Physical Health Considerations Prior to Further Assessments
Order Instructions:
You need to respond to following case study and provide a 1000 word medication management plan for the individual.
CASE STUDY 2: Rebecca
Rebecca is a 30 year old woman who is married with twelve month old daughter. Rebecca has had two (2) previous admissions to the mental health unit after attempting suicide, this is her third admission. Her husband Paul rang the triage team expressing concern that Rebecca was relapsing, he reported that she had been staying in bed saying she was tired all the time, crying and unable to care for their daughter. Rebecca’s husband reports their relationship is under strain. Both sets of parents are helping with the care of their child.
Family History
Rebecca is the youngest child of three siblings with two older brothers aged 39 and 36 years; her parents are very supportive and have a good relationship with Rebecca and her husband. Rebecca’s maternal grandmother and her aunt have a diagnosis of major depression. Rebecca and Paul live in the same suburb as her parents. Rebecca’s parents are active members of the carer’s group run by the local Mental Health service. Rebecca is to be discharged next week.
Medical History
– Nil physical problems
Psychiatric History
Rebecca was first diagnosed with Major Depressive Disorder at the age of 25 and has had three admissions to inpatient care in the past 5 years. Rebecca is currently being managed on mianserin hydrochloride – 120mg PO daily.
Current Mental State Examination Appearance & Behaviour:
– Looks stated age of 30
– Average height and weight
– Black hair, unkempt
– Dressed appropriate to weather, slightly dishevelled
– Has scars on both wrists
– Reluctant to be involved in conversation with intermittent eye contact
Cognition:
-Orientated to time, place and person. Not able to maintain concentration throughout interview.
Mood:
– Rebecca says she is very sad and tired
Affect:
– Congruent when discussing events leading to admission
Speech:
– Slow with monosyllabic responses
Form of thought:
– Logical and sequential
Content of thought:
– Believes that her husband and daughter would have a better life if she wasn’t
around. She states that she is not a good mother.
Perception:
– No perceptual disturbances elicited
Insight:
– Moderate insight into illness, states she knows she has depression and will take medication but doesn’t believe that it will do any good.
Judgement:
– Judgement is poor, however, she is willing to take medication, and try to stay well. – Is accepting of the need for case-management, has agreed to attend counselling
with her husband.
Please do NOT seek out medication management plan templates from the web. The assignment is to be presented in a question/answer format, No dot points and not as and essay (i.e. no introduction or conclusion). Each answer must be supported with citations.
You will need to reference according to APA referencing.(valid in Australia only articles and journals minimum 10. )
These are the question
Q1. What physical health considerations should be undertaken prior to giving this medication to the consumer?
Q2. Provide rationales for the use of this medication in this consumer.
Q3. What are the side effects / adverse effects of this medication? Indicate the management strategies that would be used to deal with these effects?
Q4. Discuss the relationship between medication management and recovery principles in mental health.
I AM ATTACHING THE MARKING GUIDE PLEASE FOLLOW THAT OR ESSAY WILL BE RETURNED TO FIX.
SAMPLE ANSWER
Physical Health Considerations Prior to Further Assessments
Despite the fact that physical and mental health conditions may be deemed as separate, research has proved that they are indeed interrelated and that the treatment of one may exacerbate the extent of severity in the other. The reverse is also true (NICE, 2009). The statement, therefore, explicitly suggests that in patients that have been diagnosed with both physical and mental problems, a great risk emanating from assessment and treatment of depression exists (Collinwood, 2013).
Therefore, treatment of depression disorders cannot be done in absentia. For instance, a study carried out by Moy et al., (2009) found that about 22% of patients diagnosed with Severe Chronic Pulmonary Disease had some form of mild depression. The treatment for depression may come under strain considering that some forms of antidepressant medications may or may not be effective depending on the type of physical complications present or the extent of it (Goldberg, 2010). Therefore, it may be impossible to rank the effectiveness of one antidepressant drug over another.
Rebecca’s case is one that meets the current diagnosis for depression threshold by satisfying both ICD-10 and DSM-IV systems. These symptoms include her constant complaints of lack of energy, loss of interest, low moods, poor judgment, being disheveled, and loss of self-worth—to the extent of making a third attempt at suicide. The fact that her condition is not linked to any physical problems makes it far easier to diagnose. However, her treatment alternatives implore the consideration of her past family history of depression as both her maternal grandmother and Aunt were previously diagnosed with depression at some point in their lives.
Rationale for Antidepressant Use on Rebecca
As is standard, medical guidelines implore for a thorough and comprehensive background assessment on patients to be performed so as to arrive at the best alternative for depression management. According to the National Institute for Health and Care Excellence (2009), a general practitioner must carry out case identification and recognition to ascertain the current state of the patient. The specificities that entail of this stage includes the identification of possible comorbid diseases that may act as risk factors preceding the occurrence of depression. However, because Rebecca had no prior physical ailments, it was imperative to go-on to the next stage.
