Feizma Case Studies

There are different therapies that are used to help treat those who have suicidal ideation, behaviors, and attempts. For individuals to be successful in recovery one or more treatments may be necessary. Succession of recovery is a group effort and wiliness between individuals, family, friends, psychiatrists, and therapists. A traditional anti-depressive medication treatment is started to help reduce negative thoughts (Rovick, 2016). These medications increase serotonin levels in the brain to increase happier thoughts. However; depending on the individual, multiple medications are prescribed to target each symptom displayed. In some cases mood stabilizers or anti-psychotics are needed in correlation with the anti-depressants. Individuals with depression and PTSD are prescribed a SSRI and a medication to target the PTSD. Medications do not work quickly, the average time for depressive

Overall, there is an agreement that patients with minor depressive symptoms should be prescribed a form of psychotherapy. Cognitive behavioral therapy is shown to be favorable over the other types of psychotherapies for depression treatment. However, some bias may exist due to cognitive behavioral therapy being the most studied form of psychotherapy. The evidence shows that cognitive behavioral therapy should be prescribed as a first line treatment. However, the large number of antidepressants prescribed by primary providers demonstrates a disconnect between evidence and practice. After reviewing the most up to date literature and APA guidelines (2013) the consensus is that psychotherapy should be prescribed for outpatients with minor depressive symptoms. Sufficient evidence suggests that cognitive behavioral therapy should be prescribed for all patients with minor depressive symptoms.

Jann States that sufferers of BPD are three times more likely to suffer a depressive episode than a manic or hypomanic episode. (Jann, 2014) The Joanna Briggs institute Identified that the suicide rate for bipolar suffers are 15 times higher than that of non-affected individuals of the same age and sex. Eighty percent of these suicides occur during a depressive episode. (Hung Chu, 2016). Therefore appropriate pharmacological therapy not only during the maintenance period to reduce reoccurrence but also during these acute episodes is highly important. Pharmaceutical treatment includes the use of medication such as mood stabilizers, anti-psychotics and anti-depressants. The Joanna Briggs institute recommends that combination therapy involving both mood stabilizers such as Sodium valproate or lithium valproate and antipsychotics risperidone, olanzapine, quetiapine and haloperidol is best to treat acute mania associated with Bipolar. As it increases adherence to medication regime. (Tufanaru, 2016) The same institute encourages the use Olanzapine as a monotherapy or in combination with fluoxetine in the treatment of Depression associated with Bipolar disorder. (Hung chu, 2016) Lithium continues to be the first line mood stabilizer under current guidelines but may be used in conjunction with Carbamazepine where depression is evident. (Hung chu, 2016) The Australian and New Zealand Journal of Psychiatry 2015 also shows preference for combination therapy

Gloaguen (1998) used meta-analysis to compare the use of CBT and behavioural therapy in treating patients with depression. The study was controlled for using waiting list and placebo controls. CBT was found to be superior when compared to the controls, and also when compared to behavioural therapy, although most of the behavioural therapy trials analysed were uncontrolled. This aside, when compared to control groups CBT does have an advantage over no treatment, which is evidence of the concept that it is better than nothing for individuals suffering from depression as it can improve their quality of life. A recent trial (DeRubeis et al., 2005) found antidepressants (serotonin reuptake inhibitors) to be equally as effective in the treatment of individuals with moderate to severe as CBT. Although both treatments can be seen as equally effective, the use of CBT does not require people to ingest drugs, so if both are equally as effective the CBT would be the clear choice for individuals with depression. The evidence for the area of depression and the usefulness of CBT is mixed, in spite of this, it 's merits are clearly obvious.

Mood stabilizers are usually the first line of defense. Lithium treats both manic and depressive episodes. It usually takes about 7 to 14 days for therapeutic levels to be reached. The nurse should monitor for lithium toxicity which would include signs such as slurred speech, muscle weakness, gastrointestinal upset, sedation, and mental confusion. Anticonvulsants such as valproic acid and divalproex sodium are now commonly used as mood stabilizers as well. Atypical antipsychotics and antidepressants may be used in treatment as well. Antidepressants should be used cautiously as they increase the risk of mania or hypomania occurring (Halter, 2014, p.240). A concern associated with antidepressants and anticonvulsants is the increase in occurrences of suicidal thoughts, and the presence of unusual behaviors (National Institute of Mental Health, 2012). In recent pharmacological studies the anticonvulsant valproic acid and atypical antipsychotic quetiapine showed that, in patients with this particular dual diagnosis, alcohol consumption was significantly reduced while on these medications (Farren, Hill, & Weiss,

With any medication prescribed it is the duty of the prescriber an any mental health professional working directly with that client to provide them with as much psychoeducation as possible. It is vital that the client understands the benefits and risks of the medication. FUrthermore, it is vital for the client to understand that the client must be willing to commit to the process of finding the correct cocktail if you will.

