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Therapeutic Approaches

.. rapeutic Day Services (TDS) run by the Community Mental Health Team (CMHT) on a regular basis. These services consist of various groups such as art therapy groups, music therapy groups, anxiety management, and depression groups. This service also has a canteen and recreational meeting area, which is run and staffed by some of the long term clients as well as clients that no longer use the service but wish to continue to offer support to others. This will allow Joan to meet other people of a similar age group and circumstance to herself as well as benefiting from some of the therapeutic groups that are available. To help relieve the symptoms of Joan’s depression she is prescribed two Lofepramine 70mg at night. Breggin, (1993) states that the aim and justification for psychiatric drug treatment is to relieve a person who is tormented and preoccupied with their mental experiences whilst neglecting most other parts of their life.

Ironbar, (1989) however, points out that chemotherapy can have unpleasant and potentially harmful side effects if not administered and monitored carefully. Lofepramine is a member of the tricyclic antidepressant group. The most important point to remember about tricyclic drugs is that they take a number of weeks to exert their antidepressant effects. As the effect is delayed and as depressed clients may not comply with medication if it appears ineffective, it is important that Joan’s keyworker informs Joan about the dynamics of the medication and continues to encourage and monitor Joan’s compliance with the medication. Lofepramine also has a wide range of physical side effects that Joan’s keyworker should monitor for, from dry mouth to gastrointestinal upset. Joan’s keyworker also arranges a regular weekly visit to Joan’s home, this is not only to monitor medication, but also to allow Joan’s keyworker to assess her mental well being and presentation of self.

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This will allow the keyworker to monitor for any signs of the depression worsening, and to ensure that Joan does not neglect herself. To meet Joan’s long term goals the care team arrange for Joan to attend the Therapeutic Day Services initially for one day per week during the first month, and then to increase this, after an assessment at the end of the first month, to two or three days per week. The assessment after the first month will focus upon the effectiveness of the medication, and how Joan has managed within the day services. Joan will also be present at this assessment so as to feed back to the carte team her own thought and feeling on the package of care she is receiving. If Joan and the care team then decide that Joan will benefit from continuing with the services currently provided, there will be a monthly assessment focusing upon Joan’s progress. In addition to this there will be continuous monitoring from the keyworker so that the team can take any action necessary if Joan relapses into crisis. Taking into account the variables surrounding Joan’s situation and the fact that the care package has only recently been implemented it is difficult to analyse how effective the package of care will be.

However, Joan is a very sensible lady who has no problems with contacting someone for help, as long as that help is made readily accessible. Joan’s depression stems from poor contact with her family and gradually increasing isolation from society. Most of Joan’s social circle has died around her leaving a social void in her life, attending the Therapeutic Day Services is meant primarily to allow Joan to leave her house and meet with new people on a regular basis. The care team decided Joan’s visits to the day centre should start with one day a week and increase after a month, this is to give the medication time to become effective, and to allow Joan time to get to know the layout of the day centre and get to know some of the staff and clients that are there. Social interaction is a vital part of our mental well being.

Smith, (1990) states that people who experience poor family relations often need a great deal of social support, social and emotion stress plays a significant role in the symptoms of serious mental disorders. In addition to the social benefits of Joan’s attendance of the day hospital, it will also give the care team a chance to meet Joan and to encourage her involvement in some of the therapeutic groups available. Joan’s medication if effective will lift the main symptoms of her depression which will allow Joan to feel better within herself and so more able to interact with others. Regular visits from the keyworker will allow Joan to be monitored for any side effects of the medication, and allow the keyworker to chat to Joan and listen to her thoughts and feelings. In conclusion the author feels that the care package that has been put in place by the care team is the most appropriate for Joan’s current circumstances, the regular assessments will allow for changes in Joan to reflect in the care package.

The medication prescribed to Joan will help relieve the main symptoms of depression chemically, so that Joan may feel able to work on her depression cognitively through therapy groups and one to one sessions. This may lead to a lesser reliance on medication, and leave Joan at less risk from the many side effects that may occur. Bibliography BREGGIN. P, (1993). Toxic Psychiatric, Drugs and Electroconvulsive Therapy.

The Truth and the Better Alternatives. London, Harper Collins. WOOD. D, (1992). The Prescription of Exercise for Depression. The Physician & Sports Medicine, Volume 6, 37-42.

FISHEL. A, & JEFFERSON. C. B, (1983) Assertiveness Training for Hospitalised, Emotional Disturbed. Journal of Psychosocial Nursing, Volume 21, 22-27.

IRONBAR. N. V, HOPPER. A, (1989) Self-Instruction in Mental Health Nursing. 2nd Edition, Bailliere Tindall. LYTTLE. J, (1994) Mental Disorder – Its Care & Treatment, Bailliere Tindall.

McFARLANE. J. T, (1978). Running Out of Depression. The Physician and Sports Medicine, Volume 6, 49-56. McKEON.

C. K, (1992). Comparison of Effectiveness of Group Interventions for Depressed Women. Archives of Psychiatric Nursing, Volume 7, 277-283. NEUMAN.

B, (1989) The Newman System Model. 2nd Edition, Prentice Hall. ROPER. N, LOGAN. W, & TIERNEY.

A. J, (1986). The Elements of Nursing. London, Churchill Livingstone. SELIGMAN. M, (1991). Learned Optimism.

New York. SMITH, A.T, (1976). Cognitive Therapy and Emotional Disorders. New York, International Universities Press. THOMPSON. C, (1989). Affective Disorders.

John Wiley & Sons Ltd, Chichester. UNITED KINGDOM CENTRAL COUNCIL for Nursing, Midwifery and Health Visiting, (1992). Code of Professional Conduct. London, UKCC.


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