Analyze and apply critical thinking skills in the psychopathology of mental health patients and provide treatment and health promotion while applying evidence-based research.Scenario:
Jax is a 66-year-old Caucasian female whose wife has encouraged her to seek treatment. She has never been in therapy before, and has no history of depression or anxiety. However, her alcohol use has recently been getting in the way of her marriage, and interfering with her newly-retired life. She describes drinking increasing amounts over the last year, currently consuming approximately a six-pack of beer per day. She notes that this amount “doesn’t give me the same buzz as it used to.” She denies ever experiencing “the shakes” or any other withdrawal symptoms if she skips a day of drinking.
Jax comments that her wife is her biggest motivation to decrease her alcohol use. She tells Jax that she gets argumentative and irritable when she drinks, though she does not always remember these incidents. She has also fallen while intoxicated twice, causing bruises both times and hitting her head on one of the occasions.
Questions:
Remember to answer these questions from your textbooks and NP guidelines. At all times, explain your answers.
Describe the presenting problems/issues. Is there any information that was not provided that you would need to formulate a diagnosis?
Generate a primary and differential diagnosis using the DSM5 and ICD 10 codes.
What physiological and psychological processes lead to substance dependence?
Full Answer Section
To formulate a diagnosis, it would be helpful to know more about Jax's drinking history, including:
- How did her drinking start?
- What triggers her to drink?
- What are the consequences of her drinking?
- Does she have any other mental health conditions?
- Is there any family history of substance abuse?
Primary and differential diagnosis
Primary diagnosis: Alcohol use disorder, moderate (DSM-5 code 303.90; ICD-10 code F10.22)
Differential diagnosis:
- Major depressive disorder
- Generalized anxiety disorder
- Bipolar disorder
- Dementia
- Alcohol-induced psychosis
Physiological and psychological processes leading to substance dependence
Substance dependence is a complex condition that involves both physiological and psychological processes.
Physiological processes:
When a person consumes alcohol, it enters the bloodstream and travels to the brain. Alcohol binds to GABA receptors in the brain, which have a calming effect. Over time, the brain can adapt to the presence of alcohol and become less sensitive to its effects. This can lead people to drink more alcohol in order to achieve the same desired effect.
Psychological processes:
A number of psychological factors can also contribute to substance dependence. These include:
- Stress
- Anxiety
- Depression
- Loneliness
- Boredom
- Peer pressure
- Family history of substance abuse
Treatment and health promotion
The primary goal of treatment for alcohol use disorder is to help the person reduce their alcohol use or stop drinking altogether. There are a number of different treatment options available, including:
- Individual therapy
- Group therapy
- Medication-assisted treatment
- Self-help groups, such as Alcoholics Anonymous
In addition to treatment, it is also important to promote health and well-being in people with alcohol use disorder. This can be done by:
- Encouraging healthy eating and exercise
- Helping people develop coping skills for stress and anxiety
- Connecting people with social support resources
Evidence-based research
There is a strong body of evidence-based research to support the effectiveness of a number of different treatments for alcohol use disorder. These treatments include:
- Cognitive-behavioral therapy (CBT): CBT is a type of therapy that focuses on helping people identify and change negative thoughts and behaviors. CBT has been shown to be effective in reducing alcohol use and improving outcomes in people with alcohol use disorder.
- Motivational interviewing (MI): MI is a type of therapy that focuses on helping people develop their own motivation to change their behavior. MI has been shown to be effective in increasing engagement in treatment and reducing alcohol use in people with alcohol use disorder.
- Medication-assisted treatment (MAT): MAT is a combination of medication and therapy. MAT is one of the most effective treatments for alcohol use disorder.
Conclusion
Jax is a 66-year-old Caucasian female who has been experiencing increased alcohol use over the last year. She is motivated to decrease her alcohol use, but she needs help to do so. There are a number of different treatment options available, including individual therapy, group therapy, medication-assisted treatment, and self-help groups. Jax should work with a healthcare professional to develop a treatment plan that is right for her.
Sample Answer
Presenting problems/issues
Jax's presenting problems include:
- Increased alcohol use over the last year
- Drinking approximately a six-pack of beer per day
- Alcohol use causing arguments and irritability
- Falling while intoxicated twice, causing bruises and hitting her head on one occasion
Information needed to formulate a diagnosis