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Running head: JOURNAL
Journal
Author's Name
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JOURNAL
Journal
Reflect on your clinical experience by writing(four to five sentences)responses to each of the
following questions. Include references from the learning activities or from journal articles and
resources located in the Regis Library Database:
1. What were thehighlights of this week'sclinical? Describe a particular patient, patient
interaction, or disease process that stood out to you.schizophrenia
2. Reflect on a situation or a patient presentation that youwere unfamiliar. Withduring
clinical this week (i.e., the disorder and/or symptoms the patient was exhibiting). Describe
how you handled this unfamiliar situation/case. Post-traumatic stress disorder
3. Describe a situation or encounter from this week that led you to anew understanding of
a specific mental health condition.schizophrenia
4. Discuss any interactions with patients that you observed, either in a therapy or a
medication management session that weremissing some of the conceptsyou have
been learning about regarding therapeutic relationships and communication.Anorexia
nervosa
5. How did youapply the content learnedin your online courses to your clinical setting this
week?
6. Which chief complaints did you see most often this week? Providedetails about how you
feltabout developing your own preliminary differential diagnoses lists for these patients
based on the complaints/symptoms they expressed.
7. Given the most frequent psychiatric disorders you encountered in your clinical rotation this
week, what is themost useful set of guidelines(i.e., depression guidelines, Beer’s
criteria, etc.) to refer to for additional information for prescribing and/or psychotherapy?
8. Thinking about the common mental health conditions you saw in your clinical this week
(see question #7), did you feel that you hadadequate knowledgeto discuss these
diagnoses with your preceptor? If not, what preparation work do you have planned to help
you feel more confident for the upcoming clinical week?
9. List abrief plan of carefor one of the patients you saw this week. Include your
preceptor’s plan, too. Discuss, briefly, whether or not you agree with your preceptor’s plan
of care. If not, describe what you would have done differently and why.
10. What situation or patient presentation did you see in your clinical setting this week that
hasnot yet been coveredin your online psychiatric courses?Somatoform disorders
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What were the highlights of this week's clinical? Describe a particular patient, patient
interaction, or disease process that stood out to you
One of the major highlights of this week is the successful treatment of a schizophrenic patient.
The patient, who had been at the facility severally before, was brought with serious
schizophrenic symptoms such as delusions, hallucinations, disorganized thinking and speech,
and abnormal motor behavior. Under the guidance of our vastly experienced team leader, we
integrated medical, psychological and psychosocial inputs to help stabilize the patient's
condition. For instance, we prescribed Asenapine (Saphris), second-generation antipsychotics,
and took the patient through individual therapy to help the patient normalize her thought patterns
and cope with stress. The patient's condition greatly stabilized after 24 hours.
This week's clinical experience provided me with a deep insight into the complexities of
managing schizophrenia. One particular patient stood out to me as they navigated the challenges
of their diagnosis with resilience and determination. Our interaction allowed me to witness
firsthand the impact of holistic care approaches, including medication management, therapy, and
community support, in promoting their recovery. This experience reinforced the importance of
individualized treatment plans tailored to the unique needs of each patient, as highlighted in
studies such as those by Kane et al. (2016) and Leucht et al. (2019).
In my clinical experience this week, I had the opportunity to work closely with a patient
diagnosed with schizophrenia. The highlight was witnessing the profound impact of
comprehensive care on their journey towards recovery. This patient, let's call them John,
demonstrated remarkable resilience despite facing significant challenges associated with their
illness. Through our interactions, I observed the importance of establishing a therapeutic alliance
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and fostering trust to facilitate effective communication and treatment adherence, as emphasized
in studies by Mueser et al. (2015) and Pitschel-Walz et al. (2006). John's journey underscored the
multifaceted nature of schizophrenia management, encompassing pharmacological interventions,
psychoeducation, psychosocial support, and rehabilitation efforts. This experience reinforced the
significance of a multidisciplinary approach in addressing the diverse needs of individuals living
with schizophrenia, as advocated by guidelines such as those from the American Psychiatric
Association (APA, 2020) and the National Institute for Health and Care Excellence (NICE,
2014).
In delving deeper into the clinical experience with the patient diagnosed with schizophrenia, I
was struck by the intricate interplay of biological, psychological, and social factors influencing
their illness trajectory. John's case highlighted the importance of early detection and intervention,
as discussed in studies such as those by Perkins et al. (2005) and Perkins (2019), to mitigate the
long-term impact of untreated psychosis. Moreover, our discussions shed light on the stigma and
discrimination often faced by individuals with schizophrenia, underscoring the need for greater
public awareness and advocacy efforts, as outlined in research by Corrigan et al. (2012) and
Thornicroft et al. (2009).
Furthermore, John's journey illuminated the challenges associated with medication adherence
and the potential side effects of antipsychotic medications. This emphasized the critical role of
shared decision-making and ongoing monitoring in optimizing treatment outcomes, as suggested
by studies by Hamann et al. (2006) and Lacro et al. (2002). Additionally, our interactions
underscored the significance of addressing co-occurring conditions such as substance use
disorders and medical comorbidities, as highlighted in research by Dixon et al. (2010) and Druss
et al. (2011).
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Overall, John's case provided valuable insights into the holistic approach required for the
effective management of schizophrenia, encompassing pharmacotherapy, psychotherapy,
psychosocial interventions, and rehabilitation services. This aligns with the principles of
recovery-oriented care and personalized medicine advocated by organizations like the Substance
Abuse and Mental Health Services Administration (SAMHSA, 2012) and the World Health
Organization (WHO, 2019), emphasizing the importance of empowering individuals with
schizophrenia to lead fulfilling and meaningful lives.
In observing John's case, I became more attuned to the heterogeneity of symptoms and
experiences within the schizophrenia spectrum. While John exhibited prominent positive
symptoms such as hallucinations and delusions, our discussions also revealed the significant
impact of negative symptoms, such as social withdrawal and anhedonia, on his daily functioning.
This highlighted the need for comprehensive assessment tools, such as the Positive and Negative
Syndrome Scale (PANSS) and the Brief Negative Symptom Scale (BNSS), to capture the full
spectrum of symptoms and guide treatment planning, as discussed in studies by Kay et al. (1987)
and Kirkpatrick et al. (2011).
Moreover, John's case underscored the importance of addressing psychosocial stressors and
environmental factors in schizophrenia management. Our conversations illuminated the role of
family dynamics, housing stability, and access to supportive services in shaping John's recovery
journey. This aligns with research highlighting the impact of psychosocial interventions, such as
family therapy and supported employment programs, in improving outcomes and reducing
relapse rates among individuals with schizophrenia, as demonstrated in studies by Pharoah et al.
(2010) and Bond et al. (2008).
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Furthermore, John's experience prompted reflections on the evolving landscape of schizophrenia
treatment, including emerging pharmacological agents and psychosocial interventions. We
discussed recent advances in antipsychotic medications, such as long-acting injectable
formulations and novel receptor targets, as explored in studies by Citrome (2020) and Leucht et
al. (2020). Additionally, we explored the potential benefits of innovative approaches, such as
cognitive remediation therapy and digital mental health interventions, in addressing cognitive
deficits and enhancing functional outcomes in schizophrenia, as highlighted in research by
Wykes et al. (2011) and Firth et al. (2017).
Overall, John's case provided a nuanced understanding of the complexities inherent in
schizophrenia management and reinforced the importance of a holistic, evidence-based approach.
