The Psychopharmacology Treatment Planner (Practice Planners Series) / Edition 1

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Overview

The Psychopharmacology Treatment Planner provides all the elements necessary to quickly and easily develop formal treatment plans that satisfy the demands of HMOs, managed care companies, third-party payors, and state and federal review agencies.

  • Saves you hours of time-consuming paperwork, yet offers the freedom to develop customized treatment plans for clients whose therapy includes psychotropic drugs
  • Organized around 28 main presenting problems regularly treated with a combination of psychotropic and psychotherapeutic interventions or treatment modalities, from ADHD, dementia, and substance abuse to antisocial behavior, bipolar disorders, and more
  • Over 1,000 well-crafted, clear statements describe the behavioral manifestations of each relational problem, long-term goals, short-term objectives, and clinically tested treatment options
  • Easy-to-use reference format helps locate treatment plan components by behavioral problem or DSM-IV-TR(TM) diagnosis
  • Includes a sample treatment plan that conforms to the requirements of most third-party payors and accrediting agencies (including HCFA, JCAHO, and NCQA)
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Product Details

  • ISBN-13: 9780471433224
  • Publisher: Wiley
  • Publication date: 10/28/2003
  • Series: PracticePlanners Series , #96
  • Edition description: New Edition
  • Edition number: 1
  • Pages: 288
  • Product dimensions: 7.00 (w) x 9.90 (h) x 0.70 (d)

Meet the Author

ARTHUR E. JONGSMA, Jr., PhD, is Series Editor for the bestselling PracticePlanners®. He is also the founder and Director of Psychological Consultants, a group private practice in Grand Rapids, Michigan.

DAVID C. PURSELLE, MD, is Assistant Professor in the Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine in Atlanta, Georgia.

CHARLES B. NEMEROFF, MD, PhD, is the Reunette W. Harris Professor and Chairman of the Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine in Atlanta, Georgia.

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Read an Excerpt


The Psychopharmacology Treatment Planner



By David C. Purselle Charles B. Nemeroff Arthur E. Jongsma, Jr.


John Wiley & Sons


Copyright © 2003

David C. Purselle Charles B. Nemeroff Arthur E. Jongsma, Jr.
All right reserved.



ISBN: 0-471-43322-5



Chapter One


ADJUSTMENT DISORDER WITH
DEPRESSION OR ANXIETY


BEHAVIORAL DEFINITIONS

1. Depressive symptoms (e.g., sad mood, tearfulness, feelings of hopelessness)
that develop in response to an identifiable stressor (e.g.,
medical illness, marital problems, loss of a job, financial problems,
conflicts about religion).

2. Anxiety symptoms (e.g., nervousness, worry, jitteriness) that develop
in response to an identifiable stressor.

3. Symptoms cause distress beyond what would normally be expected.

4. Significant impairment in social and/or occupational functioning because
of the symptoms.


LONG-TERM GOALS

1. Alleviate symptoms of stress-related depression through medication
and/or psychotherapy.

2. Alleviate symptoms of stress-related anxiety through medication
and/or psychotherapy.

3. Stabilize anxiety and/or depression levels while increasing ability to
function on a daily basis.

4. Learn and demonstrate strategies to deal with dysphoric and/or anxious
moods.

5. Effectively cope with the fullvariety of life's stressors.

SHORT-TERM OBJECTIVES

1. Describe the signs and symptoms
of an adjustment disorder
that are experienced and note
their impact on daily life.
(1, 2, 3)

2. Describe other symptoms or
disorders that may also be
present. (4, 5)

3. Verbalize any current suicidal
thoughts and any history of
suicidal behavior. (6, 7, 8)

4. Outline a complete and accurate
medical and psychiatric
history, including treatment
received and its effectiveness.
(9, 10)

5. Cooperate with a physical
examination and laboratory
tests. (11, 12)

6. Pursue treatment for concurrent
medical problems that
may contribute to depressive
and anxiety symptoms.
(13, 14)

7. Complete psychological
testing and other questionnaires
for measuring depressive and
anxiety symptoms. (15)

8. Express an understanding of
possible causes for adjustment
disorder and the relationship
between substance abuse
and adjustment disorder.
(16, 17)

9. Verbalize an understanding
of treatment options, expected
results from medication, and
potential side effects.
(18, 19)

10. Participate in psychotherapy
sessions as planned with the
therapist. (20, 21)

11. Verbalize any symptoms of
anxiety that are experienced.
(22, 23)

12. Take prescribed antianxiety
or hypnotic medications
responsibly at times ordered
by the physician.
(24, 25, 26, 27)

13. Report as to the effectiveness
of the antianxiety medication
and any side effects that
develop. (28, 29)

14. Verbalize any depressive
symptoms that are experienced.
(30, 31)

15. Adhere to the SSRI antidepressant
medication as
prescribed by the physician.
(32, 33)

16. Report as to the effectiveness
of the SSRI antidepressant
medication and any side effects
that develop. (34, 35, 36)

17. Retain a remission or significant
reduction in depressive
and/or anxiety symptoms.
(37, 38, 39)

THERAPEUTIC INTERVENTIONS

1. Explore the adjustment disorder
symptoms that are experienced
by the patient (e.g., excessive
worry about a current stressor,
sad mood, decreased sleep, reduced
appetite).

