Psychopathology with PEER RESPONSES

Running Head: PSYCHOPATHOLOGY 1

Psychopathology

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Professor

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PSYCHOPATHOLOGY 2

Goal:To analyze and apply critical thinking skills in the psychopathology of

mental health patients and provide treatment and health promotion while

applying evidence-based research.

Helen is a 45-year-old African American female who separated two months ago from her husband of

25 years after he had an extramarital affair. In addition to running the household and managing 18-year-old

fraternal twins, she works part-time at a local dry cleaning business. Helen started experiencing increased anxiety, lack of ability

to fall asleep, and daytime tiredness over the last three months. The symptoms have progressed over the last four weeks to increasing sadness, inappropriate guilt,

poor

appetite, and decreased energy levels. Helen is struggling to maintain her usual activities and is starting to feel that “life is not worth living,” but she has not had any

suicide ideation per se. Helen has no personal or family history of psychiatric illness. She uses alcohol once or twice a month but not to excess. Helen’s medical history

is significant for lower-extremity neuropathy of unknown origin.

Remember to answer these questions from your textbooks and clinical guidelines to create your evidence-based treatment plan.

At all times, explain your answers.

1. Summarize the clinical case.

2. What is the DSM5 diagnosis? Identify the rationale for your diagnosis using the DSM5 diagnostic criteria.

3. According to the clinical guidelines, which one pharmacological treatment is most appropriate to prescribe? Include the medication name, dose, frequency and

rationale for this treatment.

4. According to the clinical guidelines, which one non-pharmacological treatment would you prescribe? (exclude psychotherapy modalities)

benefits of the chosen rationale for this treatment.

5. Include an assessment of medication's appropriateness, cost, effectiveness, safety, and potential for patient adherence.

6. Use a local pharmacy to research the cost of the medication. Use great detail when answering questions 3-5.

Submission Instructions:

Your initial post formatted and cited in current APA style with support from at least

2 academic sources.Your initial post is worth 8 points.

You should respond to at least two of your peers by extending, refuting/correcting,

or adding additional nuance to their posts.Your reply posts are worth 2 points (1

point per response.)

All replies must be constructive and use literature where possible.

PSYCHOPATHOLOGY 3

Psychopathology

Summary of the clinical case

Hellen has been separated from her husband of 25 years for complete two months key

reason being due to his infidelity. In the due course, she began to experience growing feelings of

anxiety, a condition compounded by a lack of ability to fall asleep and daytime tiredness for the

last three months. Her situation advanced to increasing signs of sadness, feelings of inappropriate

guilt, and deprived appetite including reduced energy levels. Consequently, she has found it

rather difficult to uphold her normal activities.

What the DSM-5 diagnosis entails

i. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)

serves as the principal authority on which psychiatric diagnoses are based. Hence,

DSM classifications determine treatment recommendations including payment by the

health care providers (Doenges, Moorhouse & Murr, 2016).

ii. The rationale for diagnosis suing the DSM-5 diagnostic criteria (Gulanick & Myers,

2016)

PRIORITY PROBLEM RATIONALE

1 Disturbed thoughts The diagnosis of disturbed thought processes defines

an individual experiencing rather visibly altered

perception and cognition interfering with his/her daily

living.

The patient was unable to sustain her normal daily

activities as a consequence of the symptoms she

experienced.

She even admitted that she developed the feeling, “life

PSYCHOPATHOLOGY 4

is not worth living”.

2 Chronic low self-

esteem

The patient has also developed a sense of guilt and a

growing feeling of sadness.

Chronic low self-esteem is characterized by self-

negating expressions and recurring feel of

worthlessness.

3 Self-care deficit Evidently, the patient is increasingly struggling to

uphold her normal activities.

The ADLs or activities of daily living are

demonstrated as the things people accomplish on daily

basis like feeding themselves, bathing, dressing,

working, and relaxing among others.

In other cases, some people may find it difficult to

perform self-care i.e. activities one performs

individually in the course of his/her life in fostering

one's personal well-being.

Self-care deficit refers to the inability or failure of an

individual to carry out self-care.

4 Hopelessness The state of hopelessness is evidenced by a lack or the

loss of interest in life and sleep disorders including

negative thoughts, as demonstrated by the patient.

5 Risk of self-directed

violence

The patient has developed the feeling that life is not

worth living, a sensation that may progress to

harboring the thoughts of suicide and similar behavior.

