Overview (Considering patient is an acute state of illness)
Treatment can be given in an outpatient setting because she has good support from her family and friends, has good insight, low risk of self harm and harm to others and she is able to come for follow-up.
No Mental Health Act issues are concerned as consenting to treatment.
Acute Management
Biological
Upon starting treatment, discuss with the patient about the treatment options, expected outcomes (of treatment/not taking treatment/ adverse side effect), duration of treatment and prognosis.
Offer Selective Serotonin Receptor inhibitor (SSRI) as first line treatment. Sertraline, per oral, 50mg daily, titrate according to response, maximum 200mg per day. If able to tolerate an SSRI and response well, continue with treatment at least …show more content…
Advice about: relaxation training (breathing exercise, Yoga/Tai Chi, muscle relaxation), problem-solving techniques, self-help (books, website)
3. Individual or Group Cognitive behavioral therapy (CBT): would offer depending on the patient’s preference
Social
Currently patient has good support from husband and family and good financial status. However, she will be treated in outpatient setting. Thus, community psychiatric nurse would be helpful to assess family dynamic and identify stressor.
Promote regular exercise and healthy diet, good sleep, cut down on caffeinated beverages
Long Term Management
Biological
Review the effectiveness and side effects of the drug every 2–4 weeks during the first 3 months of treatment and every 3 months thereafter. Monitor concordance. Advice the patient to continue medication at least a year as the likelihood of relapse is high.
Psychological
Continue with Psychoeducation and CBT
Continue non-specific symptomatic interventions (self-help relaxation technique, problem solving technique)
Social
Promote regular exercise and healthy diet, good sleep, cut down on caffeinated beverages
Structured reflection on management plan (max 200
Treatment can be given in an outpatient setting because she has good support from her family and friends, has good insight, low risk of self harm and harm to others and she is able to come for follow-up.
No Mental Health Act issues are concerned as consenting to treatment.
Acute Management
Biological
Upon starting treatment, discuss with the patient about the treatment options, expected outcomes (of treatment/not taking treatment/ adverse side effect), duration of treatment and prognosis.
Offer Selective Serotonin Receptor inhibitor (SSRI) as first line treatment. Sertraline, per oral, 50mg daily, titrate according to response, maximum 200mg per day. If able to tolerate an SSRI and response well, continue with treatment at least …show more content…
Advice about: relaxation training (breathing exercise, Yoga/Tai Chi, muscle relaxation), problem-solving techniques, self-help (books, website)
3. Individual or Group Cognitive behavioral therapy (CBT): would offer depending on the patient’s preference
Social
Currently patient has good support from husband and family and good financial status. However, she will be treated in outpatient setting. Thus, community psychiatric nurse would be helpful to assess family dynamic and identify stressor.
Promote regular exercise and healthy diet, good sleep, cut down on caffeinated beverages
Long Term Management
Biological
Review the effectiveness and side effects of the drug every 2–4 weeks during the first 3 months of treatment and every 3 months thereafter. Monitor concordance. Advice the patient to continue medication at least a year as the likelihood of relapse is high.
Psychological
Continue with Psychoeducation and CBT
Continue non-specific symptomatic interventions (self-help relaxation technique, problem solving technique)
Social
Promote regular exercise and healthy diet, good sleep, cut down on caffeinated beverages
Structured reflection on management plan (max 200