Mental Health Disorders Research Essay

Mental Health Disorders Research Essay

Instructions/Descriptions

Mental Health Disorders Research Essay

Mental, Health, Disorders, Research, Essay

KT is a 24-year-old female who presents to her doctor’s office while on home during spring break. KT expresses that she has been worried about her personal, academic and professional life. She states she is constantly worried about passing her exams and that she’ll of her friends who gets engaged.

Anxiety is one of the most common mental health disorders that motivates individuals to seek help. Primary care providers often encounter those with GAD and should feel comfortable with recognizing common symptoms. Individuals with GAD often report feelings of excessive fear or worry that can be difficult to control. (Munir & Takov, 2021).

Other common symptoms patients may report include: restlessness, fatigue, poor concentration, irritability, muscle tension and trouble sleeping. (Chisholm-Burns, M. A., et al, 2019).  Individuals with GAD may also experience physical symptoms such as trembling or palpitations. (Stonerock, et al., 2016).

Onset usually occurs in early adulthood, and tends to persist throughout an individual’s life. Factors commonly linked to GAD include: female gender, single, poor health, low education and presence of stressors. (Munir & Takov, 2021). Depression and substance use can co-occur with GAD. Untreated or undertreated GAD can lead to poor quality of life, increased morbidity and mortality and improper hospital utilization.  (Chisholm-Burns, M. A., et al, 2019).

Immediate goals to treatment include: reducing severity and duration of anxiety. Other goals are to help the patient return to a healthy, well-balanced state.  When determining an appropriate treatment plan, providers should assess the patient’s symptom severity, comorbidities, medical status, age, access to care, cost and preference. (Chisholm-Burns, M. A., et al, 2019).

There are several ways in which an individual can improve and control their symptoms before progressing to medication management. Some nonpharmacologic interventions include: therapy, exercise and diet. Patients should be educated to stay away from stimulates such as caffeine or diet pills. Avoiding alcohol, substances and decongestants are other key factors to include during your discussion as these could potentially worsen symptoms. (Chisholm-Burns, M. A., et al, 2019).

Exercise should be encouraged as it has been shown to help improve symptoms. “Exercise may represent a promising, affordable, and easily accessible treatment option for individuals with anxiety.” (Stonerock, et al., 2016).  Therapy, such as CBT (cognitive behavioral therapy) has been proven to help patients change thinking habits and dysfunctional behavior. (Chisholm-Burns, M. A., et al, 2019).

In terms of medication management, I would assist KT with her GAD by starting on an antidepressant. Antidepressants, such as SSRI’s, have helped reduce anxiety and are the drug of choice for GAD. (Chisholm-Burns, M. A., et al, 2019).  Unlike benzodiazepines, there are no known addictive qualities about this class of medication and have tolerable side-effects for most. SSRIs are also commonly used in other disorders such as depression, panic, OCD and SAD. (Chisholm-Burns, M. A., et al, 2019).

However, it is reported that benzodiazepines are the most effective and widely prescribed medication for short-term management of GAD. (Chisholm-Burns, M. A., et al, 2019). Benzodiazepines can also aid with sleep or as an adjunct when initiating an antidepressant. However, this class of drugs is known to have the potential for misuse. Major side effects to taking benzos include: drowsiness, physical and mental impairment, sedation and amnesia.

Patients taking this class of drug may also experience confusion, irritability, aggression and excitement. Individuals could potentially develop withdrawal symptoms if they were to discontinue taking them suddenly. It is imperative to taper these agents when stopping as there is a risk of seizures associated with abrupt discontinuation. (Chisholm-Burns, M. A., et al, 2019).

In the second case study, 49-year-old WD presents for a follow-up with his physician a week after having an MI. WD met criteria for MDD. His PMH includes: treatment refractory hypertension, T2DM and severe uncontrolled narrow angle glaucoma.

MDD is common and often debilitating for some. “The term major, introduced in DSM-III, and unchanged in DSM-5, aims to distinguish clinical depressions with significant effects of functioning from milder cases that are not disabling.” (Paris, J., 2014). Individuals with MDD experience symptoms that affect their mood, thought process, physical health and relationships.

Signs and symptoms of MDD include: depressed mood, lack of interest or pleasure in activities, changes to appetite, weight and sleep habits. Individuals may also present with fatigue, loss of energy, feelings of worthlessness and difficulty concentrating. Patient’s reporting these symptoms should be taken seriously as undertreated or untreated MDD may lead to suicide attempts and/or suicide. (Chisholm-Burns, M. A., et al, 2019).

