychotherapy with Individuals
Week 10: Case Study
IDENTIFICATION: The patient is a 69-year-old, widowed African American male who is the father of one adult child and grandfather of six grandchildren. The patient is self-referred to a psychiatric outpatient clinic.
CHIEF COMPLAINT: “I need help with depression and anxiety.
HISTORY OF CHIEF COMPLAINT: The patient reports that his father is dying, and he has been experiencing worsening of depression and anxiety symptoms over the past few months. He is seeking a psychiatric evaluation at his son’s advice. The patient does not enjoy being with his family.
He has difficulty falling asleep, but then spends the day lying on the couch and reports feeling like he is “moving in slow motion.” He reports feeling tired all the time. He has also stopped going to his volunteer job at the nursing home.
He responded to the practitioner’s question of “why depressed now?” by saying that with the imminent death of his father, he is losing his main support. In addition to his father’s illness, the patient was diagnosed and treated for prostate cancer this year. He received psychotherapy at that time which focused on his anxiety about the diagnosis, his denial of its severity, his wish to “not know what he knew,” and, ultimately, end-of-life issues.
PAST PSYCHIATRIC HISTORY: The patient was never hospitalized for psychiatric reasons. He has no history of suicidal thoughts, gestures, or attempts. The patient described either a partial or negative response from several medications he had been prescribed from his primary care provider (PCP) over the course of a several years, including Effexor, Prozac, Zoloft Lexapro and Duloxetine. Psychotherapy with Individuals Essay Paper
He is currently prescribed Lorazeapm 1 mg BID by his PCP which he has been taking for several years.
MEDICAL HISTORY: GERD, HTN and hyperlipidemia. History of prostate cancer.
HISTORY OF DRUG OR ALCOHOL ABUSE: The patient denies history of drug and alcohol abuse.
FAMILY PSYCHIATRIC HISTORY: Patient reports that his mother had depression. He is an only child and does not recall any emotional difficulties in grandparents or other relatives.
Personal History
Perinatal: No known perinatal complications.
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TRAUMA/ABUSE HISTORY: Denies
Mental Status Examination
Appearance: Well-groomed, appropriately dressed, older Gentleman who is obese
Behavior and psychomotor activity: Good eye contact, pleasant, cooperative. Slightly unsteady gait uses walker.
Consciousness: Alert and able to answer all questions appropriately.
Orientation: Oriented to person, place, time, and situation.
Memory: Intact. Good recent and remote memory.
Concentration and attention: Appears to have good concentration during the interview but reports that he has recently had trouble concentrating while reading.
Visuospatial ability: Not formally assessed.
Abstract thought: Within normal limits, appropriate use of metaphors.
Intellectual functioning: Patient has Masters degree
Speech and language: Normal rate and rhythm.
Perceptions: No abnormalities present.
Thought processes: Goal directed, but evidence of guilt and rumination consistent with depressive symptomatology.
Thought content: Patient is highly anxious and expresses thoughts of sadness, frustration. He is preoccupied with thoughts about the anticipated loss of his father.
Mood: Depressed and anxious.
Affect: Congruent with mood.
Impulse control: Good.
Judgment/insight/reliability: Good.
