Group therapy Journal entry assignment
The journal entry is comprised of data from two patients at a certain psychiatric session review of different family back grounds and ages. Their ages and all relevant information pertaining to their care are well highlighted with the focus being on the application of group therapy in their management.
Demographics of client 1
Kate is a 18yr old college student undertaking art and literature in one of the colleges in America. She is a born and raised American in New York who also is involved in part time paint work that helps her raise tuition fee for study. She has called off two semesters due to mental disturbances and hence resulted to visiting the psych unit.
Chief complain
She visited the hospital due to feelings of nervousness, restlessness, insomnia, and irritability. Due to such physiological changes she has recently been feeling often tired even while performing her daily duties. She is easily agitated. She is always worried about her life and studies. She can no longer sit and concentrate in class as a result. Every time she experiences a difficult situation she feels fear and becomes unable even to handle uncertainty.
History of presenting illness
The symptoms started about 6months ago and she thought that it was something minor. They started as mild anxiety and overreactions that caused her to use depressants to try and curb the feelings. However, they have now interfered with her way of performing daily functions. She can no longer continue her studies or painting. She is unable to rest peacefully unless when she takes benzodiazepines such as diazepam to calm her down. Her parents are very worried as no one among them has ever experienced that before.
Past psychiatric history
She is the only one diagnosed with such symptoms among her whole family with two brothers and a sister. The mother however, explains that she noted some form of disturbance in her mother while she was very young and not completely recalling what happened. She explained that after several consultations and hospital reviews there was reduced chaos and fights in the house. She relates that to what Kate is going through. Kate was diagnosed with generalized anxiety disorder.
Past medical history
She has never been admitted in a hospital though she is currently on some over the counter medications for relaxation. She has no known allergy to any medicine or food. She has never undergone any surgical operation and she underwent all her medical immunizations in childhood.
History of substance abuse
She used to take alcoholic beverages occasionally but has since then ceased due to the development of the illness. She has never smoked tobacco or marijuana in her life.
DSM-V Diagnosis
Generalized anxiety disorder is one of the most misdiagnosed mental health disorders due to its close symptoms with other mental diseases. It is commonly confused due to most doctors and physicians only associating it with anxiety and when the patient presents without one it becomes challenging to diagnose (Lader 2015). Based on the fifth edition of the diagnostic and statistical manual of mental disorders (DSM-V), there are key symptoms to watch out for in generalized anxiety disorder. The first step of diagnosis is to assess for excess worry associated with other physical symptoms, and then after confirmation there is ruling out of other mental disorders. To rule out any other mental condition there should be excessive worry and anxiety for at least six months, the symptoms of worry should be challenging to regulate and usually shifting from one topic to the other even in adults, the anxiety should be accompanied by at least three of the following physical symptoms: fatigue, irritability, increased muscle weakness, insomnia, restlessness, and impaired concentration (Stein & Sareen 2015).
Demographics for client 2
Sam is a 18yr old American who has worked as an accountant in one of the banks in Virginia for approximately 7yrs. He has been working there until three months ago when he was given a medical leave due to escalation in some behaviour that was considered inappropriate at work.
Chief complain
He was brought in the company of the fiancee who explained that Sam is no longer expressive, always moody at home, he is never interested in anything, does not eat which has led to his reduced weight, is no longer interested in going to work as before and if he goes, never takes time to dress neatly. She explained that it is long since she saw him happy as mostly he is thinking and disoriented. Additionally, he never sleeps at night.
History of present illness
Christine her fiance, explains that she started receiving calls from the boyfriend’s manager asking why he was late for work or why he never changed his dressing. At first she never considered that great of a deal until when Sam was given compulsory leave. That forced her to seek services from a nearby clinic. After three weeks of management without change she took the initiative of coming to the facility. Sam was diagnosed to suffer from major depressive disorder.
Past psychiatric history
Sam is the only person that has been affected by such symptoms in their family. There is no one else who has experienced such even as his parents confirmed.
Medical history
Sam has no known history of chronic illness. He has never undergone any surgical operation. No known food or drugs allergies. His mother is however hypertensive since the age of 47yrs but has been well managed to date.
History of substance abuse
He occasionally takes alcoholic beverage and scotch whiskey.
DSM-V Diagnosis
According to the DSM-V manual for diagnosing mental illnesses, the criterion for major depressive disorder is that the patient must experience two or more symptoms within two weeks period of either depressed mood or loss of pleasure and interest (Otte et al.,2016). For general symptoms, the patient should present with at least five of the following symptoms; loss of appetite or significant loss of weight, sleep disturbances such as insomnia or hypersomnia, feelings of unworthiness and suicidal ideations, they should show decreased ability to think or concentrate, increased agitation, and retardation. The symptoms should then cause a disruption in occupational or other daily functioning activities (Schmaal et al.,2016). Additionally, there should be significant impairment in social functions and distress as well.
Cognitive behavioural therapy
The cognitive behavioural therapy (CBT) is a form of psychotherapy for the management of mental health disorders through promotion of happiness and modifying some of the patient’s dysfunctional behaviors, thoughts, and their emotions (Robichaud et al.,2019). Unlike the traditional methods of treatment that focus on poking childhood memories, CBT focuses on solution finding by encouraging the patients to fight their distorted abilities and change some of their unwanted behaviors. All mental problems cause distress that relates to behaviour, thoughts, and perceptions. Thus, through CBT, all harmful thoughts are identified and classified as appropriate or inappropriate depiction of reality and then the therapists help the patients challenge and overcome the habits. It is applicable in managing all patients including children and elderly. CBT has been very effective some common mental conditions such as anxiety disorders, major depressive disorders, post-traumatic stress disorder, and obsessive compulsive disorders.
Legal and ethical implications
Just like other aspects of healthcare, there are legal and ethical implications for counselling mental health clients and their families. All practitioners should be involving when counselling the patients such that the information becomes known even to the family members. Consultation with other members is important as well so as to gather experiences and more knowledge on the matter of mental health. All patients and families should be involved in the management and thus willingly sign the consent for acceptance (Kramer et al.,2015). Additionally, confidentiality should be upheld to optimum levels as the information acquired is not supposed to be known by anyone else even the professionals unless the team taking care of the patient.
References
Kramer, G. M., Kinn, J. T., & Mishkind, M. C. (2015). Legal, regulatory, and risk management issues in the use of technology to deliver mental health care. Cognitive and Behavioral Practice, 22(3), 258-268.
Lader, M. (2015). Generalized anxiety disorder. Encyclopedia of psychopharmacology, 699-702.
Otte, C., Gold, S. M., Penninx, B. W., Pariante, C. M., Etkin, A., Fava, M., … & Schatzberg, A. F. (2016). Major depressive disorder. Nature reviews Disease primers, 2, 16065.
Robichaud, M., Koerner, N., & Dugas, M. J. (2019). Cognitive behavioral treatment for generalized anxiety disorder: From science to practice. Routledge.
Schmaal, L., Veltman, D. J., van Erp, T. G., Sämann, P. G., Frodl, T., Jahanshad, N., … & Vernooij, M. W. (2016). Subcortical brain alterations in major depressive disorder: findings from the ENIGMA Major Depressive Disorder working group. Molecular psychiatry, 21(6), 806.
Stein, M. B., & Sareen, J. (2015). Generalized anxiety disorder. New England Journal of Medicine, 373(21), 2059-2068.