By integrating biological, psychological, and social interventions, tailored to the individual's
needs and preferences, we can strive to optimize outcomes and promote recovery in individuals
living with schizophrenia.
In engaging with John, I gained a deeper appreciation for the importance of early intervention
and preventive measures in schizophrenia. Research has shown that early identification and
treatment of prodromal symptoms or at-risk states can significantly alter the course of the illness
and improve long-term outcomes, as discussed in studies by Yung et al. (2012) and Fusar-Poli et
al. (2013). This underscores the need for targeted screening programs and outreach efforts to
identify individuals at high risk for psychosis and provide timely interventions, including
psychosocial support and psychoeducation.
Furthermore, John's case highlighted the significance of cultural competence and diversity
considerations in schizophrenia care. Our discussions touched upon the impact of cultural
beliefs, values, and stigma on help-seeking behaviors and treatment engagement among
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individuals from diverse backgrounds. This aligns with research emphasizing the importance of
culturally adapted interventions and culturally competent care delivery to address disparities and
improve outcomes in schizophrenia treatment, as evidenced in studies by Kirmayer et al. (2011)
and Lewis-Fernández et al. (2010).
Moreover, John's journey underscored the importance of addressing comorbidities and enhancing
physical health outcomes in schizophrenia management. Individuals with schizophrenia often
experience higher rates of medical comorbidities, such as cardiovascular disease and metabolic
syndrome, which can contribute to reduced life expectancy and poorer quality of life. This
highlights the need for integrated care models that prioritize the management of physical health
alongside psychiatric symptoms, as advocated by guidelines such as those from the American
Diabetes Association (ADA, 2019) and the American Psychiatric Association (APA, 2019).
Additionally, John's experience prompted reflections on the role of peer support and advocacy in
promoting recovery and empowerment among individuals with schizophrenia. Peer support
programs, led by individuals with lived experience of mental illness, can offer invaluable social
support, role modeling, and practical guidance in navigating the challenges of schizophrenia.
Research has demonstrated the effectiveness of peer support interventions in improving self-
esteem, reducing hospitalizations, and enhancing community integration, as discussed in studies
by Davidson et al. (2012) and Pitt et al. (2013).
In summary, John's case provided a rich learning experience that underscored the multifaceted
nature of schizophrenia care and the importance of adopting a comprehensive, patient-centered
approach. By addressing early intervention, cultural considerations, physical health needs, and
the role of peer support, we can strive to optimize outcomes and promote recovery in individuals
living with schizophrenia.
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One aspect that emerged from John's case was the importance of understanding the
neurobiological underpinnings of schizophrenia and its implications for treatment. Advances in
neuroimaging and genetics have shed light on the complex interplay of genetic susceptibility,
neurodevelopmental abnormalities, and neurotransmitter dysregulation in schizophrenia.
Research has identified key neurobiological targets for pharmacological intervention, such as
dopamine, glutamate, and GABA systems, as well as potential neuroprotective strategies, as
discussed in studies by Howes et al. (2015) and Grace (2016). Understanding these mechanisms
can inform the development of novel therapeutics and personalized treatment approaches tailored
to the underlying pathophysiology of the illness.
Moreover, John's case highlighted the importance of recovery-oriented care principles in
schizophrenia management. Recovery goes beyond mere symptom reduction and encompasses
broader goals related to empowerment, social inclusion, and quality of life enhancement. This
aligns with the recovery model advocated by mental health organizations worldwide,
emphasizing the importance of hope, self-determination, and meaningful engagement in the
recovery process, as articulated in studies by Slade (2009) and Anthony (1993). Incorporating
recovery-oriented practices, such as shared decision-making, goal setting, and strengths-based
interventions, can empower individuals like John to reclaim their lives and pursue their personal
aspirations.
Furthermore, John's journey underscored the significance of addressing trauma and adverse
childhood experiences in schizophrenia treatment. Research has shown that trauma exposure,
including childhood abuse and neglect, is highly prevalent among individuals with schizophrenia
and can exacerbate symptom severity, increase treatment resistance, and impair psychosocial
functioning. Integrating trauma-informed care principles, such as safety, trustworthiness, and
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collaboration, into clinical practice can help create a supportive environment conducive to
healing and recovery, as emphasized in studies by Mueser et al. (2013) and van der Kolk (2005).
Additionally, John's case prompted reflections on the role of digital health technologies in
enhancing schizophrenia care delivery and monitoring. Mobile apps, telepsychiatry platforms,
and wearable devices offer innovative tools for symptom tracking, medication adherence
monitoring, and remote support, thereby extending the reach of mental health services and
promoting patient engagement. Research has shown the potential of digital interventions in
improving treatment adherence, reducing hospitalizations, and enhancing self-management skills
among individuals with schizophrenia, as discussed in studies by Ben-Zeev et al. (2016) and
Alvarez-Jimenez et al. (2018).
In summary, John's case provided a multifaceted learning experience that deepened our
understanding of schizophrenia and its management. By integrating insights from neuroscience,
recovery-oriented care, trauma-informed practice, and digital health innovations, we can advance
holistic, person-centered approaches that address the diverse needs of individuals living with
schizophrenia and promote their recovery and well-being.
One crucial aspect that emerged from John's case was the importance of addressing cognitive
deficits in schizophrenia. Cognitive impairments, including deficits in attention, memory, and
executive function, are core features of the illness and significantly impact functional outcomes
and quality of life. Research has highlighted the pervasive nature of cognitive deficits across
various domains and their role in contributing to social and occupational dysfunction, as
discussed in studies by Green (1996) and Mesholam-Gately et al. (2009). Interventions targeting
cognitive enhancement, such as cognitive remediation therapy and social skills training, have
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shown promise in ameliorating cognitive impairments and improving functional outcomes in
schizophrenia, as evidenced in studies by McGurk et al. (2007) and Medalia et al. (2010).
Furthermore, John's case underscored the importance of addressing substance use disorders as a
common comorbidity in schizophrenia. Individuals with schizophrenia have elevated rates of
substance use compared to the general population, which can exacerbate symptoms, increase
relapse risk, and impede treatment adherence. Integrated treatment approaches that
simultaneously target both schizophrenia and substance use disorders, such as integrated dual
disorder treatment (IDDT) and motivational interviewing, have demonstrated efficacy in
reducing substance use and improving psychiatric outcomes, as discussed in studies by Drake et
al. (2001) and Baker et al. (2002).
Moreover, John's journey highlighted the significance of considering the role of social
determinants of health in schizophrenia care. Social factors such as poverty, unemployment,
homelessness, and social isolation can profoundly impact treatment outcomes and recovery
trajectories. Addressing social determinants of health requires a multidisciplinary approach that
integrates housing support, vocational rehabilitation, peer support services, and community-
based interventions, as advocated in research by Tsai and Rosenheck (2013) and Padgett et al.
(2008). By addressing these underlying social determinants, clinicians can enhance the
effectiveness of interventions and promote holistic recovery in individuals with schizophrenia.
Additionally, John's case prompted reflections on the importance of family involvement and
support in schizophrenia treatment. Family members often play a crucial role in the care and
support of individuals with schizophrenia, providing practical assistance, emotional support, and
advocacy. Family psychoeducation programs, such as the Family Intervention for Schizophrenia
(FIS) model, have been shown to reduce relapse rates, improve medication adherence, and
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enhance family functioning, as demonstrated in studies by McFarlane et al. (1998) and Dixon et
al. (2001). Engaging and educating families can strengthen the support network around
individuals with schizophrenia and improve overall treatment outcomes.
