Question

• JN is a 27-year-old female patient suffering from depression and PTSD which stems from abuse as a child. She has a past history of substance use disorder which included alcohol and narcotics. She has been sober for 5 years and routinely attends Alcoholics Anonymous and Narcotics Anonymous. She has a supportive sponsor and is in regular contact with her. She is overweight with a height of 5’4’’ and a weight of 185 pounds. She has type II diabetes that is treated with metformin 1000mg daily and pioglitazone 30mg daily. Her depression and PTSD were treated with sertraline 100mg once daily. The sertraline has allowed for a moderate improvement in her depression, but the patient is complaining about not being able to sleep in part because of nightmares and flashbacks.

1. List at least three different treatment options for this patient.
2. When taking into consideration the patient’s metabolic comorbidities and history of substance abuse, what treatments should be avoided?
3. What treatment course would you prescribe (include the medication/medications, dose, monitoring and patient education)?

Answer 1

a.The different treatment options for this patients are

• Cognitive behaviour therapy helps to find out new ways by talking to the patient when they express their feelings and emotions when the incident happened
• Medication like selective seratonin reuptake inhibitor helps to reduce depression and nightmares
• Stress inoculation training helps to teach meditation, exercises,breathing techniques to reduce the negative thoughts due to the event

b.The medication regimen may elevate the patients blood sugar or in certain cases may lead to hypoglycemia ,may further lead to put on weight. When these two conditions co exist the patient will be at risk of getting cardiovascular problems The medication can lead to withdrawal symptoms. So these type of medications and treatment should be avoided.

The therapy which makes the patient aggravate or further lead to negative symptoms can impact the treatment

c.The patien will be in need if a Selective Serotonin Reuptake Inhibitor (SSRI).They act by producing the Seratonin at the right place of brain where emotion are exhibited by a person and control it.

The initial dose is 5mg and can be increased gradually as per the patient days.

Monitor the patient for side effects

• Educate the patient about the side effects
• Not to drive
• Do not take alcohol
• Report immediately in case of any suicidal thoughts