2. Determine what stressors are
present and the time course of
symptoms in relation to the
stressors.

3. Gather information from the
patient about the impact of the
symptoms on daily life (e.g.,
impaired social or occupational
functioning, neglect of routine
chores).

4. Assess the patient for comorbid
disorders (e.g., see the Personality
Disorder, Psychosis, and
Panic Disorder chapters in this
Planner).

5. Gather detailed personal and
family history information regarding
the patient's substance
abuse and its potential contribution
to the adjustment disorder;
refer the patient for in-depth
substance abuse treatment, if
indicated (see the Chemical
Dependence chapters in this
Planner).

6. Explore the patient's current and
past suicidal thoughts and suicidal
behavior; check for family
history of suicide (see interventions
designed for Suicidal Ideation
in this Planner).

7. Administer to the patient an objective
assessment instrument
for assessing suicidality (e.g.,
the Beck Scale for Suicidal Ideation);
evaluate the results and
give feedback to the patient.

8. Arrange for hospitalization
when the patient is judged to
be harmful to himself/herself
or others or unable to care
for his/her basic needs.

9. Explore the patient's history of
previous treatment for any psychiatric
disorder and the success
of, as well as tolerance for, that
treatment.

10. Assess the patient for the presence
of other medical problems
and the medications used to treat
them.

11. Perform a complete physical and
neurological examination on the
patient and send his/her blood
and/or urine for analysis to assess
any medical problem that
may contribute to the adjustment
disorder (e.g., cancer, diabetes,
hypertension, cardiovascular
disease).

12. Provide feedback to the patient
regarding the results and
implications of the physical
examination and laboratory
test results.

13. Treat or refer the patient for
treatment for any medical problem
that may be causing or contributing
to the adjustment
disorder.

14. Monitor the patient's progress in
recovery from concomitant disorders
and the impact on his/her
mood.

15. Administer objective instruments
to assess the patient's depressive
and anxiety symptoms (e.g., Beck
Depression Inventory [BDI],
Hamilton Depression Rating Scale
[HDRS], Montgomery Asberg
Depression Rating Scale
[MADRS], Hamilton Anxiety
Rating Scale [HARS]); evaluate
the results and give him/her
feedback.

16. Emphasize the negative and
dangerous impact of substance
abuse on adjustment disorder
symptoms.

17. Educate the patient on the possible
contributing factors (e.g.,
stressful life events, maladaptive
coping skills) and signs of adjustment
disorder.

18. Discuss appropriate treatment
options with the patient
including medication and
psychotherapy.

19. Educate the patient on psychotropic
medication treatment including
the expected results,
potential side effects, and dosing
strategies.

20. Assess the patient for potential
benefit from psychotherapy and
refer him/her to a psychotherapist,
if necessary.

21. Monitor the patient's response to
psychotherapy; assess his/her
ability to verbalize a basis for
progress in recovery from the
adjustment disorder (e.g., improved
mood, reduced anxiety,
increased ability to cope with
adversity, improved social and
occupational functioning).

22. Explore the adjustment disorder
symptoms that are experienced
by the patient (e.g., excessive
worry about a current stressor,
sad mood, decreased sleep, reduced
appetite).

23. Determine if the patient has debilitating
symptoms of anxiety
(e.g., worry, nervousness, reduced
sleep) that interfere with
his/her functioning.

24. Prescribe to the patient an anxiolytic
or hypnotic agent (e.g., zolpidem
[Ambien(r)], zaleplon [Sonata(r)],
lorazepam [Ativan(r)],
flurazepam [Dalmane(r)],
triazolam [Halcion(r)], diazepam
[Valium(r)], chloral hydrate
[Noctec(r)], estazolam [ProSom(r)],
temazepam [Restoril(r)])
to help the patient with sleep
(see the Sleep Disturbance chapter
in this Planner).

25. Consider the use of a long-acting
benzodiazepine (e.g.,
clonazepam [Klonopin(r)],
diazepam [Valium(r)]) to help
alleviate excessive daytime
anxiety.