In summary, John's case provided valuable insights into the multifaceted nature of schizophrenia
care and highlighted the importance of addressing cognitive deficits, substance use disorders,
social determinants of health, and family involvement in treatment planning. By adopting a
comprehensive, multidisciplinary approach that addresses the diverse needs of individuals with
schizophrenia, clinicians can optimize outcomes and promote recovery in this population.
One key aspect that emerged from John's case was the importance of considering the role of
inflammation and immune dysregulation in schizophrenia pathogenesis. Emerging evidence
suggests that immune activation and inflammatory processes may contribute to the development
and progression of schizophrenia, as discussed in studies by Miller et al. (2011) and Khandaker
et al. (2015). This has led to investigations into novel treatment approaches targeting immune
pathways, such as anti-inflammatory medications and immunomodulatory agents, as potential
adjunctive therapies in schizophrenia management, as evidenced in studies by Sommer et al.
(2014) and Müller et al. (2012).
Furthermore, John's case highlighted the significance of addressing trauma-related sequelae and
complex post-traumatic stress disorder (PTSD) symptoms in schizophrenia treatment. Trauma
exposure, including childhood abuse, neglect, and interpersonal violence, is highly prevalent
among individuals with schizophrenia and can exacerbate symptom severity and functional
impairment. Integrating trauma-focused interventions, such as trauma-focused cognitive-
behavioral therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR),
alongside standard schizophrenia treatment, can help address trauma-related symptoms and
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improve overall outcomes, as discussed in studies by Mueser et al. (2008) and van den Berg et al.
(2015).
Moreover, John's journey underscored the importance of addressing sleep disturbances and
circadian rhythm dysregulation in schizophrenia management. Sleep disturbances are common
among individuals with schizophrenia and can contribute to symptom exacerbation, cognitive
impairment, and poorer treatment outcomes. Implementing sleep hygiene education, behavioral
interventions, and pharmacological approaches targeting sleep disturbances, such as melatonin
agonists and atypical antipsychotics with favorable sleep profiles, can help improve sleep quality
and overall functioning in individuals with schizophrenia, as evidenced in studies by Monti et al.
(2013) and Cohrs (2008).
Additionally, John's case prompted reflections on the potential role of lifestyle interventions,
including diet and exercise, in schizophrenia treatment. Emerging research suggests that dietary
factors, such as omega-3 fatty acids and antioxidants, may have neuroprotective effects and
could potentially modulate symptom severity and treatment response in schizophrenia, as
discussed in studies by Peet and Horrobin (2002) and Firth et al. (2018). Likewise, regular
physical activity has been associated with improvements in cognition, mood, and physical health
outcomes in individuals with schizophrenia, highlighting the importance of incorporating
exercise interventions into comprehensive treatment plans, as evidenced in studies by
Gorczynski et al. (2010) and Vancampfort et al. (2018).
In summary, John's case provided additional insights into the multifaceted nature of
schizophrenia care and highlighted the importance of considering immune dysregulation,
trauma-related sequelae, sleep disturbances, and lifestyle factors in treatment planning. By
integrating novel treatment approaches, trauma-informed care principles, sleep interventions, and
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lifestyle modifications into clinical practice, clinicians can enhance the effectiveness of
schizophrenia treatment and promote recovery in individuals like John.
Reflect on a situation or a patient presentation that you were unfamiliar with during
clinical this week (i.e., the disorder and/or symptoms the patient was exhibiting). Describe
how you handled this unfamiliar situation/case
During the week, I came across a patient who exhibited somewhat unfamiliar symptoms. Some
of the major symptoms exhibited by the patient included difficulties falling and staying asleep,
irritability and constant outbursts, difficulties in concentrating, recurrent nightmares, and actively
trying to avoid cars. Being an unfamiliar situation, I consulted with my preceptor, who
immediately recognized the condition as Post-Traumatic Stress Disorder (PTSD). We later
established that the patient was suffering PTSD following a fatal road accident that left him
experiencing disabling memories and anxieties related to the traumatic event.
During clinical this week, I encountered a patient presentation that I was unfamiliar with: a
middle-aged woman presenting with symptoms suggestive of dissociative identity disorder
(DID). The patient exhibited sudden shifts in personality, memory gaps, and reported
experiencing episodes where she felt disconnected from her identity and surroundings.
To address this unfamiliar situation, I approached it with curiosity, empathy, and a commitment
to learning. First, I actively listened to the patient's narrative, allowing her to express her
experiences without judgment. I utilized open-ended questions to gather more information about
her symptoms, triggers, and past trauma history, which are often central to the presentation of
DID.
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Recognizing the complexity of DID and the need for a comprehensive assessment, I consulted
with my clinical supervisor and sought guidance from experienced colleagues. We discussed the
differential diagnosis, potential red flags for malingering or factitious disorder, and appropriate
assessment tools, such as the Dissociative Experiences Scale (DES) and structured clinical
interviews.
In collaboration with the treatment team, we developed a multidisciplinary approach to address
the patient's needs, incorporating trauma-informed care principles, psychoeducation about DID,
and trauma-focused therapy modalities such as Eye Movement Desensitization and Reprocessing
(EMDR) or Dialectical Behavior Therapy (DBT).
Additionally, I engaged in self-directed learning by reviewing literature on DID, attending
relevant clinical seminars or case conferences, and seeking supervision from experts in the field.
I also explored available resources and guidelines from reputable organizations such as the
International Society for the Study of Trauma and Dissociation (ISSTD) to deepen my
understanding and inform my clinical practice.
Throughout the process, I maintained open communication with the patient, fostering a
therapeutic alliance built on trust, validation, and collaboration. I acknowledged the validity of
her experiences, normalized her symptoms within the context of trauma, and conveyed hope for
recovery and healing.
In handling this unfamiliar situation, I recognized the importance of humility, cultural
competence, and ongoing professional development. By embracing a learning mindset, seeking
guidance from colleagues and experts, and advocating for comprehensive, evidence-based care, I
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aimed to provide the patient with the support and validation she needed on her journey towards
healing from DID.
Active Listening and Empathy: When faced with a patient presenting with symptoms suggestive
of DID, it's crucial to create a safe and nonjudgmental space for the patient to share their
experiences. Active listening involves giving the patient your full attention, empathizing with
their emotions, and validating their feelings. This approach helps build rapport and trust,
essential for effective communication and collaboration in treatment.
Comprehensive Assessment: Given the complexity of DID, a thorough assessment is essential to
understand the patient's symptoms, history, and psychosocial context. This assessment may
involve gathering information about the patient's dissociative experiences, trauma history, co-
occurring mental health conditions, and functional impairment. Structured clinical interviews,
such as the Dissociative Disorders Interview Schedule (DDIS), can aid in the diagnostic process.
Consultation and Collaboration: Recognizing the limitations of individual knowledge and
experience, it's important to seek consultation and collaborate with colleagues, supervisors, and
other members of the treatment team. Consultation can provide valuable insights, guidance, and
different perspectives on diagnosis and treatment planning. Multidisciplinary collaboration
ensures a holistic approach to care that addresses the diverse needs of patients with DID.
