Running head: REFLECTION
Reflection
Author's Name
Institutional Affiliation
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Initial Post
Review the course content and list the top two to three areas of focus you feel that you learned the
most about. How did the content enhance your clinical experience? What areas of focus would you
like to learn more about? Are there topics in the course you think need more information available?
anxiety disorders and attention deficit hyperactivity disorder.schizophrenia,
schizoaffective disorder, or bipolar disorder
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Review the course content and list the top two to three areas of focus you feel that you
learned the most about. How did the content enhance your clinical experience? What areas
of focus would you like to learn more about? Are there topics in the course you think need
more information available?
As we move towards the end of the course, I would say it has been both an interesting and
informative exercise that has greatly improved my understanding of mental disorders. Before
undertaking this course, I had little understanding of the causes, symptoms, and treatment of
various mental health problems. One of the key areas of study that I have learned the most in this
course is anxiety disorders. From this course, I have learned about the different types of anxiety
disorders, such as panic disorder, social anxiety disorder, and generalized anxiety disorder.
According to HelpGuide (2019), anxiety disorders differ considerably hence therapies should be
tailored to specific symptoms and diagnosis. A patient who has obsessive-compulsive disorder
(OCD), for instance, has a different treatment from someone who suffers anxiety attacks. These
are some of areas of anxiety disorder that I would want to study further.
More importantly, through this course, I have learned about the fundamental differences between
each of these disorders and the various methods of treatment. This information is very important
for care providers to provide effective treatment to patients. The second area that I believe I
have earned most are bipolar disorders. Essentially, this is a mental disorder associated with
episodes of mood swings, including mania/hypomania and depression. Mayo Clinic says “Mania
is more severe than hypomania and causes more noticeable problems at work, school and social
activities, as well as relationship difficulties” 2019) Through this course, I have learned that this
type of disorder can occur in people as young as six years. Moreover, bipolar depressive
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episodes often look more like classic depression hence the need for care providers to look into
the individual's medical history to determine whether their depression is caused by bipolar
disorder or other factors such as Malaspina and Dolores.
The content learned in this course has instilled in me the requisite knowledge and skills to
provide quality care to patients with a variety of mental disorders. This new knowledge will
enable me to avoid costly errors that pose a risk to a patient's health. Additionally, this content
has broadened my knowledge and competence. After studying the many types of disorders
extensively, I have gained all-rounded knowledge to diagnose and treat a variety of mental
disorders.
However, despite everything achieved in this course so far, there are several areas that I would
wish to learn more about. One of these areas is Autism spectrum disorder (ASD). According to
Mayo Clinic (2019) there are no medical tests such as blood tastes that can be used to diagnose
ASD. This makes it difficult for doctors to diagnose the disorder since they have to rely on the
patient's behavior and development to come up with a diagnosis. As such, I would want to
study more about this particular disorder in order to build enough skills and knowledge on how
to diagnose it. For instance, I would want to study ways to make early intervention programs for
ASD patients.
The second important area that I want to study further is schizophrenia. So far, there are no
known causes of schizophrenia and its relationship with drug/substance abuse. More often than
not, schizophrenia and substance abuse tend to co-occur hence making it difficult to treat
(Khokhar et al. 2018). I would want to study some of the alternative treatment methods of
schizophrenia, such as Complementary and alternative medicine (CAM) treatments. Throughout
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our clinical weeks, schizophrenia is a disorder that has developed a keen interest, and I would
want to study and understand it better.
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References
HelpGuide (2019). Therapy for Anxiety Disorders. Retrieved from
https://www.helpguide.org/articles/anxiety/therapy-for-anxiety-disorders.htm
Khokhar, J. Y., Dwiel, L. L., Henricks, A. M., Doucette, W. T., & Green, A. I. (2018). The link
between schizophrenia and substance use disorder: A unifying hypothesis.?Schizophrenia
research,?194, 78-85.
