Psychiatric Mental Health Practicum

Please read the post of your peers . Provide take aways you have learned from 3 topics

shared by your classmates. Please include a 400-word count at least.

Angel caveda

Throughout my exploration of Electroconvulsive Therapy (ECT) as a treatment for severe

depression, I have gained invaluable insights into its multifaceted role within psychiatric care. ECT

has been a point of contention historically due to stigmatization and misconceptions, yet it remains a

powerful intervention for cases where conventional therapies fall short. This topic is not solely about

ECT's efficacy but also its broader implications on patient care, healthcare systems, and societal

perceptions of psychiatric treatments.

Introduction and Background

ECT has long been recognized for its capacity to quickly alleviate severe depressive symptoms,

offering a beacon of hope, particularly for patients suffering from treatment-resistant depression. The

critical understanding here is that ECT should not merely be a treatment of last resort but considered

earlier in the therapeutic process for certain patients, reaffirming its potential to redefine treatment

pathways. The paper examines the treatment's implications on various stakeholders—patients,

families, and healthcare systems—while also contemplating societal and economic dimensions,

including the reduction in healthcare costs compared to the burdens of untreated depression.

Essential Elements of the Literature Review

Starting with Kellner et al.'s (2020) work, the literature consistently emphasizes ECT's high

efficacy rates, especially compared to pharmacotherapy. The discussion of neurobiological

mechanisms, as explored by Takamiya et al. (2021) and Wang et al. (2020), is crucial for understanding

how ECT induces neuroplastic changes and realigns dysfunctional neural circuits associated with mood

regulation.

Furthermore, concerns about cognitive side effects persist, yet studies like those by Semkovska

et al. (2019) have pushed the frontier by advocating for methodological advancements that minimize

cognitive risks, such as ultra-brief pulse techniques and unilateral electrode placements. These findings

are significant as they pave the way toward safer application of ECT.

Discussion and Findings

Patient perceptions, critically examined by Lyndsay et al. (2020), underline the importance of

incorporating patient perspectives into treatment planning. This ensures a patient-centered approach,

addressing fears and setting realistic expectations.

In examining ECT's application to children and adolescents, works by Rask et al. (2023) and

Castaneda-Ramirez et al. (2023) illustrate the nuanced considerations required for younger

populations, encouraging the development of tailored protocols.

Finally, comparisons with emerging treatments like Ketamine highlighted by Bender (2025)

provide a more comprehensive understanding of ECT's role in modern psychiatry. This comparison

underscores the necessity for precise patient selection and personalization of treatment plans based on

individual clinical profiles, symptom severity, and treatment history.

Conclusion

The comprehensive review of literature on ECT highlights its enduring significance and

evolving role within psychiatric treatment frameworks. Advances in methodology have mitigated some

of its traditional drawbacks, such as cognitive impairment, enhancing its safety and efficacy.

Continuous research into its neurobiological impacts, patient experiences, and comparative efficacy

with novel treatments like Ketamine will further refine its application and public perception.

Overall, ECT offers profound relief for those encumbered by severe depression, especially

when integrated thoughtfully into individualized treatment strategies. The interplay of ethical, clinical,

and personal factors in the choice and implementation of ECT underscores the complexity and

dynamism of psychiatric care. As a PMHNP student, understanding this complexity is imperative for

delivering competent, empathetic, and evidence-based care to those in need.

References

Lisanby, S. H. (2019). Electroconvulsive therapy for depression. The New England Journal of

Medicine, 361, 254-259.

Kellner, C. H., Obbels, J., & Sienaert, P. (2020). When to consider electroconvulsive therapy

(ECT). Acta Psychiatrica Scandinavica, 141(4), 304–315.

Semkovska, M., et al. (2019). Cognitive function following electroconvulsive therapy for

depression: An evaluation of techniques. The Journal of ECT, 35(3), 139-147.

Rask, O., Nordenskjöld, A., Johansson, B. A., & Movahed Rad, P. (2023). Electroconvulsive

therapy in children and adolescents: results from a population-based study utilizing the Swedish

National Quality Register. European Child & Adolescent Psychiatry, 32(12), 2649–

2656. https://doi.org/10.1007/s00787-022-02123-2

Castaneda-Ramirez, S., Becker, T. D., Bruges-Boude, A., Kellner, C., & Rice, T. R. (2023).

Systematic review: Electroconvulsive therapy for treatment-resistant mood disorders in children and

adolescents. European Child & Adolescent Psychiatry, 32(9), 1529–

1560. https://doi.org/10.1007/s00787-022-01942-7

Bender, K. (2025). Treatment-Resistant Depression: Which Patients Respond to Ketamine vs

ECT? Psychiatric Times, 42(1), 26. 673 words

Discussion Post: Substance Abuse and Mood Disorders – A Dual Diagnosis

Challenge by Jorge Martinez Diaz - Saturday, June 14, 2025, 10:10 AM

Number of replies: 0

Through my research on the intersection of substance abuse and mood disorders, I have

gained valuable insights into the complex nature of dual diagnosis and the immense clinical,

social, and systemic challenges associated with it. My paper, titled Substance Abuse and

Mood Disorders: A Dual Diagnosis Challenge, explored how substance use disorders (SUDs)

and mood disorders—such as major depressive disorder (MDD) and bipolar disorder—

frequently co-occur and create a compounded set of problems that demand integrated,

individualized treatment approaches.

In the introduction, I presented the concept of dual diagnosis, which refers to the

simultaneous occurrence of a substance use disorder and a psychiatric condition, most

commonly mood disorders. The introduction highlights how individuals often turn to drugs

or alcohol as a way to self-medicate their emotional pain or to regulate mood symptoms,

which ultimately worsens both conditions. The co-occurrence of these disorders is especially

prevalent among vulnerable populations such as adolescents, individuals with trauma

histories, and those from marginalized communities. The social and financial costs of

untreated dual diagnosis are enormous, not only for individuals and families but for the

healthcare and legal systems as well.