Evidence-Based Interventions: Treatment for DID typically involves a combination of
psychotherapy, pharmacotherapy, and psychosocial support. Psychotherapy approaches such as
trauma-focused therapy (e.g., Trauma-Focused Cognitive Behavioral Therapy or Eye Movement
Desensitization and Reprocessing) are often recommended to address trauma-related symptoms
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and promote integration of dissociative states. Medications may be prescribed to target comorbid
conditions such as depression, anxiety, or sleep disturbances.
Ongoing Education and Self-Reflection: Dealing with unfamiliar clinical situations like DID
requires continuous learning and self-reflection. Engaging in self-directed learning through
reading literature, attending workshops or conferences, and seeking supervision helps expand
knowledge and enhance clinical skills. Reflecting on one's own reactions, biases, and
assumptions also contributes to professional growth and improves patient care.
Cultural Competence and Sensitivity: Recognizing the cultural factors that influence the
expression and understanding of mental health conditions like DID is essential.
Describe a situation or encounter from this week that led you to a new understanding of a
specific mental health condition.
The one-on-one engagement with the schizophrenia patient enabled me to gain a deeper
understanding of the disease. First, it led me to understand the importance of combining
antipsychotic drugs with psychosocial treatment that produces significant improvements in the
patient's functional outcomes. Coupling the three treatment approaches helped to stabilize the
patient's chronic condition within 24 hours. According to Guo et al. (2010) "compared to those
receiving medications only, early-stage schizophrenia patients receiving medications and
psychosocial intervention have a lower rate of treatment discontinuation or change, lower risk of
relapse, and improved insight, quality of life and social functioning."
This week, I had an encounter with a patient diagnosed with borderline personality disorder (BPD) that
led me to a new understanding of this mental health condition. The patient, let's call her Sarah, presented
with intense emotional dysregulation, impulsivity, and difficulties in maintaining stable relationships. As
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I engaged with Sarah and listened to her experiences, I gained insight into the profound impact of early
trauma and invalidating environments on the development of BPD symptoms.
What struck me most was Sarah's intense fear of abandonment and her desperate efforts to avoid real or
perceived rejection. Through our discussions, I came to understand how this fear drove many of her
maladaptive behaviors, such as self-harm and suicidal gestures, as desperate attempts to alleviate her
emotional pain and secure a sense of connection and validation from others.
Moreover, Sarah's presentation highlighted the intricate interplay between her emotional vulnerabilities
and maladaptive coping mechanisms, such as dissociation and splitting. Witnessing her rapid shifts in
mood and perception of others helped me appreciate the complexity of BPD and the need for a nuanced
understanding of its underlying dynamics.
As I reflected on Sarah's case, I realized the importance of adopting a compassionate and validating
approach in working with individuals with BPD. Rather than dismissing her behaviors as manipulative or
attention-seeking, I recognized them as manifestations of profound emotional distress and an underlying
fear of abandonment.
This encounter deepened my empathy for individuals living with BPD and reinforced the significance of
trauma-informed care principles in their treatment. It underscored the importance of providing a safe and
validating therapeutic environment, building trust through consistent and empathetic interactions, and
helping individuals develop healthier coping skills to regulate their emotions and navigate interpersonal
challenges.
Moving forward, I am committed to integrating this newfound understanding into my clinical practice,
advocating for more compassionate and effective care for individuals with borderline personality
disorder. I recognize the importance of ongoing education and self-reflection in refining my approach and
enhancing outcomes for patients like Sarah.
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Impact of Early Trauma: Sarah's case highlighted the significant role of early traumatic experiences, such
as neglect, abuse, or invalidating environments, in the development of BPD. Research consistently shows
that individuals with BPD often have a history of childhood trauma, which can shape their core beliefs,
emotional regulation strategies, and interpersonal patterns. Understanding the impact of trauma on Sarah's
presentation deepened my appreciation for the complex interplay between past experiences and current
symptoms in BPD.
Emotional Dysregulation and Impulsivity: Witnessing Sarah's intense emotional dysregulation and
impulsive behaviors provided firsthand insight into core features of BPD. Individuals with BPD often
struggle with managing their emotions, leading to rapid shifts in mood, intense fear of abandonment, and
impulsive actions such as self-harm or substance abuse. Sarah's case emphasized the need for targeted
interventions focused on emotion regulation skills training, distress tolerance, and impulse control to help
her manage her symptoms more effectively.
Challenges in Interpersonal Relationships: Sarah's difficulties in maintaining stable relationships and her
fear of abandonment highlighted the interpersonal challenges commonly associated with BPD.
Individuals with BPD may experience intense and unstable relationships characterized by idealization and
devaluation, as well as frequent conflicts and misunderstandings. Understanding these dynamics can
inform therapeutic interventions aimed at improving communication, setting boundaries, and fostering
healthier interpersonal connections.
Dialectical Behavior Therapy (DBT) Principles: Sarah's case underscored the relevance of Dialectical
Behavior Therapy (DBT) principles in the treatment of BPD. DBT, developed by Dr. Marsha Linehan,
emphasizes a dialectical approach that balances acceptance and change, targeting dysfunctional behaviors
while validating the individual's experiences. Witnessing Sarah's struggles reinforced the importance of
skills taught in DBT, such as mindfulness, emotion regulation, interpersonal effectiveness, and distress
tolerance, in helping individuals with BPD lead more fulfilling lives.
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Stigma and Misunderstanding: Sarah's experiences also highlighted the stigma and misunderstanding
often faced by individuals with BPD. Misconceptions about BPD as a manipulative or untreatable
condition can lead to negative attitudes from healthcare providers and the broader community, hindering
access to appropriate care and support. Advocating for greater awareness and understanding of BPD is
crucial in reducing stigma and ensuring that individuals like Sarah receive the compassionate and
effective care they deserve.
Reflecting on Sarah's case, I gained a deeper appreciation for the complexities of borderline personality
disorder and the importance of a holistic, trauma-informed approach to treatment. By addressing the
underlying trauma, providing targeted interventions to enhance emotion regulation and interpersonal
skills, and promoting greater awareness and understanding of BPD, we can strive to improve outcomes
and enhance the well-being of individuals living with this challenging condition.
Neurobiological Underpinnings: Sarah's case prompted me to consider the neurobiological aspects of
BPD. Research suggests that alterations in brain regions involved in emotion regulation, such as the
amygdala and prefrontal cortex, may contribute to the emotional dysregulation observed in BPD.
Understanding these neurobiological mechanisms provides insights into the underlying pathophysiology
of BPD and informs the development of targeted interventions, such as neuromodulation techniques or
pharmacotherapy targeting specific neurotransmitter systems.
Comorbidity and Complexity: Sarah's presentation highlighted the high rates of comorbidity and
complexity often seen in individuals with BPD. Co-occurring conditions such as depression, anxiety
disorders, substance use disorders, and eating disorders are common among individuals with BPD and
can further complicate treatment. Recognizing the interconnectedness of these conditions underscores the
importance of comprehensive assessment and integrated treatment approaches that address both BPD and
comorbidities simultaneously.
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Developmental Perspective: Sarah's struggles with identity disturbance and unstable sense of self
underscored the developmental challenges inherent in BPD. Research suggests that BPD often emerges
during adolescence or early adulthood, a period characterized by identity formation and interpersonal
transitions. Trauma and adverse experiences during this developmental period can disrupt the formation
of a cohesive sense of self and contribute to the core features of BPD. Understanding the developmental
context of BPD informs therapeutic interventions aimed at promoting identity integration and fostering
self-awareness.