Mayo Clinic (2019). Autism spectrum disorder. Retrieved from
https://www.mayoclinic.org/diseases-conditions/autism-spectrum-disorder/symptoms-
causes/syc-20352928
Mayo Clinic (2019). Bipolar disorder. Retrieved from https://www.mayoclinic.org/diseases-
conditions/bipolar-disorder/symptoms-causes/syc-20355955
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Reply Posts
In the reply posts, you should build on the original post and demonstrate substantive reflection.
Tasha Lewis-Stevens
In reflecting upon this past semester, the areas of focus I learned the most from are anxiety
disorders and attention deficit hyperactivity disorder. My clinical seminar group spent a good amount
of time on the neuroanatomy, diagnostics, and treatment of anxiety disorders. According to Bennett
and Walkup (2019), an imbalance in the amygdala-Pre Frontal Cortex (PFC) network, specifically
elevated amygdala activity and decreased PFC activity, may be a neurobiological hallmark of anxiety
disorders in that it is correlated with impaired extinction learning. Studies have suggested that
adolescence is a period of maximum imbalance between these two brain regions developmentally.
This may be related to the emergence of functionally impairing anxiety disorders during the pubertal
years. The cortico-amygdala circuitry plays an important role in fear learning. Amygdala engagement
has been demonstrated immediately following the pairing of an aversive unconditioned stimulus with
a conditioned stimulus, and the later presentation of the conditioned stimulus. The hippocampus and
the PFC have been implicated in context-dependent learning when conditioned
stimulus/unconditioned stimulus pairings are tied to spatial (hippocampus) or temporal (PFC)
frameworks (Bennett & Walkup, 2019). The clinical seminar group also discussed various patient
cases of anxiety disorder, which helped to really learn how to diagnose and treat it. Being able to
conceptualize the brain regions and neurotransmitters involved in anxiety was very helpful.
The second area of focus that brought a great deal of learning was during the group discussion
board regarding ADHD. I felt this group had wonderful resources that explained the manifestations of
ADHD, diagnostic criteria, and treatment. Attention deficit hyperactivity disorder (ADHD) is a
neurodevelopmental disorder that originates in childhood with symptoms of hyperactivity, impulsivity,
and/or inattention. These symptoms occur in more than one setting and affect cognitive, academic,
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behavioral, emotional, and social functioning. The neurotransmitters targeted in treatment are
dopamine and norepinephrine. The areas of the brain implicated are the dorsolateral prefrontal
cortex, dorsal anterior cingulate cortex, and orbitofrontal cortex. Children with ADHD generally
cannot activate the prefrontal cortex areas appropriately in response to cognitive tasks of attention
and executive functioning (Stahl, 2013, p.475).
The topics in the course that I feel need more attention are the use of cannabinoids for treatment of
mental health. With so many states legalizing medicinal marijuana, I feel it is important to learn about
the risks and benefits of using it as treatment. According to Black et al. (2019), medicinal
cannabinoids, including medicinal cannabis and pharmaceutical cannabinoids and their synthetic
derivatives, such as tetrahydrocannabinol (THC) and cannabidiol (CBD), have been suggested to
have a therapeutic role in certain mental disorders. However, there remains insufficient evidence
and information to provide guidance on the use of cannabinoids for treating mental disorders within a
regulatory framework. Black et al. (2019) stress that further high-quality studies directly examining
the effect of cannabinoids on treating mental disorders is needed. Hopefully further research can
happen quickly as legalizing and choosing these substances for treatment is risky.
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References
Bennett, S., & Walkup, J.T. (2019). Anxiety disorders in children and adolescents:
Epidemiology, pathogenesis, clinical manifestations, and course. In R. Hermann
(Ed.), UpToDate.Retrieved on December 9, 2019 from https://www-uptodate-
com.regiscollege.idm.oclc.org/contents/anxiety-disorders-in-children-and-adolescents-epidemiology-
pathogenesis-clinical-manifestations-and-course?search=neuroanatomy%20of
%20anxiety&source=search_result&selectedTitle=7~150&usage_type=default&display_rank=7
Black, N., Stockings, E., Campbell, G., Tran, L.T., Zagic, D., Hall, W.D…Degenhardt L. (2019).
Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: A systematic
review and meta-analysis. Lancet Psychiatry, 6(1): 995-1010. https://doi.org/10.1016/S2215-
0366(19)30401-8
Stahl, S.M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical
applications(4th ed.). Cambridge CB2 8BS, United Kingdom: Cambridge University Press.
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Hello Tasha, I agree with you that adolescence is a period of maximum imbalance between these
two brain regions developmentally. ADHD symptoms often include an inability to focus,
disorganization, and restlessness. Adults with ADHD may have a hard time organizing things,
listening to instructions, remembering details, or difficulty completing tasks, which can affect
their relationships at home, school, and work. People who have ADHD may exhibit different
symptoms, and they may experience them at different levels of severity, ranging from mild to
significant impairment. Treatment usually requires a combination of medication and
psychotherapeutic intervention (Roy-Byrne et al. 2015). Stimulant medications have been found
most helpful so far compared with other medications, although atomoxetine is also being studied.
There is limited evidence for selective serotonin reuptake inhibitors, and their potential for
behavioral activation may be problematic in these children. Intensive behavior modification was
shown to be beneficial in conjunction with medication for ANX + ADHD in a multimodal
treatment study of children with ADHD. Cognitive-behavioral therapy has been used to address
anxiety symptoms, but may need to be individualized in ANX + ADHD as cognitive limitations
and ADHD behaviors may otherwise interfere. Parental anxious or ADHD traits and the child's
developmental level must also be considered to optimize treatment (Weissman et al. 2016).
For pregnant women, the risk of an untreated anxiety disorder must be weighed against the risk
of damage to the unborn child as a result of treatment. A large study suggested no substantial
increase in the risk of cardiac malformations attributable to antidepressant use during the first
trimester.?However, antidepressants have been associated with increased risk of spontaneous
abortions, stillbirths, early deliveries, respiratory distress, and endocrine and metabolic
dysfunctions (Huybrechts et al. 2017).
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References:
Roy-Byrne PP, Craske MG, Stein MB, et al. A randomized effectiveness trial of cognitive–
behavioral therapy and medication for primary care panic disorder.?Arch Gen
Psychiatry.?2015;62(3):290–298.?
Weissman MM, Merikangas KR. The epidemiology of anxiety and panic disorders: An update.?J
Clin Psychiatry.?2016
Huybrechts KF., Palmsten K., Avorn J., et al Antidepressant use in pregnancy and the risk of
cardiac defects.?N Engl J Med.?2017
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Post 2:
Sean Wiest
Throughout this semester, I feel that I have been able to apply a lot of the information that we have
learned in class to my clinical rotations. This semester I have been completing my clinical at a
community mental health facility where there is specific criteria that needs met in order for the
patient to be enrolled in the program. The main criteria that needs met for the patient to be a
member of the program is that the individual must be on Medicaid or Medicare. The majority of
patients are diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder and have
case managers and other resources such as therapy that the facility provides. Throughout the
semester we have discussed the use of selective serotonin reuptake inhibitors (SSRIs) as
monotherapy with patients diagnosed with bipolar type I disorder and the negative impact it can have
on the individual. This is one of the first areas that I focused on during the semester. The use
of TCAs, MAOIs, or SSRIs when patients are in the depressed phase of bipolar disorder may cause
them to swing quickly into a manic state (polarity switch), so these types of drugs should not be used
alone when treating patients diagnosed with bipolar disorder (Ali & Milev, 2003). In addition, during
Dr. Gus's lectures he has discussed how he wants us look at disorders through the imbalance of
neurotransmitters.
During one of my therapy session I worked with a female patient who had recently been diagnosed
with bipolar I disorder. The patient felt that she was "given a life sentence" because of the stigma
surrounding individuals diagnosed with bipolar disorder. It turns out the patient did not receive much
information surrounding her new diagnosis or the reason of the change in medications. The patient
had originally been on Zoloft and Buspar because it was thought that she was only suffering from
depression and anxiety, not bipolar disorder so the physician switcher her to olanzapine (Zyprexa).
The second area that I wanted to focus on this semester was becoming comfortable educating
patients on neurotransmitters and medications. I started the discussion by educating her on the use
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of a SSRI in patients diagnosed with bipolar disorder as I previously mentioned in this post. I next
discussed that Buspar should not be prescribed as monotherapy because it does not work
independently and instead is used as an adjunct (Stahl, 2017).
