week 10: 3rd paragraph explaining why suggest alternative with evidenced based literature

Directions:

Respond to at least two of your colleagues by providing one alternative therapeutic approach. Explain why you suggest this alternative and support your suggestion with evidence-based literature.

3 Paragraphs

5-6 Sentences each paragraph

2 references

apa format

Therapy with Older Adults

Many individuals live a long and happy life without mental health issues. Although the increasingly common impression of sad, slow, and forgetful elders, mental disorders are not an inevitable result of aging. More than 20 percent of people aged 55 and over may have some sort of mental health problem. Biological changes may hinder the brain’s functioning, social changes may lead to loneliness or hopelessness, and somatic diseases also play a crucial contributory factor (de Mendonça Lima & Ivbijaro, 2013). Mental health issues can substantially impact an older person’s ability to perform basic daily living activities, decreasing their independence, individuality, and quality of life. The first step in mitigating these damaging consequences is proper diagnosis.

Patient History

Patient is a 69-year-old, widowed African American male with a chief complaint of depression and anxiety. He is brought himself to an outpatient clinic and seeking psychiatric evaluation at his son’s advice. The patient does not enjoy being with his family. He also had difficulty in falling asleep but spends all day lying on the couch and reports feeling tired all the time. He also quit volunteering at the nursing home. He denies a history of alcohol or drug abuse. Had received psychotherapy this year after being diagnosed and treated for prostate cancer. He is currently on Lorazepam 1 mg BID by his PCP which he has been taking for several years.

Diagnosis

Patient showing signs and symptoms of Major Depressive Disorder (MDD) (F32.5) as well as Anxiety Disorders (GAD) (F41.1) The rationale for MDD diagnosis is because the patient-reported not enjoying being around his family and having difficulty falling asleep. Always laying on his couch and feeling tired. He also stopped doing activities he used to enjoy doing such as working as a volunteer in a nursing home. According to the DSM?5, three or more of the problems described below should be evident over the same 2?week time period that characterizes changes in the inability to function. At least one symptom is either a depressed mood or losing interest. The client should have a depressed mood most of the day and almost every day. Substantially decreased interest or enjoyment for most of the usual activities. Substantial weight loss or gain. Insomnia. Fatigue or loss of energy (DSM-5, 2017). MDD and ADD are highly co-morbid to each other. The patient is experiencing GAD as evidenced by excessive anxiety and worry that occur more day than not for at least six months. Patient feeling tired, sleep disturbance or difficulty falling asleep (Bystritsky, Khalsa, Cameron & Schiffman, 2013). The patient was recently diagnosed and treated for prostate cancer and worrying about the end of life issues. Now he worries about the imminent death of his father.

Differential Diagnosis

Mood Disorder due to other medical conditions- The person has a medical condition and is also experiencing depression. A clinician must understand if a person is depressed because of a valid mood disorder or a medical condition. Adjustment Disorder with depressed mood: This is used when not all the criteria are met for MDD. The depressive episode happens in response to a stressful event involving other people, such as a death or loss and divorce (SAMHSA, 2016).

Treatment Strategy

Cognitive-behavioral therapy (CBT) because is one of the most evidence-based psychological approaches for treating several psychiatric disorders such as depression, anxiety disorders, somatoform disorder, and substance use disorder. Recently, psychotic disorders, behavioral medicine, marital disorders, traumatic life situations and many other psychiatric issues have been covered (Gautam, Tripathi, Deshmukh & Gaur, 2020). Interpersonal Psychotherapy (IPT) is preferred in most depression treatment guidelines and consistently proven to be an effective treatment for elderly depressed patients (van Schaik, van Marwijk, Beekman, de Haan & van Dyck, 2007).

Psychopharmacology

Tranylcypromine is an FDA approved for the treatment of Treatment-Resistant Depression. Some patients may experience stimulant like actions early in dosing. Therapeutic actions typically occur not immediately, but sometimes 2-4 weeks delayed. If it is not working within 6-8 weeks, it may necessitate a dosage increase or it may not work at all. May continue working for many years to prevent relapse of symptoms (Stahl, 2017 p.735.)

The ingestion of high tyramine foods could cause a response that has serious consequences. The patient should educate that tyramine can increase as food ages; foods prepared hours earlier should be fresh instead of leftovers. The types of fish and even types of meat, such as sausage, turkey, liver, and salami, are examples of high food tyramine levels. There may also be tyramines in such fruits, such as overripe fruit, avocados, bananas, raisins, or figs. Cheeses and alcohol are also examples.

Psychoeducation

Family psychoeducation is considered an integral part of optimal treatment, along with traditional medication and counseling. Family psychoeducation has been shown to decrease the occurrence of relapse and hospitalization (Katsuki et al., 2018)

Clinical Note: Is depression a normal part of aging.

Depression is a common problem among older adults, but it is not a normal part of aging. Studies show that these older adults feel satisfied with their lives despite having more illnesses or medical issues. However, significant life changes that happen as we get older may provoke uneasiness, stress, and sadness. For example, a loved one’s death, retirement, or dealing with a critical illness can make people feel sad or anxious. Many older adults can recover and regain emotional balance after an adjusting period, while others may not develop depression.

