Assignment: Practicum – Week 6 Journal Entry
Assignment: Practicum – Week 6 Journal Entry
Assignment: Practicum – Week 6 Journal Entry
The purpose of this paper is to develop a diagnosis for the patient receiving psychotherapy, evaluating therapeutic approaches for the patient and finally analyzing the legal and ethical implications of counseling the patient. The treatment plan will utilize the DSM-5 diagnostic criteria.
Demographics
The patient is a 59 years old white male who is currently unemployed. He is also divorced and was recently evicted from the halfway house that he was living in, which forced him to get to the streets.
Presenting Problems
CC: The patient stated, “I have been up for 3 days, I can’t function, I’m really bad this time.”
History of Present Illness
The patient is a 59 years old white male who presented as a walk in, voluntary admission, claiming that he is suicidal with a plan to jump in front of a car. He has been unable to sleep and walking for the past 3 days. He claims that he came to the hospital because he wants things figured out. He relapsed from crack cocaine 3 days ago and then evicted from the halfway house that he was living in, which led him to the streets. He also claims to have argued with his sister, who stated that she will no longer support him. He denies any psychosis, but he seems to have paranoid thoughts, thinking that he is constantly going to die, or something is going to harm him. Upon examination, the patient is withdrawn to his room. He claims to be in pain. He states that he cannot continue keeping his eyes open as he needs to sleep. He is, however, unable to give much of his history. He claims to have been taking Cymbalta and Latuda and gabapentin and trazodone before, which were effective, and as such, he wants to start taking them again. He needs to be hospitalized for safety and stabilization, following his suicidal thoughts, with a plan. He has not been able to sleep for the past 3 days. He was homes after being evicted and lost family support which made him relapse on crack cocaine.
Past Psychiatric History
The patient was in Behavioral Hospital of Bellaire in May 2018. However, he has no current therapist or psychiatrist. He is not able to provide a comprehensive medical history but claims to have been compliant to the medications that he has been taking which include trazodone, Cymbalta, Latuda, simvastatin, gabapentin, and hydroxyzine, as per the doctor’s prescription. Before trying to commit suicide, the patient attempted to overdose on pills in the past in addition to hanging himself twice. He has to several hospitals due to his unstable state.
History of Drug Abuse
The patient has been smoking crack worth $500 a day. He also drinks beer, claiming that he only takes one bottle at a time.
Medical History
The patient has a medical history of neuropathy, hyperlipidemia and chronic obstructive pulmonary disease (COPD). He, however, has no known drug or food allergies. He has been taking hydroxyzine for the management of generalized anxiety disorder, Latuda 80mg once a day at bedtime for a mood disorder, Gabapentin 600 mg three times a day for neuropathy, Trazodone 150 at bedtime to manage insomnia, Cymbalta 60 mg once daily, and Simvastatin 40mg every night for cholesterol.
DSM-5 Diagnosis
The patient is diagnosed with bipolar disorder, most recent episodes of depression, severe without psychosis and cocaine use disorder, severe. According to the DSM-5 diagnostic criteria, a patient is diagnosed with bipolar disorder, with most recent episodes of depression, and severe without psychosis when he experiences five or more of the following symptoms during the same period of 2 weeks and at least one of the symptoms should be either depressed mood or loss of interest or pleasures; depressed mood most of the day, diminished interest and pleasure in almost all daily activities, significant weight loss, slowing down of thought, fatigue, feeling worthless, diminished ability to think and recurrent thoughts of death or suicidal thoughts (American Psychiatric Association, 2017). The patient meets the criteria for this diagnosis. Consequently, the patient relapsed on cocaine use, was admitted to a rehabilitation center and reported taking too much cocaine every day. According to the DSM-5, a patient who displays 6 or more of the above symptoms has a severe disorder, just like the patient in the above case scenario.