The next stage of diagnosis as is, is to assess the risk factors such as ascertaining past first-degree relatives histories of previous cases of depression diagnosis. As was the finding, Rebecca’s relatives—her maternal grandmother and Aunt—had previous histories of psychotic disorders. Lastly, the assessment must factor in the extent to which this psychotic disorder was recurrent. In Rebecca, the rate of recurrence of depression is quite evident. She had had two previous admissions to the mental health unit following failed suicide attempts.
According to Gelenberg et al., (2010), the prescription of antidepressants must be within the confines of the patient’s profile as well a complete analysis of therapeutic response from prescription. Also, the prescription must not be in conflict with other prescription drugs; Selective Serotonin Reuptake Inhibitors (SSRIs) have been proven to raise the risks involved when administered in the presence of other drugs (Fournier et al., 2010). It has been shown that this puts patients at greater risks of complications such as gastrointestinal bleeding in analgesics and increase in plasma concentration of procyclidine in antimuscarinics among others (USPSTF, 2010).
The Side Effects of Prescription Drug and Management Strategies
Currently, Rebecca is being managed on Mianserin Hydrochloride and is on a dosage of 120mg PO daily. While these medications may offer therapeutic aid to the patient with regards to depression management, these prescriptions may breed other side effects. The extent of effects may depend on the actual prescription administered i.e. Tricyclic, Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs), Reversible Inhibitors of Monoamine Oxidase A (RIMA’s), and Monoamine Oxidase Inhibitors (MAOIs) (ASHSP, 2009).
These side effects may range from: nausea, diarrhea, headaches, insomnia, weight gain, withdrawal symptoms, sexual dysfunctions, tremors, diabetes, and serotonin syndrome (Anderson, 2009; Sweitzer and Maguire, 2009). The continued use of SSRIs such as Mianserin Hydrochloride may lead to the occurrence of heightened suicidal tendencies amongst drug users. The most common methods that can be employed to manage these symptoms include for cases such as insomnia, adding small doses of trazodone may ease the side effects; for Akathesia inclusion of clonazepam; for sexual dysfunction considering the use of Bupropion. All these are included to act as panaceas for these side effects. However, this must be done considerately of the fact that certain drugs may conflict with the antidepressant prescribed.
Relationship between Medication Management and Recovery Principles in Mental Health
It has been shown that recovery from mental illnesses varies from different unique experiences of each individual (Richard, 2011). Therefore, there have to be different recovery management plans to satisfy unique individualistic needs. And with such, cases such as relapsing are avoided. Adherence to the principles of mental health management ensures efforts channeled to treatment, with regards to medication administration, complement each other. These principles extend to changing attitudes in mental patients, evaluating other forms of medication through constant reviewing of current medication plans and ensuring social interaction by building support systems around these patients (Anthony and Farkas, 2011)). In Rebecca’s case; therefore, a constant review of her medical progress ought to be reviewed periodically as well as encouraging her and her family to build stronger support systems to aid in her recovery.
References
American Society of Health-System Pharmacists. (2009). “Medline Plus. Drugs, Supplements and Herbal Information.” Retrieved from https://www.nim.nih.gov/medlineplus/druginformation.html
Andersohn, F., Schade, R., Suissa, S. & Garbe, E. (2009). Long-term use of antidepressants for depressive disorders and the risk of diabetes mellitus. The American Journal of Psychiatry, 155 (5), 591-598
Anthony, W. & Farkas, M. (2011). The Essential Guide to Psychiatric Rehabilitation Practice. Boston: Boston University Center for Psychiatric Rehabilitation.
Collingwood, J. (2013). “The Relationship between Mental and Physical Health.” Retrieved from: http://psychcentral.com/lib/the-relationship-between-mental-and-physical-health/
Fournier JC, DeRubeis RJ, Hollon SD, Dimidjian S, Amsterdam J.D., Shelton, R.C., Fawcett, J. (2010) Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA, 303:47–53 [E]
Gelenberg AJ, Freeman MP, Markowitz JC, et al. (2010). Practice guideline for the treatment of patients with major depressive disorder. American Journal of Psychiatry, 167.
Goldberg D. (2010). The Detection and Treatment of Depression in the Physically Ill. World Psychiatry, Vol. 9, February 2010, pp. 16-20.
National Institute for Health and Care Excellence. (2009). Depression in Adults with A Chronic Physical Health Problem Treatment and Management. Retrieved from: https://guidance.nice.org.uk/cg91
Schweitzer, I., Maguire, K. & Ng, C. (2009). Sexual side effects of contemporary antidepressants: review. Australian and New Zealand Journal of Psychiatry, 43, 795-808.
United States Preventive Services Task Force. (2009). Screening For Depression in Adults. Annals of Internal Medicine, 2009; 151:784-792.
Richard, D. (2011). Prevalence and Clinical Course of Depression: A Review. Clinical Psychology Review, Vol. 31 (7) 1117.
Moy, M. L. et al. (2009). Multivariate Models of Determinants of Health-Related Quality Of Life in Severe Chronic Obstructive Pulmonary Disease. The Journal of Rehabilitation Research and Development, Vol. 46, 2009, pp. 643-54.
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