Vignette on Meredith and Richard

Vignette on Meredith and Richard

Case of Meredith

According to the fourth case, Meredith has gone through an awkward situation, and treatment of her case may sound quite challenging. As a psychiatrist, my major priority would be to make sure that Meredith is comfortable. The first step in this kind of treatment is to get acquainted with the patient’s situation. Because what affects her centred upon past events in her life, what she would need is a person with whom she will feel comfortable and who can make her feel accepted despite the circumstances.

To begin with, I will be sure to work with Meredith by engaging her in treatment by becoming her friend. First, Meredith needs not to know, that I am here to make her quit the only things she considers her comforters. She also needs to understand that I am here to make her life better. As a result, I would engage her and their family through a various number of visits. I will make her family my associates, such that Meredith will not suspect anything. After ensuring her family is close enough, I will make it a routine to visit them and interact with Meredith more frequently. I will want to get to know what she likes most, and during my visit, I will always bring her different gifts, mostly of her choice. After this, I will engage Meredith in conversations that she likes and this way, and I am confident that I will gain her trust, which is vital for this kind of treatment. After I have gained her confidence, I would like to make it known to her that my main aim is to help her cope with life. I will introduce several psychological sessions that will help us work together and get to know how to approach the problem at hand. During this period, I will introduce therapy sessions that will replace alcohol consumption. Finally, I will then go straight to the treatment.

Whereas combining Alcohol and Adderall is very dangerous for a patient, it seems to be working for Meredith. However, this will not last for a long time since the two drugs have contrasting effects on the human body. In my opinion, the two substances assist Meredith in her condition because the two substances have chemicals that impact the nervous system differently. It is important to note that Adderall contains a salt chemical that increases the effect of the neurotransmitters dopamine and additionally, a compound called norepinephrine in the areas of the brain which improve focus and alertness. On the other hand, Alcohol decreases the effect of Neurotransmitters in the brain, which the intern slows down the body process and mental functions. Therefore, the impact of Adderall is stronger than that of Alcohol, and as a result, Meredith can have more focus while forgetting her problem because her brain’s function has been tampered with. Alcohol is depressant to moderate quantities. But when used in small doses, such as in a glass of wine or beer, it usually serves as a temporally stimulant. This means that Adderall will intensify and lengthen the stimulation period Meredith will experience after its consumption. From what we have gathered, Meredith uses one glass of wine, which means that the combination will cause the Adderall to intensify and prolong the experience. Lithium will help in the reduction of many depression experiences and reduce the urge for alcohol usage. It will also help in future manic and depressive episodes.

The care level for this particular case should be collaborative care. This is because there are so many factors that are involved. The psychiatrists must collaborate with the family of the patient so as get to understand the type of care and the effectiveness of the care the patient is going to be given at a particular time. Meredith’s problem is quite complex because a physician must get to understand the background extensively. We must get to know to what extent Meredith was affected. Because Meredith has had two suicide attempts in a span of a few months, the doctor needs to get to understand the cause of these attempts and what makes her have a feeling of taking her own life. The shooting must have affected her brain’s functionality, and this is probably what makes her perceive events in different ways. Secondly, it is also possible that certain events in her life trigger her emotions. The doctor must get to understand what events agitate her to the point she would want to get them out in the form of taking her life. Substance use is also a complex situation that must be dealt with. Since her system is now used to Alcohol and Adderall, getting her system to have abnormal functionality would be a complex thing that would take time for the doctors to achieve. Her treatment will involve training, adaptation and medication.

How would you use family counseling in your treatment of Meredith?

Using family counseling will be very useful in treating this case. First, I will involve the family in couching and getting them to understand that the patient is not abnormal. The family will need to accept the condition and offer the required attention to Meredith. On several occasions, I will teach the family how to handle some strange behaviors that Meredith may show, especially when she is depressed. Finally, I will teach the family to continually encourage Meredith and avoid behaviors that may trigger her condition.

Case of Richard

How do you educate Richard on his appropriate immediate level of care? Where do you see the levels of care progressing following the initial treatment level?

Richard has only sought treatment for anxiety and hasn’t taken a step to accept that he suffers from alcohol addiction. I would, therefore, recommend that he seeks assistance concerning Alcohol and how he can be able to overcome anxiety devoid of Alcohol. I would, therefore, educate Richard through verbal means or through the use of education packets offered to patients to make him aware of the appropriate level of care that he needs. Also, education using online sources would be effective since Richard reads articles online; at least, that is how he got to know that Xanax and Alcohol, when taken simultaneously, have a fatal impact. Making Richard aware of his condition and appropriate immediate level of care will make him able to understand and manage his health throughout his entire experience and life. The treatment levels progress from outpatient level to that of intensive outpatient treatment, which is seen when he discloses that he has been undergoing therapy. Due to the extensive nature of his symptoms, Richard may also require PHP care (Partial Hospitalization) so as to get more medical care, other than just the therapy he receives.

How do you conceptualize his current anxiety symptoms in the context of his rapid ‘cold-turkey’ cessation of Xanax and Alcohol?

Richard’s symptoms worsen after he ceases taking Alcohol and Xanax. Before stopping these substances, his anxiety levels were quite low; however, after cessation, he has several panic attacks, his hands shake, and he often feels overwhelmed to the extent that he starts hallucinating. His anxiety symptoms, in my perspective, have worsened not because he has ceased using substances, but because, they have been mingled together with the impacts of addiction of alcohol and Xanax. Abrupt cessation (cold-turkey) is to a large extent the main cause of the extensiveness of his symptoms which is usually accompanied by withdrawal symptoms most of the time. One of the significant signs of withdrawal of Alcohol is the shaking or trembling occasionally and also hallucinations.

In consideration of Richard’s history of trauma and current clinical and substance-related presentation, what are your diagnostic impressions?

Based on his history of trauma and current clinical and substance-related presentation, Richard has low confidence in himself, may have depression and attention deficit. Therefore, he should seek more help from a counsellor and therapist due to the psychological condition that he has, then secondly, it would be prudent if Richard seeks a companion to stand by him in times of anxiety and help him gain confidence in facing his peers in school. This will also better his performance in class in that, although he has a 3.7 GPA, which he says was difficult to attain, he will be able to easily achieve good grades without much struggle, just like his classmates. Richard needs to, therefore, undergo tests to show the true diagnosis.

How might you treat Richard? What might couple counselling be a supportive adjunct to Richard’s treatment?

Treatment for anxiety, in most cases, is somewhat difficult to attain. However, with the right procedures, it is possible to conquer substance abuse and anxiety. For instance, in Richard’s case, counselling alone would not be enough. He would, therefore, need to couple it with other treatment such as self-care which majorly entails relaxation techniques and stress management, behavioural and meditation therapies and finally, administration of appropriate medication, e.g. selective Serotonin Reuptake Inhibitor (SSRI) which is an antidepressant that has proved to be effective to many patients of his kind and should be administered only by a qualified physician.