Review of Grief Therapies For Older Adults Assignment

NRNP/PRAC 6645 Comprehensive Psychiatric

Evaluation Note Template

CC (chief complaint): ‘ I cannot sleep well and I wake up feeling tired in the morning. I lost the motivation to engage in my occupational and routine activities. My life changed drastically after I lost my wife.”

HPI: J.J. is a 28-year-old male client who presented to the psychiatry clinic with complaints of decreased energy, inadequate sleep, and lack of motivation to engage in daily activities and occupation. He reports that symptoms began three about seven months ago but they were mild and tolerable. However, for the past three months, he has been experiencing worsening sadness and increasingly losing concentration and interest in significant activities which he believes are negatively impacting his wellbeing. Today, J.J. reports feelings of emptiness, hopelessness, and sadness and has also been progressively losing weight due to decreasing appetite. Review of Grief Therapies For Older Adults Assignment The client reports that one particular concern that worsens his symptoms is the beautiful memories that he enjoyed with his wife and a harrowing experience that he went through while he supported his wife while battling cancer. However, he reports that engaging in spiritual activities such as prayer and meditation makes him feel better and develop a sense of hope. In addition, she acknowledges having suicidal thoughts but does not have a plan to execute these recurring thoughts.

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Past Psychiatric History:

• General Statement: J.J. is a 28-year-old male client presenting to the psychiatry clinic with decreased energy, insomnia, decreased appetite, loss of weight, and lack of motivation to engage in occupational and other significant activities. The client reports having suicidal ideations but denies hallucinations and a plan to execute the recurring thoughts.
• Caregivers (if applicable): J.J. stays alone with his two young children in grades 5 and 7. He reports that his younger brother occasionally visits him for encouragement and some financial resources which he reports have been critical in helping him cope with his condition. However, due to the busy schedule at work, for the last three months, he has not met with his brother and he feels he has been neglected by his family. Review of Grief Therapies For Older Adults Assignment
• Hospitalizations: Reports two episodes of hospitalization. Was hospitalized at 9 years old due to pneumonia and at 17 years old due to a road traffic accident that led to a fracture which was later repaired with open fixators. However, he denies hospitalization due to psychiatry and mental health-related conditions.
• Medication trials: No current or previous medications for chronic conditions and mental health disorders have been administered before the admission time.
• Psychotherapy or Previous Psychiatric Diagnosis: The client does not have a history of mental health and psychiatric conditions history which have been managed before by non-pharmacological interventions.

Substance Current Use and History: No history of drugs and substance use.

Family Psychiatric/Substance Use History: His father was diagnosed with schizophrenia, alcohol use disorder, and depression which he is currently managing with medications and psychotherapy.

Psychosocial History: J.J. is currently single after the death of his wife six months ago. He has two children in grades 5 and 7. He lives in a rented apartment and works as a storekeeper in a local high school. He is the firstborn in a family of three, his parents are alive, his father with significant mental health condition, and his mother does not have any underlying chronic conditions. Review of Grief Therapies For Older Adults Assignment

Medical History: J.J. does not have any history of chronic illnesses including diabetes, hypertension, heart disease, lipid disorders, asthma, among other conditions. Reports to have enjoyed good health without any health-related conditions until he lost his wife when he started experiencing mental health conditions and complications.

• Current Medications: J.J. denies current medications since he does not have any chronic conditions requiring management.
• Allergies: He does not have any allergies to medications, pollens, or environmental pollutants. He also denies food intolerances.

• Reproductive Hx: He identifies himself as heterosexual but denies having any form of sexual activity for the past year since his wife started feeling unwell and eventually died six months ago. He does not have any plans to remarry since he says he loved his wife so much and remarrying or any form of sexual activity will be a form of betrayal.

ROS:

• GENERAL: J.J. denies fever, chills, joint pains, and muscle pains. He reports a loss of more than 10 pounds for the past two months, decreased energy, and an inability to perform most of his activities due to fatigue.
• HEENT: He denies visual changes, headaches, runny nose, ear pain, throat pain, sneezing, nasal congestion, or mouth sores.
• SKIN: J.J. Denies rashes, itch, and skin lesions.
• CARDIOVASCULAR: J.J. does not report any form of chest pain, chest discomfort, palpitations, peripheral edema, or dyspnea on exertion.
• RESPIRATORY: Denies dyspnea on exertion, cough, chest pain, shortness of breath, and increased sputum production.
• GASTROINTESTINAL: J.J. reports decreasing appetite. However, he denies nausea, vomiting, abdominal pain, and diarrhea. Review of Grief Therapies For Older Adults Assignment
• GENITOURINARY: Denies increased urge, urinary frequency, hesitancy, nocturia, polyuria, and urinary incontinence.
• NEUROLOGICAL: He denies changes in personality, headaches, visual disturbance, seizures, changes in bowel patterns, and peripheral neuropathy.
• MUSCULOSKELETAL: Denies muscle weakness, back pain, stiffness, radiating lower leg pain, and discomfort.
• HEMATOLOGIC: Denies shortness of breath, easy bruising, bleeding, or anemia.
• LYMPHATICS: Denies lymphadenopathy, splenectomy, and sweating.
• ENDOCRINOLOGIC: Denies heat and cold intolerance, no polyuria, polydipsia, and polyphagia.