The literature review section focused on ten peer-reviewed studies published between

2020 and 2025. The studies spanned epidemiological research, clinical treatment outcomes,

neurocognitive impacts, and systemic challenges. One of the most significant findings was

that depression often precedes substance use, supporting the self-medication hypothesis

(Hasin & Walsh, 2020). Others, like Watson et al. (2022), emphasized the role of emotional

dysregulation and environmental stressors in reinforcing both mood and substance use

disorders. Integrated treatment was shown to be significantly more effective than treating

each condition separately (Sacks et al., 2020; Gonzalez et al., 2021).

Another important element of the review was the impact of stigma and access disparities.

Peterson, Wallace, and Kim (2023) found that internalized stigma and systemic barriers

prevent individuals—especially those from minority communities—from seeking or

adhering to treatment. This point resonated deeply with me, as it underscores the need for

culturally competent care and stigma reduction strategies in behavioral health services.

Furthermore, early intervention was repeatedly highlighted as a game-changer. Acion et al.

(2021) used machine learning to predict dual diagnosis risk, suggesting the value of

proactive screening in schools and primary care settings.

In the discussion and findings, I synthesized how the literature revealed a recurring

pattern: untreated or poorly treated dual diagnoses lead to worse clinical outcomes, higher

relapse rates, and greater functional impairment. I also addressed the significant economic

burden—estimated at over $200 billion annually in the U.S. (Smith et al., 2023)—which

includes direct medical costs and indirect effects such as homelessness, incarceration, and

job loss. Treatment that incorporates both psychotherapeutic and pharmacologic

strategies, such as medication-assisted treatment (MAT), was shown to be most successful

when monitored by an integrated care team (Robinson & Thibault, 2022).

In the conclusion, I emphasized the need for a holistic, multidisciplinary response to dual

diagnosis. This includes early screening, neuropsychological assessments, culturally

responsive care, and systemic policy reforms. One of the key takeaways for me was that dual

diagnosis care is not just a clinical challenge but a public health and social justice issue.

Overall, this research process deepened my understanding of how intertwined mood

disorders and substance use truly are, and how critical it is to advocate for comprehensive,

person-centered care. It has also shaped the way I will approach clinical practice, with

greater awareness of the barriers my patients may face and the evidence-based strategies

that can truly support their long-term recovery.

586 words

Discussion Post: Childhood Trauma and Borderline Personality Disorder (BPD) by Aurora Hernandez - Tuesday, June 10, 2025, 8:04 PM

Number of replies: 0

For my paper, I chose to explore the connection between childhood trauma and the

development of Borderline Personality Disorder (BPD). This topic is highly relevant in both

psychiatric care and public health. I became interested in it due to the growing awareness of

how early negative experiences can shape a person's psychological growth and mental

health throughout their life. My paper aimed to investigate the link between early trauma

and BPD, the broader effects on individuals and communities, the related economic costs,

and the need for early intervention and trauma-informed care. In the introduction, I

provided an overview of BPD as a serious mental health condition characterized by

emotional instability, impulsive behaviors, and intense, unstable interpersonal relationships.

I explained that adverse childhood experiences (ACEs), such as abuse, neglect, and family

dysfunction, are often connected to a higher risk of developing BPD. The paper aimed to

show how trauma disrupts emotional growth and sets the stage for personality disorders to

develop later in life. The background section explained ACEs and how they hinder a child’s

ability to regulate emotions, form secure attachments, and build resilience. Research

indicates that these early disruptions can lead to long-term problems in the stress-response

system. For example, studies by Cattane et al. (2022) found epigenetic changes in children

exposed to trauma, which affect brain areas related to emotional control and self-

perception. These changes may increase the chances of developing BPD. In the literature

review, I examined key studies on the prevalence and biological factors of BPD in individuals

with a history of childhood trauma. Multiple sources, including Ball & Links (2019), report

that nearly 70% of individuals with BPD have faced some type of early trauma. The literature

also highlights that marginalized groups, such as LGBTQ+ youth and those from low-

income or minority backgrounds, often experience higher rates of trauma and fewer

resources, increasing their risk. Additionally, findings show that without proper help, the

emotional dysregulation and unhealthy coping strategies formed in childhood often

continue into adulthood. The discussion section focused on how childhood trauma and BPD

impact not just the individual, but also families, caregivers, educators, and wider social

systems. Those living with BPD frequently struggle to keep jobs and maintain stable

relationships. They may face repeated hospital stays or encounters with law enforcement.

This creates a heavy burden on mental health services, schools, and public safety networks.

Moreover, trauma can lead to repeated cycles of dysfunction if not treated. In terms of

findings, I pointed out that the short-term effects of childhood trauma—like anxiety, poor

academic performance, and behavioral problems—can escalate into long-term mental

health issues, including BPD, depression, PTSD, and substance use disorders. One

particularly concerning finding is the high suicide risk linked to BPD: up to 75% of affected

individuals attempt suicide, with around 10% dying by suicide (Gunderson et al., 2018). The

conclusion of my paper stressed the urgent need for early detection, trauma-informed

therapy, and preventive measures. Public health systems, educators, and policymakers must

work together to lower trauma exposure, improve access to mental health care, and support

programs that build emotional resilience in at-risk youth. Investing in early trauma

prevention can improve individual outcomes and significantly decrease the economic and

societal burdens related to untreated mental illness. This project deepened my

understanding of the long-lasting effects of childhood trauma and reinforced the

importance of early intervention and trauma-informed care in both clinical and community

settings.