MDD tends to occur more often in women than men, and occurrences are known to peak around 20-years-old.  Much like GAD, MDD is also associated with anxiety and substance use disorders. (Chisholm-Burns, M. A., et al, 2019).  Although the exact cause of MDD is unknown, it is believed to be multifactorial. Genetic predisposition, psychological stressors and underlying pathophysiology are thought the be the culprits behind MDD.

Unfortunately, for WD, is it not uncommon for individuals to experience symptoms of MDD after sustaining a serious injury. Treatment goals for those with MDD include managing symptoms and the prevention of suicide.

Individuals with MDD are encouraged to participate in therapy, however, a combination between therapy and medication management is often recommended. ECT, or electroconvulsive therapy, is a more unconventional form of treatment that can be offered to those as an alternative therapy. Generally, individuals who are considered appropriate for this form of treatment have failed other interventions. (Chisholm-Burns, M. A., et al, 2019).

SSRIs, MAOIs and TCAs are different forms of pharmacologic therapy that can be prescribed to those with suffering with MDD. St. John’s wort, an herbal medication, has shown to help reduce symptoms in those with mild to moderate depression. However, this form of treatment is not FDA approved. (Chisholm-Burns, M. A., et al, 2019).

Discussing potential side effect, such as sexual dysfunction, should be a part of patient education and discussion since this could lead to nonadherence. When selecting an appropriate form of treatment, providers should use the algorithm based on the American Psychiatric Association Practice Guideline for the Treatment of Patients with Major Depressive Disorder. (Chisholm-Burns, M. A., et al, 2019). Caution should be used if or when the patient is ready to discontinue use, as they may relapse in to a depressive state.

JM, a 42-year-old female, presents for management of her insomnia. JM admits to having a dysregulated sleep schedule as she tends to sleep all day on Sunday’s. She also admits to being in an abusive relationship and experiences depression. JM is currently unemployed, drinks 6-8 cups of coffee a day and does not pay attention to her eating or exercise habits. JM is currently on Restoril 30mg HS.

Insomnia, can be defined as difficulty initiating sleep, maintaining sleep or frequent awakenings. (Chisholm-Burns, M. A., et al, 2019).  Diagnostic criteria states to be an individual must experience these symptoms for at least 3 months. Insomnia is often associated with other mental health disorders and/or stressors. It is reported that once the stressor is removed, patients generally experience improved quality of sleep. Other factors that may cause insomnia include: pain, medication, stimulants, GERD, thyroid abnormalities and asthma. (Chisholm-Burns, M. A., et al, 2019).

In the case of JM, she has a few things that would inhibit her to have a restful night’s sleep. Patient education is imperative in JM’s case as she could benefit from proper sleep hygiene. Education should include: keeping a regular schedule, frequent exercise, avoiding alcohol or stimulants in the late afternoon/early evening, maintaining a comfortable sleeping environment, avoiding large meals before bed and daytime naps.

Other key factors to touch on when educating JM include: only going to bed when she is tired, using the bed for sleep or intimacy only, no watching TV or eating or reading in bed.  JM could also benefit from relaxation techniques such as muscle relaxation, mediation, biofeedback or imagery. (Chisholm-Burns, M. A., et al, 2019).

Pharmacologic interventions include the use of Benzodiazepines, sedating antidepressants, and melatonin. Since JM is currently on a medication to help her with sleeping, (the dose was also recently increased), I would encourage JM to try the nonpharmacologic interventions before considering changing her medication. Ideally, JM would benefit from leaving her abusive relationship and could potentially use therapy to help her cope with her situation and depression.

References

Chisholm-Burns, M. A., Schwinghammer, T. L., Malone, P. M., Kolesar, J. M., Lee, K. C., Bookstaver, P.B. (2019). Pharmacotherapy: Principles and practices (5th ed.).  McGraw-Hill Education. ISBN 978-1-260-01944-5

Munir, S., Takov, V. (2021). Generalized Anxiety Disorder. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK441870/

Paris, J. (2014). The Mistreatment of Major Depression Disorder. Can J Psychiatry. 59(3). 148-151. doi: 10.1177/070674371405900306

Stonerock, G., Hoffman, B., Smith, P., Blumethal, J. (2016). Exercise as Treatment for Anxiety: Systematic Reivew and Analysis. Ann Behav Med. 49(4). 542-556. doi: 10.1007/s12160-014-9685-9

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