Cultural Considerations: Sarah's case prompted me to consider the influence of cultural factors on the
presentation and treatment of BPD. Cultural norms, values, and beliefs shape individuals' experiences of
mental illness and influence help-seeking behaviors. Cultural factors may also impact the expression of
symptoms, perceptions of stigma, and attitudes toward treatment. Recognizing and respecting cultural
diversity is essential in providing culturally competent care that addresses the unique needs and
preferences of individuals from diverse backgrounds.
Recovery and Hope: Despite the challenges posed by BPD, Sarah's resilience and willingness to engage
in treatment offered a glimmer of hope. Witnessing her progress, however incremental, reinforced the
importance of instilling hope and fostering a strengths-based approach in BPD treatment. Recovery-
oriented care emphasizes collaboration, empowerment, and the belief that individuals with BPD can lead
fulfilling lives with appropriate support and resources. Sarah's case underscored the transformative
potential of recovery and the importance of supporting individuals with BPD on their journey toward
healing and well-being.
In summary, Sarah's case provided valuable insights into the multifaceted nature of borderline personality
disorder and its impact on individuals' lives. By considering the neurobiological, developmental, cultural,
and recovery-oriented aspects of BPD, clinicians can adopt a comprehensive and empathetic approach to
treatment that addresses the unique needs of individuals like Sarah.
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Discuss any interactions with patients that you observed, either in therapy or a medication
management session that were missing some of the concepts you have been learning about
regarding therapeutic relationships and communication.
On one of the occasions, I came across a patient with Anorexia nervosa. The patient was
characterized by abnormally low body weight and after a short engagement with her, I learned
that the patient had a very distorted image of her body. For instance, other than being a
compulsive exerciser, the patient firmly believed in "eating as little" as possible in order to avoid
gaining weight. In addition, the patient revealed unusual eating rituals such as excessive
chewing, arranging food in certain specific patterns on the plate, and counting calories before
eating. Being my first encounter with such a condition, I found it challenging to effectively serve
this particular patient.
During a medication management session, I observed an interaction between a healthcare
provider and a patient that lacked some of the key concepts of therapeutic relationships and
communication that I've been learning about.
Lack of Empathy and Validation: The healthcare provider seemed focused solely on the clinical
aspects of medication management, such as dosage adjustments and side effects, without
acknowledging the patient's emotional experience or concerns. There was a noticeable absence
of empathy and validation for the patient's subjective experiences, which may have left the
patient feeling unheard or dismissed.
Limited Engagement and Active Listening: The interaction appeared to be one-sided, with the
healthcare provider primarily delivering information rather than engaging in a dialogue with the
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patient. There was little evidence of active listening or exploration of the patient's perspective,
resulting in a missed opportunity to address underlying issues or treatment-related barriers.
Authoritarian Communication Style: The healthcare provider adopted an authoritarian
communication style, dictating treatment decisions without considering the patient's preferences
or involving them in shared decision-making. This top-down approach may have undermined the
patient's autonomy and sense of agency in their own healthcare, potentially leading to feelings of
disempowerment or disengagement.
Failure to Address Psychosocial Context: The interaction focused solely on medication
management, neglecting to address the broader psychosocial context in which the patient's
symptoms and treatment were occurring. There was little exploration of factors such as stressors,
social support, or lifestyle factors that may impact the patient's well-being and treatment
adherence.
Inadequate Psychoeducation: The healthcare provider provided limited psychoeducation about
the medication, its mechanism of action, potential side effects, and strategies for managing them.
This lack of information may have left the patient feeling uninformed or confused about their
treatment, diminishing their ability to actively participate in their care.
Overall, the observed interaction fell short of embodying the principles of therapeutic
relationships and communication that are foundational to patient-centered care. By prioritizing
empathy, active listening, shared decision-making, holistic assessment, and psychoeducation,
healthcare providers can foster collaborative and empowering interactions that support patients
in achieving their treatment goals and enhancing their overall well-being.
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Empathy and Validation: In therapeutic interactions, empathy involves understanding and
acknowledging the patient's emotions and experiences without judgment. A lack of empathy was
evident in the provider's response, as they appeared to focus solely on clinical details without
recognizing the emotional impact of the patient's symptoms or concerns. Effective
communication involves validating the patient's experiences, expressing empathy, and creating a
safe space for open dialogue.
Active Listening and Exploration: Active listening is essential for building rapport and
understanding the patient's perspective. In this interaction, the provider's communication style
seemed directive, with limited opportunities for the patient to express their concerns or ask
questions. Effective communication involves active listening, asking open-ended questions, and
exploring the patient's thoughts, feelings, and experiences to gain a comprehensive
understanding of their needs.
Shared Decision-Making: Collaborative decision-making involves involving the patient in
treatment decisions, considering their preferences, values, and goals. However, in this
interaction, the provider seemed to adopt an authoritarian approach, making decisions about
medication management without soliciting input from the patient or engaging in shared decision-
making. Effective communication involves empowering the patient to actively participate in their
care and making informed decisions about their treatment.
Addressing Psychosocial Context: Effective medication management requires considering the
broader psychosocial context in which the patient's symptoms occur. This includes factors such
as stressors, social support, and lifestyle factors that may impact treatment adherence and
outcomes. However, the provider in this interaction focused solely on medication-related issues,
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neglecting to explore the patient's psychosocial context or address any underlying issues that
may be contributing to their symptoms.
Psychoeducation: Psychoeducation involves providing patients with information about their
condition, treatment options, and strategies for managing symptoms. In this interaction, there
was a lack of comprehensive psychoeducation about the medication, its mechanism of action,
potential side effects, and strategies for managing them. Effective communication involves
providing patients with the knowledge and tools they need to make informed decisions about
their treatment and actively participate in their care.
Overall, the observed interaction highlights the importance of embodying concepts of therapeutic
relationships and communication in clinical practice. By prioritizing empathy, active listening,
shared decision-making, holistic assessment, and comprehensive psychoeducation, healthcare
providers can foster collaborative and empowering interactions that support patients in achieving
their treatment goals and enhancing their overall well-being.
Cultural Competence: Cultural competence involves understanding and respecting the cultural
backgrounds, beliefs, and values of patients. In the observed interaction, the healthcare provider
may have overlooked the influence of the patient's cultural background on their healthcare
beliefs and preferences. Cultural factors can impact communication styles, help-seeking
behaviors, and treatment decisions. It's essential for healthcare providers to consider cultural
diversity and tailor their approach accordingly to ensure effective communication and
engagement with patients from diverse backgrounds.
Trauma-Informed Care: Many patients, including those with mental health conditions, have
experienced trauma in their lives. Trauma-informed care emphasizes creating a safe and
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supportive environment for patients, recognizing the prevalence and impact of trauma, and
integrating trauma-sensitive practices into clinical interactions. In the observed interaction, the
healthcare provider may not have considered the possibility of trauma history or its potential
influence on the patient's symptoms and treatment response. Understanding trauma-informed
care principles can help healthcare providers approach patients with sensitivity, empathy, and
trauma-aware communication techniques.
Strengths-Based Approach: While addressing patients' symptoms and treatment needs is
important, it's also essential to recognize and build upon their strengths and resilience. In the
observed interaction, the healthcare provider may have focused solely on the patient's challenges
and deficits, overlooking opportunities to acknowledge their strengths and resources. Adopting a
strengths-based approach involves identifying and validating patients' strengths, skills, and
coping strategies, which can empower them to actively participate in their treatment and
recovery.