One pharmacological treatment I would prescribe according to the clinical

guidelines and the rationale for the treatment option

The medication name that would be provided for Helen is that of prescribing to her some

antidepressant medications such as the selective serotonin reuptake inhibitors, i.e., SSRIs. It is

PSYCHOPATHOLOGY 5

important to note that the SSRIs are taken in tablet form whereby an individual will have to take

one to three tablets once a day. The moment of taking the tablets may be during the morning,

lunchtime, or in the evening but it should be once in a day. The same tablets will be taken for

around two weeks and may even be prolonged up to four weeks before the effects of the drugs or

these tablets may start being realized. The specific tablets that would be recommended to such a

patient are the 250mg of imipramine equivalents (50mg of fluoxetine). The other important thing

to consider is the cost of the above medication and which would go to around $62.50 for 30

tablets and this is the cost whenever a person does not have an insurance coverage. In case the

medication has an insurance coverage, then the price would be relatively lower. The notable side

effects of the above medication would be feeling agitated, anxious, and shaky as well as

experiencing indigestion. There is also an aspect of dizziness, blurred vision, losing appetite, and

losing weight.

Regarding the effectiveness of the above dosage, it is important to argue that they are

highly effective in fighting the menace. As an example, an individual would start feeling relieved

and relaxed after taking the medication and would start falling asleep after maybe two weeks of

using the medication and as time goes on, the person is likely to recover fully from the

depression. It is also important to note that the medication is among the most commonly utilized

drugs in managing depression and is typically a first-line form of treatment accompanied by

comprehensive talk therapy.

Antidepressants are basically medications with the ability to assist in relieving symptoms

of such conditions as depression, anxiety disorders (social anxiety disorder), dysthymia, seasonal

affective disorder, or mild chronic depression among others. These medications work by

correcting chemical imbalances of neurotransmitters within the brain and that are linked to

PSYCHOPATHOLOGY 6

influencing mood changes and behavior and the above aspects also adds to the effectiveness of

the prescribed medication.

One non-pharmacological treatment I would prescribe

The use of Cognitive Behavioral Therapy (CBT)

An increasingly recommended alternative to pharmacological treatment options,

psychotherapists train their patients on new skills that can greatly help them in taking full control

of their conditions by understanding and effectively managing related symptoms. Studies in the

area have demonstrated that the approach has almost similar modalities and mechanisms to the

use of antidepressant medications (Shatkin, 2018). Nevertheless, the method presents rather

unlimited benefits to the patients as it is considered to positively impact the patients long after

the treatment of an existing condition ends. The main objective of the approach is to assist

patients to change their rather negative and disproving behaviors that contribute to states of

anxiety and ultimately stress and depression and embrace more positive ways of thinking and

view of life.

An assessment of medication's appropriateness, cost, effectiveness, safety, and potential for

patient adherence

There is explicit and equally convincing evidence that indeed appropriate and sufficient

psychological interventions have the potential to effectively treat and manage a wide range of

both child and adult health problems and other relevant complications. Nonetheless,

psychological treatment options can prove highly reliable and cost-effective treatment options as

compared to conventional pharmacological treatment interventions. Besides, psychological

interventions present better opportunities for inducing significant overall health care cost

reductions in the sense that beneficiaries often end up dropping or rather abandoning the

PSYCHOPATHOLOGY 7

utilization of the majority of these traditional healthcare services. To some greater extent, the

overall reductions achieved in the health care systems may even prove more as compared to that

of psychological services.

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References

Boyd, A. (2008). Psychiatric nursing: Contemporary practice. Lippincott Williams & Wilkins.

Doenges, E., Moorhouse, F. & Murr, C. (2016). Nurse's pocket guide: Diagnoses, prioritized

interventions, and rationales. FA Davis.

Gulanick, M. & Myers, L. (2016). Nursing Care Plans: Diagnoses, Interventions, and Outcomes.

Elsevier Health Sciences.

Shatkin, J. (2018). Sleep hygiene and CBT for insomnia (CBT-I). Journal of the American

Academy of Child & Adolescent Psychiatry, 57(10): 21.

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Peer Posts With Responses:

Week 3 Discussion

Case Summary

Helen's husband had an affair after being married to her for 25 years. Since the divorce,

Helen started to feel more anxious, had trouble falling asleep, and was exhausted during the day

for at least three months. In addition, she complains of feeling less happy about life, unwarranted

guilt, poor appetite, and reduced energy levels. These symptoms make it impossible for Helen to

continue with her everyday activities.

DSM5 Diagnosis and Rationale

Helen could be diagnosed with major depressive disorder (MDD). According to the DSM5,

to meet these criteria, Helen must experience five or more of the following symptoms; depressed

mood, loss of interest or pleasure, weight loss/gain, insomnia or hypersomnia, psychomotor

agitation or retardation, fatigue, feeling worthless or excessive/inappropriate guilt, decreased

concentration, and thoughts of death/suicide (American Psychiatric Association [APA], 2022).

