Psychotherapy With Older Adults
According to the Institute of Medicine, more than 20% of the growing older adult population has a mental health disorder (IOM, 2012). In the past, many older adults avoided psychotherapy because of the associated social stigma, but with the growing acceptance of therapy and awareness of mental health issues, more of this population is seeking the help they need. In your role, as the psychiatric mental health nurse practitioner, you have the opportunity to help these older adult clients overcome challenges that may have plagued them for a lifetime.
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This week, as you explore psychotherapy with older adults, you assess clients and consider the appropriateness of various therapeutic approaches. NURS 6640: Psychotherapy with Individuals – Week 10: Case Study
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.
Chapter 18, “Psychotherapy With Older Adults” (pp. 625–660)
Chapter 20, “Termination and Outcome Evaluation” (pp. 693–712)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
McGuire, J. (2009). Ethical considerations when working with older adults in psychology. Ethics & Behavior, 19(2), 112–128. doi:10.1080/10508420902772702
Swift, J. K., & Greenberg, R. P. (2015). What is premature termination, and why does it occur? In Premature termination in psychotherapy: Strategies for engaging clients and improving outcomes (pp. 11–31). Washington, DC: American Psychological Association. doi:10.1037/14469-002
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. NURS 6640: Psychotherapy with Individuals – Week 10: Case Study
Assess clients presenting with depression
Analyze therapeutic approaches for treating clients presenting with depression
Evaluate outcomes for clients presenting with depression
Review this week’s Learning Resources and reflect on the insights they provide.
Review the Week 10: Case Study from this week’s Learning Resources Below:
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NURS 6640: 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. NURS 6640: Psychotherapy with Individuals – Week 10: Case Study
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. NURS 6640: Psychotherapy with Individuals – Week 10: Case Study.
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.
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.
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. NURS 6640: Psychotherapy with Individuals – Week 10: Case Study
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?
What standard guidelines would you use to treat or assess this patient?
Clinical Note: Is depression a normal part of aging?
Support your approach with evidence-based literature. NURS 6640: Psychotherapy with Individuals – Week 10: Case Study
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