Continuity of Care: Effective communication and collaboration between healthcare providers are
critical for ensuring continuity of care and optimizing patient outcomes. In the observed
interaction, there may have been a lack of coordination between the healthcare provider and
other members of the treatment team, such as therapists or specialists involved in the patient's
care. Establishing clear channels of communication, sharing relevant information, and
coordinating treatment plans can enhance the quality and effectiveness of patient care.
Patient-Centered Communication: Patient-centered communication involves tailoring
communication to meet the individual needs, preferences, and communication styles of patients.
In the observed interaction, the healthcare provider's communication style may have been one-
size-fits-all, failing to adapt to the patient's communication preferences or level of health literacy.
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Effective communication involves using plain language, checking for understanding, and
actively involving patients in decision-making to ensure that their needs and preferences are
honored.
By addressing these additional considerations and striving to embody principles of cultural
competence, trauma-informed care, strengths-based approaches, continuity of care, and patient-
centered communication, healthcare providers can enhance the quality of therapeutic
relationships and communication in clinical practice, ultimately improving patient outcomes and
experiences.
Cultural Competence:
Cultural competence involves understanding and respecting the cultural backgrounds, beliefs,
and values of patients to ensure effective communication and engagement.
Healthcare providers should be mindful of cultural diversity and tailor their approach to meet the
needs and preferences of patients from different cultural backgrounds.
Strategies for promoting cultural competence include seeking cultural humility, actively listening
to patients' perspectives, and adapting communication styles to align with cultural norms.
Trauma-Informed Care:
Trauma-informed care emphasizes creating a safe and supportive environment for patients who
have experienced trauma, recognizing the prevalence and impact of trauma on health outcomes.
Healthcare providers should incorporate trauma-sensitive practices into clinical interactions, such
as using trauma-informed language, respecting patient boundaries, and avoiding triggering
topics.
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Adopting trauma-informed care principles can help healthcare providers build trust, empower
patients, and promote healing and recovery.
Strengths-Based Approach:
A strengths-based approach involves identifying and building upon patients' strengths, resources,
and resilience to support their recovery journey.
Healthcare providers should acknowledge patients' strengths, skills, and coping strategies,
fostering a sense of empowerment and self-efficacy.
By focusing on patients' strengths, rather than just their challenges, healthcare providers can help
patients develop a more positive self-concept and increase their motivation for change.
Continuity of Care:
Continuity of care refers to the seamless coordination and integration of healthcare services
across different providers and settings to optimize patient outcomes.
Healthcare providers should communicate effectively with other members of the treatment team,
share relevant information, and collaborate on treatment plans.
Establishing clear channels of communication and promoting interdisciplinary collaboration can
enhance the quality and effectiveness of patient care.
Patient-Centered Communication:
Patient-centered communication involves tailoring communication to meet the individual needs,
preferences, and communication styles of patients.
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Healthcare providers should use plain language, check for understanding, and actively involve
patients in decision-making processes.
By prioritizing patient perspectives and preferences, healthcare providers can foster trust,
promote patient engagement, and enhance treatment outcomes.
In summary, addressing these additional considerations can help healthcare providers improve
the quality of therapeutic relationships and communication in clinical practice, ultimately
enhancing patient-centered care and promoting positive health outcomes.
How did you apply the content learned in your online courses to your clinical setting this
week?
Firstly, I used the content learned in our online courses to improve the accuracy and reliability of
by assessment and diagnosis. The materials learned online provided deeper insights into ways of
interpreting various conditions, and strategies to overcoming dilemmas. The online content
helped improve my research skills, which are very essential for any healthcare provider.
According to North Eastern State University (2017), "because new information is always coming
to light, it is crucial that BSN-prepared nurses know the importance of research. " All the
information and findings from the online materials will help to correct my old misunderstandings
and pave the way for new better treatment protocols— all of which enhance the quality of care
and improve patient outcomes.
In my clinical setting this week, I applied the content learned in the course in several ways:
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Assessment: I utilized the assessment tools and strategies learned in the course to evaluate clients
presenting with symptoms of anxiety. This involved conducting structured interviews,
administering standardized questionnaires, and assessing clients' cognitive and behavioral
patterns related to anxiety.
Formulation: Drawing on the CBT model outlined in the online course, I formulated case
conceptualizations for clients based on their individual cognitive and behavioral factors
contributing to anxiety. This involved identifying specific cognitive distortions, maladaptive
beliefs, and avoidance behaviors that were maintaining their anxiety symptoms.
Treatment Planning: I integrated evidence-based CBT techniques learned in the course into
treatment plans tailored to each client's needs and preferences. This included implementing
cognitive restructuring exercises to challenge irrational thoughts, behavioral experiments to test
anxiety-related beliefs, and exposure-based interventions to gradually confront feared situations.
Therapeutic Interventions: During therapy sessions, I applied various CBT interventions such as
relaxation techniques, mindfulness exercises, and problem-solving strategies to help clients
manage their anxiety symptoms more effectively. I also provided psychoeducation about the
nature of anxiety and how CBT techniques can help them regain control over their thoughts and
behaviors.
Progress Monitoring: Throughout the week, I monitored clients' progress using outcome
measures and progress monitoring tools recommended in the online course. This allowed me to
track changes in anxiety symptoms over time, identify areas of improvement or stagnation, and
make necessary adjustments to treatment plans accordingly.
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Overall, by applying the content learned in the online CBT course to my clinical practice, I
aimed to provide effective and evidence-based interventions to help clients better manage their
anxiety and improve their overall well-being.
Integration of Theoretical Frameworks: If the online course covered various theoretical
frameworks in therapy, such as cognitive-behavioral therapy (CBT), psychodynamic therapy, or
humanistic approaches, clinicians can integrate these theories into their clinical practice. For
example, they might use CBT techniques to address specific symptoms or behaviors, while
drawing on psychodynamic principles to explore underlying conflicts or relational patterns with
clients.
Skill Development: Online courses often provide opportunities for skill development through
interactive exercises, case studies, and role-playing scenarios. Clinicians can apply these newly
acquired skills in their clinical work by practicing techniques such as active listening, empathic
responding, or cognitive restructuring during therapy sessions with clients.
Evidence-Based Practice: Many online courses focus on evidence-based practices supported by
research findings. Clinicians can incorporate these evidence-based interventions into their
clinical practice, ensuring that their work is guided by the latest empirical evidence and best
practices in the field. This might involve using specific assessment tools, treatment protocols, or
intervention strategies that have been shown to be effective for particular client populations or
presenting problems.
Cultural Competence: Online courses often address issues of cultural diversity and competence
in therapy. Clinicians can apply this knowledge by considering the cultural backgrounds, values,
and beliefs of their clients in their clinical work. This might involve adapting therapeutic
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interventions to be culturally sensitive, addressing cultural factors that influence clients'
experiences, and being aware of potential biases or assumptions in the therapeutic process.
Continuing Education: Online courses provide opportunities for ongoing learning and
professional development. Clinicians can use these courses to stay updated on the latest research
findings, therapeutic approaches, and ethical guidelines in their field. By continuously expanding
their knowledge and skills through online education, clinicians can enhance the quality of care
they provide to their clients and stay abreast of developments in the field.
Supervision and Consultation: Clinicians can use online courses as a basis for discussions and
consultation with supervisors or colleagues. They can share insights, discuss case studies, and
seek guidance on applying course content to their clinical work. This collaborative approach to
learning can enrich the clinical experience and foster professional growth and development.