References

Bystritsky, A., Khalsa, S. S., Cameron, M. E., & Schiffman, J. (2013). Current diagnosis and treatment of anxiety disorders. P & T : a peer-reviewed journal for formulary management, 38(1), 30–57.

de Mendonça Lima, C. A., & Ivbijaro, G. (2013). Mental health and wellbeing of older people: opportunities and challenges. Mental health in family medicine, 10(3), 125–127.

DSM-5. (2017). https://dsm.psychiatryonline.org/. https://dsm.psychiatryonline.org.

Gautam, M., Tripathi, A., Deshmukh, D., & Gaur, M. (2020). Cognitive Behavioral Therapy for Depression. Indian journal of psychiatry, 62(Suppl 2), S223–S229. https://doi.org/10.4103/psychiatry.IndianJPsychiat…

Katsuki, F., Takeuchi, H., Inagaki, T., Maeda, T., Kubota, Y., Shiraishi, N., Tabuse, H., Kato, T., Yamada, A., Watanabe, N., Akechi, T., & Furukawa, T. A. (2018). Brief multifamily Psychoeducation for family members of patients with chronic major depression: a randomized controlled trial. BMC psychiatry, 18(1), 207. https://doi.org/10.1186/s12888-018-1788-6

SAMHSA (2016). Substance Abuse and Mental Health Services Administration. Table 3.19, DSM-IV to DSM-5 Adjustment Disorders Comparison – Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health – NCBI Bookshelf. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t19/.

van Schaik, D. J., van Marwijk, H. W., Beekman, A. T., de Haan, M., & van Dyck, R. (2007). Interpersonal psychotherapy (IPT) for late-life depression in general practice: uptake and satisfaction by patients, therapists and physicians. BMC family practice, 8, 52. https://doi.org/10.1186/1471-2296-8-52

20 hours ago

JesseCraig

G’day! ?? Getting started on your question. Do you have any extra materials for me before I start?

20 hours ago

Illuminatigirl111 (hidden)

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)

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20 hours ago

Rubric Detail

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NAME: NRNP_6640_WEEK10_DISCUSSION_RUBRIC

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	Satisfactory	Unsatisfactory
Quality of Work Submitted: The extent of which work meets the assignned criteria and work reflects graduate level critical and analytic thinking.	26 (26%) – 30 (30%) Assignment meets expectations. All topics are addressed with a minimum of 50% containing good breadth and depth about each of the assignment topics.	0 (0%) – 25 (25%) Assignment superficially meets some of the expectations. Two or more required topics are either not addressed or inadequately addressed.
Quality of Work Submitted: The purpose of the paper is clear.	4 (4%) – 5 (5%) Purpose of the assignment is stated, yet is brief and not descriptive.	0 (0%) – 3 (3%) No purpose statement was provided.
Assimilation and Synthesis of Ideas: The extent to which the work reflects the student’s ability to: Understand and interpret the assignment’s key concepts.	8 (8%) – 10 (10%) Demonstrates a clear understanding of key concepts.	0 (0%) – 7 (7%) Shows a lack of understanding of key concepts, deviates from topics.
Assimilation and Synthesis of Ideas: The extent to which the work reflects the student’s ability to: Apply and integrate material in course rsources (i.e. video, required readings, and textook) and credible outside resources.	16 (16%) – 20 (20%) Integrates specific information from 1 credible outside resource and 2-3 course resources to support major points and point of view.	0 (0%) – 15 (15%) Includes and integrates specific information from 0 to 1 resource to support major points and point of view.
Assimilation and Synthesis of Ideas: The extent to which the work reflects the student’s ability to: Synthesize (combines various components or different ideas into a new whole) material in course resources (i.e. video, required readings, textbook) and outside, credible resources by comparing different points of view and highlighting similarities, differences, and connections.	16 (16%) – 20 (20%) Summarizes information gleaned from sources to support major points, but does not synthesize.	0 (0%) – 15 (15%) Rarely or does not interpret, apply, and synthesize concepts, and/or strategies.
Written Expression and Formatting Paragraph and Sentence Structure: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are clearly structured and carefully focused–neither long and rambling nor short and lacking substance.	4 (4%) – 5 (5%) Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity 80% of the time.	0 (0%) – 3 (3%) Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity < 60% of the time.
“Written Expression and Formatting English writing standards: Correct grammar, mechanics, and proper punctuation”	3 (3%) – 5 (5%) Contains a few (1-2) grammar, spelling, and punctuation errors.	0 (0%) – 2 (2%) Contains many (? 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
“Written Expression and Formatting The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.”	3 (3%) – 5 (5%) Contains a few (1-2) APA format errors.	0 (0%) – 2 (2%) Contains many (? 5) APA format errors.

Total Points: 100

NAME: NRNP_6640_WEEK10_DISCUSSION_RUBRIC

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20 hours ago