Individualized Plan
The care plan for this patient will include both pharmacological and non-pharmacological approaches. He will first need to be admitted to the acute psychiatry unit where he will be guarded, given his capabilities to cause harm to himself and even others. The patient will then be restarted on Latuda 80 mg oral tablets once a day for the management of mood disorder, Cymbalta 60mg delayed release capsules once a day for the management of major depressive disorder and recurrent severe without psychotic features, Trazodone 150mg at bedtime for management of insomnia, gabapentin 600mg three times a day for the management of neuropathy, and Atarax for long term management of anxiety disorder (Stahl, 2018). He claims to have been stable with these drugs and hence positive desirable outcome is expected. His old records will also be reviewed together with lab findings before the patient is discharged. He will have to return to the clinic after 4 weeks for further evaluation and assessment. Motivational interview is also recommended for effective recovery of the patient, and to avoid relapse.
Motivational Interview
Motivational interviewing will help the client build motivation for both cognitive behavioral therapy and medicinal therapy. Motivational interviewing is aimed at resolving ambivalence towards recovery. Patients addicted to substance abuse usually hurt themselves, and as such, a part of them usually wants to quit while another part may simultaneously want to keep on using the drug. Hence motivational interview will help such patients to quit substance abuse and enhance recovery with minimal chances of relapse. The National Institute on Drug Abuse and The Substance Abuse and Mental Health Service Administration recognize motivational interviewing as an enhancement therapy for effective treatment of substance use disorder (Madson, Schumacher, Baer, & Martino, 2016). Consequently, motivated clients have proven to be more likely to buy into the rehab process and maximumly benefit from other therapies.
Legal and Ethical Implications of Counseling
Taking care of patients with mental disorders is usually accompanied by several legal and ethical implications. For instance, the current healthcare system protocols require that the care provided be patient-centered. As such, the patient plays a significant role in determining the best care that they feel are best for them, even when the physician disagrees. The patient is entitled to all the relevant information about the available treatment options, from their dosing and frequency to their benefits and side effect. The informed consent form also requires that the physician only shares information about the patient’s condition with his approval. However, in instances where the patient is not of sound mind or may cause harm to himself or others, the physician can then share the information with the concerned family members so that the patient can be watched to avoid any harm (Conway, & O’Connor, 2016). Lastly, the nurse is required to observe and respect the patient’s cultural beliefs when administering care to promote the patient’s health and boosts their trust in medicinal therapy.
Time Log
List the objective(s) met and briefly describe the activities you completed during each time period. If you are not on-site for a specific week, enter “Not on site” for that week in the Total Hours for This Time Frame column. Journal entries are due in Weeks 4, 8, and 11; include your Time Log with all hours logged (for current and previous weeks) each time you submit a journal entry.
You are encouraged to complete your practicum hours on a regular schedule, so you will complete the required hours by the END of WEEK 11.
| Time Log | ||||||
| Week
|
Dates | Times
|
Total Hours for This Time Frame |
Activities/Comments | Learning Objective(s) Addressed | |
| 6 | 2 | Co-counseling sessions, independent counseling sessions, working on the treatment plan. | Cognitive behavioral therapy techniques and motivational interviewing techniques. | |||
| 6 | 2 | Co-counseling sessions, independent counseling sessions, modification of the treatment plan. | Cognitive behavioral therapy techniques, motivational interviewing techniques, and evaluation of the treatment outcome. | |||
| Total Hours Completed: 4 |
References
American Psychiatric Association. (2017). Diagnostic and statistical manual of mental disorders: DSM-5. Arlington, VA: American Psychiatric Association.
Conway, M., & O’Connor, D. (January 01, 2016). Social Media, Big Data, and Mental Health: Current Advances and Ethical Implications. Current Opinion in Psychology, 9, 77-82.
Madson, M. B., Schumacher, J. A., Baer, J. S., & Martino, S. (June 01, 2016). Motivational Interviewing for Substance Use: Mapping Out the Next Generation of Research. Journal of Substance Abuse Treatment, 65, 1-5.
Stahl, Stephen. (2018). Prescribers Guide: Antipsychotics. stahl’s essential psychopharmacology. Place of publication not identified: CAMBRIDGE University PR.