Physical exam:

Vital signs: T 97.9, BP 128/87mmHg, oxygen saturation 99% on room air, BM 21.7Kg/M2.

Diagnostic results: Diagnostic investigations ordered for this client include a complete blood count, thyroid function tests, vitamin D and B12, and a comprehensive metabolic assessment which are all within the normal limits. Adminstration of Beck’s Depression Inventory (BDI) indicated a score of 15 demonstrates the presence of mild depression. Secondly, the Inventory of Complicated Grief Revised (IGF-R) also shows a significant relationship with the recent spouse loss. Lastly, the Columbia Revised Severity Rating Scale (C-SSRS) indicates passive suicidal ideation without specific plans or intent to execute the idea.

Assessment

Mental Status Examination: The 28-year-old African American man is well groomed, and his dress matches his gender, weather, and time of the day. His appearance appears congruent with the stated chronological age. J.J. exhibits a depressed mood with flat affect and minimal eye contact with the examiner. He has a coherent speech but is noted to be slow with decreased volume, reflecting psychomotor retardation. He offers adequate information and maintains focus on the stated topic. He has a linear thought with a goal-oriented intention. However, he does not have any delusions or hallucinations. His cognitive functions seem to be intact with accurate orientation to time, person, and place. He has a disturbed emotional state that makes it challenging to evaluate his emotional state. He reports suicidal ideations but does not have a plan or intention of executing the thought. Overall, his mental status assessment confirms the profound sense of sadness related to the loss. Review of Grief Therapies For Older Adults Assignment

Differential Diagnoses:

Major Depressive Disorder (ICD F32*): The fifth edition of the Diagnostic and Statistical Disorder for Mental Health and Psychiatric Conditions identifies depressed mood, markedly diminished interests or pleasure in activities, weight loss or gain, insomnia or hypersomnia, psychomotor agitation, fatigue and loss of energy, feeling of worthlessness or guilt, recurrent thoughts of death, and diminished ability to think or concentrate (Karrouri et al., 2021). The features must occur for six months with at least one episode of features lasting more than two weeks. J.J presents with these features which match with the MDD features as outlined by the DSM 5 TR. Therefore, these features require comprehensive assessment and implementation of a collaborative plan to achieve the best results.

Persistent Complex Bereavement Disorder (PCBD) (ICD F43.1-F43.25): This condition is defined when the individual experiences stress and dysfunction related to the loss of a loved one. The bereavement for dysfunction includes persistent and pervasive longing for the diseased, and persistent preoccupation with the deceased. Criterion C includes additional features such as intense emotional pain, sorrow, and yearning related to death, excessive avoidance of reminders, and excessive preoccupation with the circumstances of the death (Morgan & Townsend, 2020). The person may feel detached and less support from the community and may experience suicidal ideation. Therefore, since J.J. reports features associated with the complex bereavement and grief process following the loss of his wife due to advanced cancer, it is necessary to evaluate the best treatment approach for helping him cope with his needs.

Adjustment Disorder with Depressed Mood (ICD F43.21): This disorder is characterized by the development of emotional and behavioral problems in response to identifiable stressors, occurring within three months of a stressful event such as the loss of a loved one. These symptoms are often clinically significant and result in marked distress that is out of proportion and significantly impair the social, occupational, and other areas of impairment (Colvin & Ceide, 2021). Although the client’s symptoms emerged following the significant stressor of his wife’s death, the severity and specific nature of the symptoms fit more closely with MDD than an adjustment disorder. Adjustment disorder with depressed mood could be considered if the symptoms were less severe and did not meet the full criteria for MDD. Review of Grief Therapies For Older Adults Assignment

Case Formulation and Treatment Plan:

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) will focus on identifying and challenging the client’s negative thoughts, beliefs, and attitudes related to his loss and depressive symptoms, with an emphasis on modifying these cognitive distortions to alleviate emotional distress. By employing specific techniques such as cognitive restructuring and behavioral activation, the therapist will work with the client to develop healthier thought patterns. This approach will support the client to engage in once-enjoyable activities, aiming to break the cycle of depression and reduce symptoms of grief (Karrouri et al., 2021). Homework assignments between sessions will encourage the application of skills learned in therapy to real-life situations, reinforcing positive changes. This structured approach will also incorporate grief-specific interventions, acknowledging and processing feelings of loss in a constructive manner.

Supportive Psychotherapy

Supportive Psychotherapy will provide a safe and empathetic environment for the client to express his feelings and thoughts related to bereavement and depressive state. The therapist will use active listening, validation, and empathy to enhance the client’s self-esteem. In addition, support psychotherapy will be applied in enhancing coping mechanisms, facilitating a natural grieving process while offering guidance on managing complex emotions. These approaches focus on fostering resilience (Morgan & Townsend, 2020). Through establishing a strong therapeutic alliance, the client will be encouraged to explore personal values and strengths. The technique will help the client in redefining his sense of self and purpose post-loss. Additionally, the approach aims to build a foundation of emotional support, enabling the client to navigate his grief with an enhanced sense of security and understanding.