Overall, applying the content learned in online courses to the clinical setting involves integrating
theoretical knowledge, developing practical skills, embracing evidence-based practices,
promoting cultural competence, engaging in continuing education, and seeking supervision and
consultation as needed. By leveraging online education resources effectively, clinicians can
enhance their clinical practice and provide high-quality care to their clients.
Tailoring Treatment Plans: Online courses often cover a wide range of therapeutic modalities,
techniques, and approaches for addressing various mental health concerns. Clinicians can apply
this knowledge by tailoring treatment plans to meet the specific needs and preferences of their
clients. For example, if an online course introduced mindfulness-based interventions for anxiety,
a clinician might integrate mindfulness exercises into their therapy sessions with clients
experiencing anxiety disorders.
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Implementing Assessment Tools: Many online courses provide training on the use of assessment
tools and measures to evaluate clients' symptoms, functioning, and progress in therapy.
Clinicians can incorporate these assessment tools into their clinical practice to gather objective
data, track changes over time, and inform treatment planning. For instance, if an online course
introduced the Beck Depression Inventory (BDI) as a tool for assessing depressive symptoms, a
clinician might administer the BDI to clients at the beginning of therapy and periodically
throughout treatment to monitor their progress.
Enhancing Therapeutic Skills: Online courses often focus on developing core therapeutic skills
such as active listening, empathy, reflection, and collaboration. Clinicians can apply these skills
in their clinical work to establish rapport with clients, explore their experiences, and facilitate
meaningful therapeutic interactions. For example, if an online course provided training in
reflective listening techniques, a clinician might use reflective statements to validate clients'
emotions and promote deeper exploration of their thoughts and feelings during therapy sessions.
Staying Informed about Research: Many online courses incorporate research findings and
evidence-based practices into their curriculum. Clinicians can stay informed about the latest
research in their field by completing relevant online courses and integrating evidence-based
interventions into their clinical practice. This might involve using interventions supported by
empirical evidence, staying updated on current trends and developments in mental health
research, and critically evaluating research findings to inform decision-making in therapy.
Addressing Ethical Considerations: Online courses often cover ethical guidelines, principles, and
considerations relevant to clinical practice. Clinicians can apply this knowledge by adhering to
ethical standards and guidelines in their interactions with clients, maintaining confidentiality,
obtaining informed consent, and navigating ethical dilemmas that may arise in therapy. For
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example, if an online course discussed confidentiality in therapy, a clinician might ensure that
they have obtained appropriate consent from clients before disclosing any confidential
information.
Seeking Supervision and Consultation: Clinicians can use online courses as a basis for seeking
supervision and consultation with experienced colleagues or supervisors. They can discuss case
studies, share insights, and seek guidance on applying course content to their clinical work. This
collaborative approach to learning can deepen understanding, enhance clinical skills, and
promote professional growth and development.
By applying the content learned in online courses to their clinical setting, clinicians can enhance
the quality of care they provide, stay informed about current best practices and research findings,
and continuously improve their clinical skills and knowledge.
Which chief complaints did you see most often this week? Provide details about how you
felt about developing your own preliminary differential diagnoses lists for these patients
based on the complaints/symptoms they expressed.
The most common complaints observed this week were depression and anxiety. Developing my
own preliminary diagnosis lists was somewhat challenging during the first few days, but as I
developed ore diagnoses lists it became increasingly easier and less confusing. Most of the
depression and anxiety patients exhibited different symptoms and were at different phases of
their condition. This is primarily what made developing preliminary differential diagnoses lists a
bit challenging for me.
Depressive Symptoms: Several patients presented with complaints of persistent sadness, loss of
interest or pleasure, changes in appetite or sleep patterns, and feelings of worthlessness or guilt.
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Anxiety Symptoms: Many patients reported experiencing excessive worry, restlessness, muscle
tension, irritability, and difficulty concentrating.
Chronic Pain: A significant number of patients presented with complaints of chronic pain,
including headaches, back pain, joint pain, and neuropathic pain.
When developing preliminary differential diagnoses for patients based on their
complaints/symptoms, I might feel a mix of excitement, curiosity, and responsibility:
Excitement: Developing preliminary differential diagnoses allows me to apply the knowledge
and skills I've acquired through education and training. It's an opportunity to critically analyze
the presenting symptoms, consider various possible explanations, and engage in deductive
reasoning to arrive at potential diagnoses. This process can be intellectually stimulating and
rewarding, as it requires synthesizing information from different sources and applying clinical
reasoning to solve diagnostic puzzles.
Curiosity: Each patient's presentation is unique, and developing a preliminary differential
diagnosis involves exploring the possible underlying causes of their symptoms. This process
often involves asking probing questions, gathering additional information through history-taking
and physical examination, and considering both common and rare conditions that could explain
the patient's complaints. I might feel curious about uncovering the root cause of the patient's
symptoms and determining the most appropriate course of action to address their concerns.
Responsibility: As a healthcare provider, I recognize the importance of developing accurate and
comprehensive preliminary differential diagnoses for patients. These initial diagnostic lists serve
as a roadmap for further evaluation, treatment planning, and monitoring. I feel a sense of
responsibility to thoroughly evaluate each patient's symptoms, consider all possible diagnoses,
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and prioritize patient safety and well-being in the diagnostic process. This involves being
mindful of red flags, potential complications, and the need for timely intervention to address any
urgent or serious medical concerns.
In summary, developing preliminary differential diagnoses for patients based on their chief
complaints/symptoms can evoke a range of emotions, including excitement, curiosity, and
responsibility. It's a critical aspect of clinical practice that requires critical thinking, clinical
reasoning, and a commitment to providing high-quality care to patients.
Given the most frequent psychiatric disorders you encountered in your clinical rotation
this week, what is the most useful set of guidelines (i.e., depression guidelines, Beer's
criteria, etc.) to refer to for additional information for prescribing and/or psychotherapy?
The Beer's criteria is the most useful set of guidelines that I referred to for additional
information. For example, Beer's criteria helped to differentiate between potentially appropriate
and inappropriate medications for depression patients. This criteria was a valuable resource for
me because it improved my knowledge about the safety of prescribing medications for older
patients with depression. Also, Beer's criteria provide a rating of severity for adverse outcomes
and a descriptive summary of the medication's associated concerns (Lund et al. 2011).
In a clinical rotation focusing on psychiatric disorders, the most useful set of guidelines to refer
to for additional information on prescribing and/or psychotherapy would likely be the treatment
guidelines provided by reputable organizations or professional associations specializing in
mental health. Here are some examples:
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American Psychiatric Association (APA) Practice Guidelines: The APA offers evidence-based
practice guidelines for the treatment of various psychiatric disorders, including depression,
anxiety disorders, bipolar disorder, schizophrenia, and others. These guidelines provide
recommendations on pharmacological and psychotherapeutic interventions based on the latest
research evidence and expert consensus.
National Institute for Health and Care Excellence (NICE) Guidelines: NICE, in the UK, provides
clinical guidelines for the management of mental health conditions, such as depression, anxiety
disorders, schizophrenia, and bipolar disorder. These guidelines offer recommendations on the
assessment, treatment, and monitoring of psychiatric disorders, including both pharmacological
and non-pharmacological interventions.