26. Avoid the use of benzodiazepines
and other hypnotics if the
patient has a history of substance
abuse; use an alternative
medication (e.g., hydroxyzine
[Atarax(r) , Vistaril(r)], diphenhydramine
[Benadryl(r)], trazodone
[Desyrel(r)]) for the
patient.

27. Instruct the patient to minimize
his/her use of medication and
take it only when symptoms
become intolerable.

28. Titrate the medication every two
to three days, as tolerated, until
the patient's symptoms are controlled
or the maximum dose is
reached.

29. Monitor the patient frequently
for the development of side effects,
response to medication,
adherence to treatment, and
abuse of the medication.

30. Explore the adjustment disorder
symptoms that are experienced
by the patient (e.g., excessive
worry about a current stressor,
sad mood, decreased sleep, reduced
appetite).

31. Determine if the patient has debilitating
depressive symptoms
(e.g., sad mood, tearfulness, decreased
appetite) in response to
a chronic stressor (e.g., chronic
medical illness, ongoing financial
or legal problems).

32. Consider prescribing a selective
serotonin reuptake inhibitor
(SSRI) (e.g., fluoxetine
[Prozac(r)], sertraline [Zoloft(r)],
paroxetine [Paxil(r)], citalopram
[Celexa(tm)], escitalopram
[Lexapro(tm)]) to help treat the patient's
depressive symptoms (see
the Depression chapter in this
Planner).

33. Titrate the patient's SSRI antidepressant
medication to the
minimum effective dose for
treating the patient's symptoms.

34. Monitor the patient frequently
for the development of side effects,
response to the SSRI
medication, and adherence to
treatment.

35. Increase the dose of the SSRI
antidepressant every four to six
weeks, as tolerated, until the patient
has a satisfactory response
or the maximum dose is reached.

36. Repeat administration of objective
rating instruments for assessment
of the patient's depression
and anxiety; evaluate the
results and give him/her
feedback.

37. Maintain the patient on current
medication until the stressor(s)
resolve and/or the patient develops
better coping skills to reduce
his/her depression or anxiety
without medication.

38. Continue antidepressant treatment
indefinitely if he/she has
had previous episodes of adjustment
disorder and has shown
limited or no progress in developing
adequate coping skills to
effectively deal with adversity.

39. Reduce medications gradually
over several days to weeks;
monitor closely for recurrence
of symptoms and/or withdrawal.

DIAGNOSTIC SUGGESTIONS:


Axis I:
309.0 Adjustment Disorder with Depressed Mood

309.24 Adjustment Disorder with Anxiety

309.28 Adjustment Disorder with Mixed Anxiety and
Depressed Mood

309.3 Adjustment Disorder with Disturbance of
Conduct

309.4 Adjustment Disorder with Mixed Disturbance
of Conduct and Emotions

309.9 Adjustment Disorder Unspecified

296.xx Major Depression

309.81 Posttraumatic Stress Disorder

308.3 Acute Stress Disorder

V62.82 Bereavement

305.00 Alcohol Abuse

305.60 Cocaine Abuse

Axis II: 301.83 Borderline Personality Disorder

(Continues...)







Excerpted from The Psychopharmacology Treatment Planner
by David C. Purselle Charles B. Nemeroff Arthur E. Jongsma, Jr.
Copyright © 2003 by David C. Purselle Charles B. Nemeroff Arthur E. Jongsma, Jr..
Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents

PracticePlanners® Series Preface.

Acknowledgments.

Introduction.

Adjustment Disorder with Depression or Anxiety.

Anger Management.

Antisocial Behavior.

Anxiety.

Attention Deficit/Hyperactivity Disorder (ADHD)—Adult.

Borderline Personality.

Chemical Dependence—Relapse Prevention.

Chemical Dependence—Withdrawal.

Chronic Fatigue Syndrome.

Chronic Pain.

Cognitive Deficits—Dementia.

Cognitive Deficits—Developmental Disorder.

Depression.

Dissociation.

Eating Disorder.

Female Sexual Dysfunction.

Impulse Control Disorder.

Male Sexual Dysfunction.

Mania/Hypomania.

Medical Issues—Delirium.

Obsessive-Compulsive Disorder (OCD).

Phobia-Panic/Agoraphobia.

Posttraumatic Stress Disorder (PTSD).

Psychoticism.

Sleep Disturbance.

Social Discomfort.

Somatization.

Suicidal Ideation.

Appendix A: Commonly Used Psychiatric Medications.

Appendix B: Bibliotherapy.

Appendix C: Index of DSM-IV-TR Codes Associated with Presenting Problems.

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