Treatments vary depending on the type and severity of symptoms, and whether the disorder is depressive-type or bipolar-type ".While in PPBHC facility J.M.B was given Depakote ER 100 mg twice daily which is an anticonvulsant and first line treatment for acute mania. Seroquel XR 300 mg P.O at bedtime which was increased to Seroquel 400 mg P.O. at bedtime and Seroquel 200 mg P.O one per day in am to be discontinued in one month. Thorazine 100 mg P.O. / IM every 6 hours for psychosis. J.M.B. was also getting Ativan 4 mg P.O every 8 hours, Lorazepam 4 mg P.O. / IM every 6 hours as needed for agitation and Benadryl 100 mg P.O. / IM every 6 hours which is an anticholinergic agent used to treat extrapyramidal side effects. Along with medical management to treat schizoaffective disorder there is also group therapy, psychotherapy and electroconvulsive therapy (ECT) which is used to subdue severe manic behavior (Varcarolis & Halter (2010). More importantly, group therapy was ordered as part of J.M.B plan of

Treatments using anti-depressants is well documented, but there are very few studies documenting only the use of psychotherapy. However, in one study done using the Cognitive–behavioral analysis system of psychotherapy (CBASP) as a maintenance treatment, the overall findings show that psychotherapy in itself can be successful. “ There were 82 patients who were treated with CBASP long term. Patients were chosen at random to reduce their treatment to monthly or to an observational status. The patients, only treated monthly with CBASP, showed a smaller amount of reoccurring symptoms then the patients in the observational status. These findings support the use of only CBASP as a maintenance treatment for depression.” (Klein, 2004)

In some instances, antidepressants have been found to be more effective among depressed patients with suicidal ideation at baseline. The medication involved a combination of sustained-release bupropion and escitalopram to reduce the suicidal ideation than sustained-release venlafaxine plus mirtazapine. In patients with mild to moderate depression, the antidepressant medication had

Time magazine called them the military’s secret weapon (Thompson). Many pets eat them every day (Horowitz). They are effective in treating the most common male sexual disorder (Yue). Antidepressants have many uses, but they are primarily used in the treatment of mental health disorders. Their discovery was monumental for the science of psychiatry. Antidepressants are the primary treatment for a myriad of mental health disorders. However, many scientists, clinicians and patients question the effectiveness of antidepressants for this broad scope. Examination of effectiveness, side effects and alternative treatments suggest reduction in the scope of antidepressant use for mental health disorders.

A case report showed Dextromethorphan was effective in a middle-aged man with Major Depressive Disorder. A 51-year–old Caucasian male with DSM-V Major Depressive Disorder, recurrent, severe, non-psychotic and Generalized Anxiety Disorder was treated with 600 mg/day of CYP2D6 inhibitor bupropion XL (a common antidepressant drug) and a 60 mg BID oral dose of Dextromethorphan. The patient showed improvement in major depressive disorder without side effects. This case study was the first to show the fast acting effect of Dextromethorphan in major depressive disorder in humans. This adds to the building literature on the antidepressant effects observed in Dextromethorphan. The report suggested the administration of other common antidepressants with Dextromethorphan, such as lithium might prolong the duration of the rapid-antidepressant effect [19].

These include Cognitive-Behavioral Therapy and/or psychotherapy to transform negative thinking into more productive and positive thinking, and medications to lower symptoms of anxiety and other co-occurring disorders. Medications for anxiety include Xanax, Klonopin, Ativan, etc.; however, in Leon’s case, medications can be introduced, though, it should be taken into consideration that he has not experienced a panic attack or unexpected anxiety, so to provide medications solely for anxiety should be researched further in this case. As for his depression, medications can be prescribed to manage his depressive symptoms (Zoloft, Prozac, Celexa, etc.) to help with his progress and increase levels of energy to maintain this progression. Also, there are options outside of outpatient treatment that can be greatly beneficial for the individual experiencing anxiety and this includes activities such as exercise (which has been proven to be quite effective in helping anxiety and depression), mediation, and a change in

Dr. Rhae Laps, a family practice physician, reports that in cases of depression she generally prescribes antidepressants as a first order intervention. She reports that it is quite often that even after responding well to antidepressants, her patients experience recurrence of their depressive symptoms. Dr. Laps would like our consultation on whether other treatment options would help protect her patients from relapse, and what factors may predict relapse.

As the literature remains inconclusive as to the relation between current major treatment modalities and depressive disorder, and given the extremities of the potential dangers of antidepressant medications, it is apparent that there is a need to develop new interventions, which show greater efficacy, safety, and acceptability.

Strengths of individual approach are CBT is comparably effective as drugs for depressive patients. The study that supports this statement is Elkin et al. (1989). It involves 280 depressive patients with 28 clinicians and randomly assigned them into treatment groups that applies IPT, CBT, antidepressant drugs and control group (placebo and normal therapy management). It ran for 16 weeks and psychologists check them at the beginning of the study, after 6 weeks, and after 18 months. The result shows that over 50% of patients in CBT and drug group alleviate depressive symptoms, while control group has 29% of recovered patients. This study supports that CBT and IPT, which are individual approach, are equally effective as using antidepressant drugs. Furthermore, applying CBT with medication is very beneficial in preventing recurrence. This supported by Riggs et al. (2007). The study aims to investigate effectiveness of CBT in combination with either a placebo or an SSRI. It used 126 adolescents aged between 13 and 19 years old with depressive behaviors. They are randomly distributed into 2 groups, which are ‘CBT with placebo’ and ‘CBT with SSRI’ group. ‘CBT with placebo’ group shows 67% of patients on parts that ‘very much improved’ or ‘much improved’. ‘CBT with SSRI group’ shows 76% of patients on same parts. This study supports that CBT with drugs show better outcome than only using