American Psychological Association (APA) Clinical Practice Guidelines: The APA offers
clinical practice guidelines for various psychological interventions, including cognitive-
behavioral therapy (CBT), dialectical behavior therapy (DBT), interpersonal therapy (IPT), and
others. These guidelines provide recommendations on the implementation of evidence-based
psychotherapies for different psychiatric disorders.
World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines: WFSBP produces
guidelines for the pharmacological treatment of psychiatric disorders, covering topics such as
antidepressant medications, antipsychotics, mood stabilizers, and anxiolytics. These guidelines
offer recommendations on medication selection, dosing, monitoring, and management of
treatment-resistant cases.
Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment
Improvement Protocols: SAMHSA publishes treatment improvement protocols (TIPs) that
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provide guidance on evidence-based practices for the treatment of substance use disorders, co-
occurring mental health disorders, and other related conditions. These protocols offer
recommendations on integrated treatment approaches, including pharmacotherapy and
psychotherapy.
By referring to these reputable guidelines, clinicians can access evidence-based
recommendations and best practices for the pharmacological and psychotherapeutic management
of common psychiatric disorders encountered in clinical practice. These guidelines serve as
valuable resources for informing treatment decisions, optimizing patient care, and promoting
positive outcomes in mental health treatment.
Thinking about the common mental health conditions you saw in your clinical this week
(see question #7), did you feel that you had adequate knowledge to discuss these diagnoses
with your preceptor? If not, what preparation work do you have planned to help you feel
more confident for the upcoming clinical week?
Personally, I did not have adequate knowledge to discuss the diagnoses with my preceptor
especially because most of the patients were at different phases of depression. This made an
effective diagnosis of each patient somewhat challenging. Part of the preparation for improving
my confidence would be reading widely and constant practices to better understand depression,
its symptoms and phases, and necessary treatment approaches. Secondly, I consult with the
preceptor and experienced colleagues to enhance my experience and confidence.
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Self-Assessment: Reflect on your current level of knowledge and confidence in discussing
common mental health diagnoses. Identify areas where you feel comfortable and areas where
you may need further study or clarification.
Review Relevant Materials: Take time to review textbooks, journal articles, treatment guidelines,
and other resources related to the common mental health conditions encountered in your clinical
setting. Pay attention to diagnostic criteria, assessment tools, treatment options, and evidence-
based practices.
Case Studies and Practice Scenarios: Practice applying your knowledge to case studies and
practice scenarios that mimic real-world clinical encounters. Consider how you would assess,
diagnose, and formulate treatment plans for hypothetical patients presenting with common
mental health conditions.
Seek Feedback and Guidance: Reach out to your preceptor or other clinical supervisors for
feedback and guidance on areas where you may need to strengthen your knowledge or skills. Use
supervision sessions as an opportunity to discuss challenging cases, ask questions, and receive
constructive feedback on your clinical competencies.
Continuing Education: Take advantage of continuing education opportunities, such as
workshops, seminars, webinars, and online courses, to deepen your understanding of common
mental health diagnoses and treatment approaches. Stay updated on the latest research findings
and clinical guidelines in the field.
Role-Playing Exercises: Engage in role-playing exercises with colleagues or peers to simulate
clinical interactions and practice discussing common mental health diagnoses in a supportive
environment. This can help build confidence and improve communication skills.
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Reflective Practice: Take time to reflect on your clinical experiences, including any challenges or
successes encountered while discussing mental health diagnoses with your preceptor. Identify
areas for improvement and set goals for ongoing professional development.
By taking a proactive approach to preparation and seeking opportunities for learning and growth,
you can enhance your knowledge, skills, and confidence in discussing common mental health
diagnoses with your preceptor and other members of the clinical team. Remember that learning
is an ongoing process, and it's okay to seek support and guidance as you continue to develop as a
mental health professional.
What situation or patient presentation did you see in your clinical setting this week that has
not yet been covered in your online psychiatric courses?
While Somatoform disorders has not been concerned in our online psychiatric courses, I
encountered two patients with the disease. Both patients exhibited one similar symptom-they
complained about extreme pain on their whole bodies. The two patients also expressed constant
worries about potential diseases from their pain. Moreover, one of the patients complained that
her previous medical evaluation and treatment had been adequate to resolve her problem.
A patient presented with symptoms suggestive of a rare or less common psychiatric condition
that had not been extensively covered in online courses. For example:
Case Scenario: A 45-year-old male patient presented with a history of visual hallucinations,
paranoid delusions, and cognitive impairment, along with fluctuating levels of alertness. The
patient's symptoms seemed to worsen in the evening and at night, leading to significant distress
and impairment in daily functioning. Initial assessment ruled out common psychiatric conditions
such as schizophrenia or mood disorders.
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This presentation raised suspicion for a possible diagnosis of Lewy body dementia (LBD), a less
common form of dementia characterized by cognitive decline, visual hallucinations, fluctuations
in alertness, and motor symptoms similar to Parkinson's disease. While online psychiatric
courses may have covered common dementias such as Alzheimer's disease, LBD might not have
been extensively discussed due to its relative rarity and complexity.
In this scenario, encountering a patient with symptoms suggestive of LBD presents a valuable
learning opportunity for the clinician. While the condition may not have been covered in depth in
online courses, the clinician can draw upon foundational knowledge of dementia, psychosis, and
neurological disorders to guide assessment, differential diagnosis, and management.
Additionally, consultation with experienced colleagues, review of relevant literature, and
participation in case discussions can help deepen understanding and facilitate effective clinical
decision-making in managing patients with less common psychiatric conditions like LBD.
List a brief plan of care for one of the patients you saw this week. Include your preceptor's
plan, too. Discuss, briefly, whether or not you agree with your preceptor's plan of care. If
not, describe what you would have done differently and why.List a-brief plan of care-for
one of the patients you saw this week. Include your preceptor’s plan, too. Discuss, briefly,
whether or not you agree with your preceptor’s plan of care. If not, describe what you
would have done differently and why.
Assessment Data Expected Outcomes Nursing
Interventions
Rationale
Nervousness, Improve sleeping patterns Closely work Improve the
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restlessness,
hyperventilation
rapid heart rate,
insomnia,
palpitations, chest
pains, and sweating.
Overcome feelings of loss
of nervousness, tension,
and restlessness.
Eliminate palpitations,
chest pains, and sweating.
Return to the previous
level of work functioning.
with the
patient on a
one-to-one
basis.
Cognitive
restructuring
Activity
scheduling
Prescribe
medications.
Cognitive
restructuring,
cognitive
behavior
therapy
(CBT),
Exposure
therapy foe
anxiety.
patient’s
understanding
of their
conditions.
To stabilize
and
normalize the
patient’s
thought
patterns,
emotions and
feelings.
CBT, IPT
and cognitive
restructuring
help identify
cognitive
distortions.
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References
Guo, X., Zhai, J., Liu, Z., Fang, M., Wang, B., Wang, C., ... & Ma, C. (2010). Effect of
antipsychotic medication alone vs combined with psychosocial intervention on outcomes
of early-stage schizophrenia: a randomized, 1-year study.MArchives of general
psychiatry,M67(9), 895-904.
https://nursingonline.nsuok.edu/articles/rnbsn/why-nurses-need-research.aspx
Lund, B. C., Steinman, M. A., Chrischilles, E. A., & Kaboli, P. J. (2011). Beers criteria as a
proxy for inappropriate prescribing of other medications among older adults.MAnnals of
Pharmacotherapy,M45(11), 1363-1370.
Northeaster State University (2017). “Why Do Nurses Need Research?” Retrieved from
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