James Jensen is a 55-year-old artist. He is on VA disability benefits and cannot work. He has two grown children and was recently divorced after 20 years of marriage. He was diagnosed with bipolar disorder after an incident of drunk driving 10 years ago. He has since joined Alcoholics Anonymous and treats his bipolar with medication. The divorce has caused him to sink into a depression. He lives alone in the home where he raised his children with his ex-wife. He is independent in all ADLs, including driving and community mobility at an ambulatory level. He has lost interest in his artwork and is gaining weight rapidly from inactivity. He loves the outdoors, especially hiking and fishing, but has recently lacked the motivation to go. He has a few close friends in the arts community, and his children visit him often. James saw his therapist for a routine medication check. The doctor is concerned with his weight gain and depressed state and is increasing cognitive behavioral therapy and adjusting his antidepressant. He has referred James to you, a CTRS at the outpatient mental health VA facility, to help him reach his goals. James’ provider shares the following information from his most recent visit:
Significant past medical history: Disability discharge VA due to mental health. Patient has a history of alcohol abuse. Mood stabilized with medication. Patient has a tendency to self-medicate. Lithium used as requires patient to complete routine blood work.
Medications: Lithium 600 mg orally in the morning and at nighttime. Lurasidone (Latuda) 40 mg orally once a day.
Cognition/perception: Current depressive state due to social situation. Vacillates between mania and depression. Maintained with medication. Patient reports high level of sadness and lack of motivation. Patient tends to stop medication when mood elevates.
Physical Examination: WNL”
Client Goals
1.Increase social supports
2.Learn techniques to cope with stress
3.Increase exercise to maintain healthy weight
1. Create a treatment plan for James Jensen, using evidence-based practice to guide your decision on appropriate interventions following the DENT problem-solving method
a. Define the problem: Clearly identify and articulate the specific problem or challenge that needs to be addressed. This involves understanding the current situation, desired outcomes, and any constraints or limitations (1 paragraph)
b. Explore possible solutions: Generate a range of potential solutions or approaches to solving the problem. Encourage creative thinking and consider different perspectives or alternative options.(1 paragraph)
c. Narrow down options: Evaluate the potential solutions and select the most feasible and effective ones. Consider the advantages, disadvantages, and potential risks associated with each option.(1 paragraph)
d. Take action: Implement the chosen solution or solutions. Develop a plan, allocate resources, and set specific goals and timelines for execution. (1 paragraph)
2.What assessment would be most appropriate for you to give to James? (1 paragraph: Question 2 and Question 3)
3.What factors must be considered when planning James’ intervention?
4.What is your PICO question? (1 paragraph: Question 4 and Question 5)
5.What outcomes do you anticipate from your treatment plan?
6.How will you evaluate the outcomes of your treatment plan? (1 paragraph: Question 6 and Question 7)
7.What contraindications should you consider in James’ treatment? (1 paragraph)
8.What recreational activities would be appropriate considering James’ interests, goals, and current functioning level?” 1 paragraph)
- Treatment Plan for James Jensen:
a. Problem: The specific problem to address is James’ depression, lack of motivation, weight gain, and social isolation following his divorce. The desired outcomes are to increase social supports, learn techniques to cope with stress, and increase exercise to maintain a healthy weight. The limitations include James’ bipolar disorder and tendency to self-medicate.
b. Possible solutions:
- Social supports: Encourage James to reconnect with his close friends in the arts community and explore support groups or community programs for individuals experiencing similar challenges.
- Coping with stress: Introduce James to stress management techniques such as mindfulness, deep breathing exercises, and relaxation techniques. Teach him cognitive-behavioral strategies to reframe negative thoughts and develop healthier coping mechanisms.
- Exercise and weight management: Collaborate with James to develop an exercise plan tailored to his interests and abilities. Gradually reintroduce outdoor activities like hiking and fishing, possibly by organizing group outings or inviting his children to participate.
c. Narrow down options:
- Social supports: Based on James’ existing relationships, focus on fostering connections within his arts community and explore opportunities for group activities or events.
- Coping with stress: Cognitive-behavioral therapy (CBT) can be effective in addressing negative thoughts and coping strategies. Consider incorporating CBT techniques into therapy sessions and providing James with resources for self-help.
- Exercise and weight management: Assess James’ current physical abilities and gradually increase activity levels, starting with short walks and building up to longer hikes or fishing trips.
d. Take action:
- Social supports: Facilitate introductions or encourage James to reach out to his close friends. Provide information about support groups and community programs.
- Coping with stress: Implement CBT techniques during therapy sessions, and provide James with relevant resources and exercises to practice between sessions.
- Exercise and weight management: Develop a personalized exercise plan for James, including a variety of activities he enjoys. Set specific goals and timelines for increasing physical activity.
- The most appropriate assessment for James would be a combination of interviews, self-report measures, and observation. Use a standardized depression assessment tool to measure the severity of his depressive symptoms and track changes over time. Conduct a social support assessment to evaluate his current network and identify areas for improvement. Additionally, observe James’ physical functioning and activity level during sessions and encourage him to provide self-reports on his exercise habits and motivation.
- Factors to consider when planning James’ intervention include:
- James’ bipolar disorder and the need for mood stabilization with medication.
- His tendency to self-medicate and potential non-adherence to medication.
- The impact of the recent divorce on his mental health and motivation.
- James’ physical capabilities and any limitations that may affect his exercise plan.
- The importance of considering his preferences and interests to increase engagement and motivation.
- PICO question: In adult individuals with depression and bipolar disorder, does a combination of cognitive-behavioral therapy (CBT) and social support interventions compared to standard treatment alone lead to improved social functioning, stress management, and physical activity engagement?
- Anticipated outcomes from the treatment plan:
- Increased social supports: James will have reconnected with his friends in the arts community and potentially joined support groups or community programs.
- Improved stress management: James will demonstrate the ability to identify and utilize effective coping techniques, resulting in reduced depressive symptoms and increased resilience.
- Increased exercise and weight management: James will engage in regular physical activity, leading to weight maintenance or weight loss and improved overall well-being.
- Evaluation of outcomes: Regularly assess James’ progress by tracking his depressive symptoms using standardized measures. Measure changes in social support through self-reports and observe his participation in social activities. Monitor his exercise levels through self-reports and objective measures like pedometers or activity trackers.
- Contraindications to consider in James’ treatment:
- Adherence to medication: Address James’ tendency to stop medication when his mood elevates and emphasize the importance of consistent medication management for mood stabilization.
- Lithium and routine blood work: Ensure James understands the necessity of completing routine blood work due to his lithium medication.
- Recreational activities appropriate for James: Considering James’ interests, goals, and current functioning level, outdoor activities that align with his love for nature and the arts could be beneficial. Options may include hiking, fishing, nature walks, visiting art exhibitions or galleries, and engaging in creative endeavors such as painting or sculpting. Gradually reintroducing these activities in a supportive and encouraging environment can help rekindle his passion and motivation.