She complains of being unable to fall asleep, fatigue, depressed mood, thoughts of suicide, and

not eating well. She meets the criteria for MDD, and understandably so.

One Pharmacological Treatment to Prescribe

Comprehensive assessment and proper diagnosis are required for depression management

(Grover et al., 2017). Since the first day of our undergraduate programs, we have been taught

that assessment is an essential factor inInursingIcare. We must understand their diagnosis to

provide the patient with the proper medication. Many depressed patients will also exhibit anxiety

symptoms (Grover et al., 2017). In addition, with the growing severity of depression, patients

may exhibit psychotic symptoms and catatonic characteristics (Grover et al., 2017).

IIII Citalopram hydrobromide is a selective inhibitor of serotonin reuptake (SSRI). The FDA has

approved citalopram hydrobromide primarily for treating depression in adults (Shoa et al., 2021).

PSYCHOPATHOLOGY 10

Citalopram is offered in 10 mg, 20 mg, 40 mg oral tablets, and 10 mg/5 mL oral solution (Shoa

et al., 2021). Starting dose would be 20 mg daily, with or without food, without prejudice to the

time of day (Shoa et al., 2021). The maximum daily dose for persons older than 60 or with poor

CYP2C19 metabolizers is 20 mg (Shoa et al., 2021). You can increase the dose in those under 60

to the max daily dose of 40mg (Shoa et al., 2021). The reason to use an SSRI-type medication is

to increase serotonin levels and thus create a “happier” less depressed patient. However, it must

be noted that these can sometimes take 2-6 weeks before symptom improvement (Shoa et al.,

2021).

A Non-pharmacological Treatment for MDD

Antidepressants, electroconvulsive therapy (ECT), and psychosocial therapies make up most

of the treatment choices for depression management (Grover et al., 2017). ECT is a great way to

help treat depression and has been a successful treatment alongside medications. In psychiatric

clinical practice, electroconvulsive therapy (ECT) is a beneficial treatment modality (Singh &

Kar, 2017). In treating depressive episodes, manic episodes, and mixed episodes in bipolar

affective disorder, ECT offers superior mood-stabilizing properties than medication (Singh &

Kar, 2017). Typically, electroconvulsive therapy produces a speedier therapeutic response than

existing psychiatric medicines (Singh & Kar, 2017). I have seen this in the outpatient setting

where ECTs are performed. However, the downside to ECT is that it has been linked to loss of

memory formation and a decline in the short-term for learning new things (Porter et al., 2020).

Assessment of Medication's Appropriateness, Cost, Effectiveness, Safety,

and Potential for Patient Adherence

This medication is appropriate at her recommended daily dose because it has the potential to

increase her mood and depression. Having more serotonin available is well-documented to

improve mood and depression symptoms. It is safe for this patient as the risk of suicidality is

low. Patient adherence is better with this type of medication due to its lack of adverse side effects

(Porter et al., 2020). The local CVS states that the cost for a one-month supply of this

PSYCHOPATHOLOGY 11

medication, dosed at 20 mg daily, is $19.77. CVS also stated that taking the maximum dose of

40 mg daily is $22.07 for a one-month supply.

References

American Psychiatric Association. (2022).Diagnostic and statistical manual of mental

disorders, text revision dsm-5-trI(5th ed.). Amer Psychiatric Pub Inc.

Grover, S., Gautam, S., Jain, A., Gautam, M., & Vahia, V. (2017). Clinical practice guidelines

for the management of depression.Indian Journal of Psychiatry,I59(5),

34.Ihttps://doi.org/10.4103/0019-5545.196973 Links to an external site.

Porter, R. J., Baune, B. T., Morris, G., Hamilton, A., Bassett, D., Boyce, P., Hopwood, M. J.,

Mulder, R., Parker, G., Singh, A. B., Outhred, T., Das, P., & Malhi, G. S. (2020). Cognitive side-

effects of electroconvulsive therapy: What are they, how to monitor them and what to tell

patients.BJPsych Open,I6(3).Ihttps://doi.org/10.1192/bjo.2020.17 Links to an external

site.

Shoa, N. S., Fariba, K. A., & Padhy, R. K. (2021).

Citalopram.StatPearls.Ihttps://www.ncbi.nlm.nih.gov/books/NBK482222/ Links to an

external site.

Singh, A., & Kar, S. (2017). How electroconvulsive therapy works?: Understanding the

neurobiological mechanisms.Clinical Psychopharmacology and Neuroscience,I15(3), 210–

221.Ihttps://doi.org/10.9758/cpn.2017.15.3.210

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