Discussion: Therapy with Older Adults

 Clients who are older have often times been dealing with their mental health disorder their entire lives, whiles other disorders may be brought on through the aging process or the trauma of losing a lifelong partner. Treatment can be challenging for both the client and the therapist. For this Discussion, you will focus on therapeutic approaches for an older adult presented in a case study. 

 Please note that the ICD 10 coding system is what in use to relay a patient’s diagnosis. Also, please make an effort to find the latest best practice peer reviewed guidelines when discussing the care of the patient below which will help you do well in this assignment. Also , please use the section as headings so I do not go looking for the answer to each item below. Please read the directions below for the assignment: 

 

Post a treatment plan for the older adult client in the Week 10: Case Study found in this week’s Learning Resources. Be sure to address the following in your post:

• Which diagnosis should be considered?
• What is the DSM-V Coding for the diagnosis you are considering?
• What is your rationale for the diagnosis? Be sure and link the client’s signs and symptoms to the DSM-V diagnostic criteria to support your diagnosis.
• What tests or tools should be considered to help identify the correct diagnosis?
• What differential diagnosis should be considered?
• What Treatment Strategy would you recommend?
• What treatment would you prescribe and what is the rationale?
• Safety
• Psychopharmacology
• Diagnostic Tests
• Psychotherapy
• Psychoeducation
• What standard guidelines would you use to treat or assess this patient?
• Clinical Note: Is depression a normal part of aging?

Use from 3 and up references.

Support your approach with evidence-based literature.

Rubric:

 

Quality of Work Submitted: The extent of which work meets the assignned criteria and work reflects graduate level critical and analytic thinking.–

Satisfactory 26 (26%) – 30 (30%)Unsatisfactory 0 (0%) – 25 (25%)

Quality of Work Submitted: The purpose of the paper is clear.–

Satisfactory 4 (4%) – 5 (5%)Unsatisfactory 0 (0%) – 3 (3%)

Assimilation and Synthesis of Ideas: The extent to which the work reflects the student’s ability to:
Understand and interpret the assignment’s key concepts.–

Satisfactory 8 (8%) – 10 (10%)Unsatisfactory 0 (0%) – 7 (7%)

Assimilation and Synthesis of Ideas: The extent to which the work reflects the student’s ability to:
Apply and integrate material in course rsources (i.e. video, required readings, and textook) and credible outside resources.–

Satisfactory 16 (16%) – 20 (20%)Unsatisfactory 0 (0%) – 15 (15%)

Assimilation and Synthesis of Ideas: The extent to which the work reflects the student’s ability to:
Synthesize (combines various components or different ideas into a new whole) material in course resources (i.e. video, required readings, textbook) and outside, credible resources by comparing different points of view and highlighting similarities, differences, and connections.–

Satisfactory 16 (16%) – 20 (20%)Unsatisfactory 0 (0%) – 15 (15%)

Written Expression and Formatting
Paragraph and Sentence Structure: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are clearly structured and carefully focused–neither long and rambling nor short and lacking substance.–

Satisfactory 4 (4%) – 5 (5%)Unsatisfactory 0 (0%) – 3 (3%)

“Written Expression and Formatting
English writing standards: Correct grammar, mechanics, and proper punctuation”–

Satisfactory 3 (3%) – 5 (5%)Unsatisfactory 0 (0%) – 2 (2%)

“Written Expression and Formatting
The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.”–

Satisfactory 3 (3%) – 5 (5%)Unsatisfactory 0 (0%) – 2 (2%) 

NURS6640: Psychotherapy with Individuals

Week 10: Case Study

IDENTIFICATION: The patient is a 69-year-old, widowed African American male who is the father of one adult child and grandfather of six grandchildren. The patient is self-referred to a psychiatric outpatient clinic.

CHIEF COMPLAINT: “I need help with depression and anxiety.

HISTORY OF CHIEF COMPLAINT: The patient reports that his father is dying, and he has been experiencing worsening of depression and anxiety symptoms over the past few months. He is seeking a psychiatric evaluation at his son’s advice. The patient does not enjoy being with his family.

He has difficulty falling asleep, but then spends the day lying on the couch and reports feeling like he is “moving in slow motion.” He reports feeling tired all the time. He has also stopped going to his volunteer job at the nursing home.

He responded to the practitioner’s question of “why depressed now?” by saying that with the imminent death of his father, he is losing his main support. In addition to his father’s illness, the patient was diagnosed and treated for prostate cancer this year. He received psychotherapy at that time which focused on his anxiety about the diagnosis, his denial of its severity, his wish to “not know what he knew,” and, ultimately, end-of-life issues.

PAST PSYCHIATRIC HISTORY: The patient was never hospitalized for psychiatric reasons. He has no history of suicidal thoughts, gestures, or attempts. The patient described either a partial or negative response from several medications he had been prescribed from his primary care provider (PCP) over the course of a several years, including Effexor, Prozac, Zoloft Lexapro and Duloxetine.

He is currently prescribed Lorazeapm 1 mg BID by his PCP which he has been taking for several years.

MEDICAL HISTORY: GERD, HTN and hyperlipidemia. History of prostate cancer.

HISTORY OF DRUG OR ALCOHOL ABUSE: The patient denies history of drug and alcohol abuse.

FAMILY PSYCHIATRIC HISTORY: Patient reports that his mother had depression. He is an only child and does not recall any emotional difficulties in grandparents or other relatives.

Personal History

Perinatal: No known perinatal complications.

TRAUMA/ABUSE HISTORY: Denies

Mental Status Examination

Appearance: Well-groomed, appropriately dressed, older Gentleman who is obese

Behavior and psychomotor activity: Good eye contact, pleasant, cooperative. Slightly unsteady gait uses walker.

Consciousness: Alert and able to answer all questions appropriately.

Orientation: Oriented to person, place, time, and situation.

Memory: Intact. Good recent and remote memory.

Concentration and attention: Appears to have good concentration during the interview but reports that he has recently had trouble concentrating while reading.

Visuospatial ability: Not formally assessed.

Abstract thought: Within normal limits, appropriate use of metaphors.

Intellectual functioning: Patient has Masters degree

Speech and language: Normal rate and rhythm.

Perceptions: No abnormalities present.

Thought processes: Goal directed, but evidence of guilt and rumination consistent with depressive symptomatology.

Thought content: Patient is highly anxious and expresses thoughts of sadness, frustration. He is preoccupied with thoughts about the anticipated loss of his father.

Mood: Depressed and anxious.

Affect: Congruent with mood.

Impulse control: Good.

Judgment/insight/reliability: Good.

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