Constructivist Psychotherapy: Distinctive Features - Essay Example

 As much as Mr. Scott accompanies his wife to run errands, the family rarely goes out. They have an entertainment system installed in their house.

            In the past few years, they have stopped going to church and have not seen their friends and family. Further, Mr. Scott is not comfortable in situations in which he is being watched by others, or where his performance is being judged. He does not attend social gatherings for fear of succumbing to an attack. Mr. Scott does this to minimize his attacks, which recently have become worse. He is certain that his disease is a heart attack and not psychiatric. Although judging from his actions and symptoms, this is not the case.

Baseline assessment

This is the first admission for Mr. Scott, who has had mild and frequent symptoms of panic disorder since he was a teenager. He has reported negative work performance, and social isolation, which are secondary to his symptoms, hence suggesting signs of depression. His symptoms include relentless chest pain, dizziness, shortage of breath, G1 distress inclusive of nausea, and sweating.

 Diagnosis

Psychiatric Diagnosis

Medication

Axis I.  Agoraphobia and panic disorder

Axis II. Deferral period

Axis III. None

Axis IV. Social and occupational problems                                                                                                                                                                                                                                                                                                                                                         outside of the spouse 

Axis V GAF 65, current 90 last year

To be diagnosed with, serotonin reuptake inhibitors (SSRIs), epinephrine reuptake inhibitors,

Benzodiazepines and cognitive, behavioral therapy (Neimeyer, 2009).

Retain prn lorazepam (Activan)

Lorazepam (Activan) 2mg

IM, for agitation, and cognitive restructuring.

Nursing diagnosis, mental status exam

Defining characteristics

Evidenced by

Impatient with interview questions

He is restless and uneasy

Articulate with speech, though speaks rapidly about his symptoms

He is coherent and logical

No hallucinations or delusions

No suicidal ideation, (positive family history in paternal aunt),

Signs of depression

Severe episodes of chest pain, breath shortness, dizziness, nausea, and sweating.

Panic disorder with agoraphobia

fear of suffering an attack in the presence of the interviewer

believes his symptoms are medical rather than psychiatric,

social isolation

Panic disorder.

Outcome

Initial

Discharge

To learn strategies to deal with social isolation, for instance, Mr. Scott drives long distances to work instead of flying.

Participate in activities in the treatment plan

Agree to go for therapy and participate to curb his panic disorder problem.

Take medication as prescribed.

Intervention 

Rationale

Goal

Commence a patient-nurse relationship by exhibiting Mr. Scott’s importance as a human being. This is accomplished by evading pessimistic critics and behavior (Jongsma, (2010).

Approach the patient calmly and encouragingly (Corey, 2009).

Assist Mr. Scott to differentiate between thoughts and reality, which is achieved by confirming that his problem is psychiatric and not medical. As a result, focus aspects are oriented toward reality. 

Assist the patient to develop effective skills in communicating with other people in his   environment

The relationship will give Mr. Scott support as he comes to terms with his panic disorder problem and its implications.

At first, the patent will argue on the basis that his problem is not psychiatric. This is because he does not want to give the impression of losing his mind. Therefore, because panic disorders tend to be repetitive, the patient learns that these recurring experiences are not validated by other people and that he should go through therapy for him to get well.

Patients with panic disorder often avoid crowded places for fear of suffering an attack

To establish whether Mr. Scott can engage in a patient-nurse relationship.

Determine if Mr. Scott is convinced that his problem is psychiatric and not medical (Belmont, 2003).

Establish circumstances that cause Mr. Scott to suffer an attack and help him overcome them.

Evaluation analysis

Outcomes

Revised outcomes

Intervention

Mr. Scott continues to have panic disorders. He has started to plan ways to deal with his disorder problem as well as, social isolation. He is even considering visiting his friends and family once he has fully recovered.

Mr. Scott understands that he has a disorder and that his problem is psychiatric and not medical

Use these strategies to deal with panic disorder, and social isolation, and be more active in his community.

Continue to learn about panic disorders

Encourage Mr. Scott to practice these strategies, and activities in therapy for his full recovery

Recommend, cognitive behavioral, therapy and a medication group.

Conclusion

After two months of treatment, Mr. Scott has made remarkable improvements. His frequent attacks have decreased significantly. Although he is still in therapy, he now flies to work instead of driving and accompanies his wife to social gatherings.