Even though I feel that I have learned a lot about bipolar disorder, I still would like to work on my
psychiatric evaluation with patients who are depressed. I believe that it is important to complete a full
psychiatric evaluation to identify if the patient has major depressive disorder (MDD) or if they are in a
depressive phase of bipolar disorder. “When a patient with bipolar I disorder has a depressive
episode, the differential diagnosis is the same as that for a patient being considered for a diagnosis
of major depressive disorder” (Sadock, Sadock, & Ruiz, 2014, p. 370). The medications prescribed
are very different depending on the signs and symptoms, which is why I feel it is important to
conduct a proper psychiatric evaluation in order to identify the correct diagnosis.
References
Ali, S., & Milev, R. (2003). Switch to mania upon discontinuation of antidepressants in patients with
mood disorders: A review of the literature. The Canadian Journal of Psychiatry. 48(4), 258-264.
Retrieved from https://journals.sagepub.com/doi/10.1177/070674370304800410
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Synopsis of psychiatry (11th ed.). London, England:
Lippincott, Williams, and Wilkins.
Stahl, S. M. (2017). Stahl’s Essential Psychopharmacology Prescriber’s Guide (6th ed.). Cambridge,
United Kingdom: Cambridge University Press
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Sean, I like your post. Schizoaffective disorder is one of the most misdiagnosed psychiatric
disorders in clinical practice. ?In fact, some researchers have proposed revisions to the diagnostic
criteria, and others have suggested removing the diagnosis all together from the DSM-5. There
were significant concerns regarding the reliability and utility of the diagnosis when it was first
introduced in the DSM. The challenges lie within the diagnostic criteria itself since the disorder
is part of a spectrum that shares criteria with many other prominent psychiatric disorders found
in clinical practice (Malaspina et al. 2013).
The term schizoaffective disorder first appeared as a subtype of schizophrenia in the first edition
of the DSM. ?It eventually became its own diagnosis despite lack of evidence for unique
differences in etiology or pathophysiology. Therefore, there have been no conclusive studies on
the etiology of the disorder. ?However, investigating the potential causes of mood disorders and
schizophrenia as individual disorders allows for further discussion.
Some studies show that as high as 50% of people with schizophrenia also have comorbid
depression. The pathogenesis of both mood disorders and schizophrenia is multifactorial and
covers a range of risk factors including genetics, social factors, trauma, and stress. Among
people with schizophrenia, there is a possible increased risk for first-degree relatives for
schizoaffective disorder and vice-versa; there may be increased risk among individuals for
schizoaffective disorder who have a first-degree relative with bipolar disorder, schizophrenia, or
schizoaffective disorder (Wilson et al. 2014).
The exact pathophysiology of schizoaffective disorder is currently unknown. ?Some studies have
shown that abnormalities in dopamine, norepinephrine, and serotonin may play a role.?Also,
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white matter abnormalities in multiple areas of the brain, particularly the right lentiform nucleus,
left temporal gyrus and right precuneus are associated with schizophrenia and schizoaffective
disorder. ?Researchers have also found reduced hippocampal volumes and distinct deformations
in the medial and lateral thalamic regions in those with schizoaffective disorder in comparison to
controls (Laursen, 2017).
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References:
Malaspina D, Owen MJ, Heckers S, Tandon R, Bustillo J, Schultz S, Barch DM, Gaebel W, Gur
RE, Tsuang M, Van Os J, Carpenter W. Schizoaffective Disorder in the DSM-5.?Schizophr.
Res.?2013
Wilson JE, Nian H, Heckers S. The schizoaffective disorder diagnosis: a conundrum in the
clinical setting.?Eur Arch Psychiatry Clin Neurosci.?2014
Laursen TM, Munk-Olsen T, Nordentoft M, Bo Mortensen P. A comparison of selected risk
factors for unipolar depressive disorder, bipolar affective disorder, schizoaffective disorder, and
schizophrenia from a danish population-based cohort.?J Clin Psychiatry.?2017