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Group Therapy for Bereavement

Group Therapy specifically tailored to those experiencing bereavement can offer unique benefits, providing the client with a sense of community and shared experience. Within this setting, the client will have the opportunity to share his story and listen to others with similar experiences. Therefore, group therapy will foster mutual support and understanding. Facilitated by a therapist, the group will explore themes of loss, coping strategies, and the process of healing. The sessions will help members feel less isolated in their grief. The collective wisdom and compassion of the group can serve as a powerful catalyst for the client’s emotional healing and growth, promoting a sense of belonging and collective resilience. Review of Grief Therapies For Older Adults Assignment

Follow-up Care

The effectiveness of these non-pharmacological therapies will be evaluated through regular follow-up sessions, initially set on a bi-weekly basis and then extending to monthly intervals as progress is observed. During these sessions, standardized assessment tools such as the Beck Depression Inventory (BDI) for depressive symptoms and the Inventory of Complicated Grief (ICG) for bereavement-related distress will be administered to quantitatively measure changes in the client’s symptoms and overall well-being (Karrouri et al., 2021). The client’s self-reported improvements in daily functioning, mood, and coping strategies will also be discussed to qualitatively assess progress. Adjustments to the treatment plan will be made based on these evaluations, ensuring that the therapeutic approaches remain aligned with the client’s evolving needs and therapeutic goals.

Reflections:

Reflecting on this case has underscored the profound impact of grief and loss on mental health, illuminating the complex interplay between bereavement and the onset of depressive disorders. It has reinforced the importance of a nuanced, compassionate approach to therapy that acknowledges the individuality of grief and the need for tailored interventions. The case highlights the necessity of integrating various therapeutic modalities to address the multifaceted nature of a person’s experience, from cognitive behavioral strategies that tackle maladaptive thoughts to supportive measures that provide a validating space for emotional expression (Frank et al., 2023). This holistic approach not only aims to alleviate symptoms but also facilitates a deeper process of healing and adaptation. Review of Grief Therapies For Older Adults Assignment

Furthermore, this case has emphasized the significance of follow-up and the careful monitoring of therapeutic progress through both qualitative and quantitative measures. The integration of regular evaluations into the treatment plan ensures that interventions remain responsive to the client’s evolving needs, enhancing the efficacy of care. It has also served as a reminder of the therapeutic power of shared experiences in group settings, providing a unique avenue for connection and support. Overall, this case has been a valuable learning experience in the intricacies of treating complex grief and depression, highlighting the critical role of adaptability, empathy, and a multifaceted therapeutic approach in facilitating recovery and resilience.

Conclusion

The 28-year-old male client’s case emphasizes the profound impact grief has on mental health and the intricate relationship between bereavement and depressive disorders. It underscores the critical need for a compassionate, nuanced therapeutic approach that honors the unique nature of an individual’s grief, requiring personalized interventions. This case demonstrates the importance of employing diverse therapeutic strategies to address the complex dimensions of a person’s experiences effectively. Regular follow-ups and adjustments to the treatment plan, based on both qualitative feedback and quantitative measures, ensure that therapy remains responsive to the client’s changing needs, thus enhancing the care’s effectiveness and supporting the individual’s journey toward healing and resilience.Review of Grief Therapies For Older Adults Assignment

References

Colvin, C., & Ceide, M. (2021). Review of grief therapies for older adults. Current Geriatrics Reports, 10(3), 116–123. https://doi.org/10.1007/s13670-021-00362-w

Frank, P., Batty, G. D., Pentti, J., Jokela, M., Poole, L., Ervasti, J., Vahtera, J., Lewis, G., Steptoe, A., & Kivimäki, M. (2023). Association Between Depression and Physical Conditions Requiring Hospitalization. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2023.0777

Karrouri, R., Hammani, Z., Benjelloun, R., & Otheman, Y. (2021). Major depressive disorder: Validated treatments and future challenges. World Journal of Clinical Cases, 9(31), 9350–9367. https://doi.org/10.12998/wjcc.v9.i31.9350

Morgan, K., & Townsend, M. (2020). Psychiatric and mental health nursing: Concepts of care in evidence-based practice. F A Davis.

I have attached the week 4 question PLUS a visit note from a therapist, please follow the NRNP/PRAC 6645 Comprehensive Psychiatric Evaluation Note Template to write a note about this patient. I’ve also attached the pdf Comprehensive Psychiatric Evaluation Note exemplar and another student’s finished note example of how they wrote theirs. If you would like to use another patient with a different problem please go ahead. You will document information about a patient examined in a group setting, using the Comprehensive Psychiatric Evaluation Note Template provided. Review of Grief Therapies For Older Adults Assignment