Situation
YW is a 54-year-old woman who was diagnosed with Fibromyalgia, Emotionally Unstable Personality Disorder of the Borderline type (BPD), Complex Post Traumatic Stress Disorder (PTSD), and Recurrent Depressive Disorder.
Background
The patient has required the help of mental health services since 1995. Her hospital admissions history includes more than 10 admissions over the period 1996 to 2017. Typical reasons for admission included low mood and emotional instability. YW finds it hard to engage with community services and feels more conformable with one on one treatment. Recently, the patient has been diagnosed with Fibromyalgia, which has further complicated her road to recovery. She has a past medical history of hypertension, Type II Diabetes, and Hypothyroidism. As a child, the patient experienced abuse from family members, and it is hard for her to recover these lost relationships.
Assessment
YW struggles to manage her self-harm urges and continues to display anxiety symptoms. She often feels discouraged and hopeless because of her Fibromyalgia diagnosis, which prevents her from performing various daily activities. Moreover, YW continues to experience nightmares connected to her past experiences of abuse. The nightmares are also often followed by persistent insomnia. YW’s motivation is reduced. However, she continues to engage with treatment and is seen to be more active in her communication with friends and family.
Recommendation
The patient continues to take various medications for all diagnoses. She takes Venlafaxine for her physical pain and depression, Zolpidem to rebalance her sleeping pattern, Doxazosin to prevent nightmares, Lorazepam to lower the symptoms of anxiety such as agitation, and Paracetamol for general pain relief. She was also recently introduced to hydrotherapy. The main recommendations for YW include the continuation of medication and its review, psychological therapy (1:1 and in groups), hydrotherapy, further exposure to community activities and participation in family life.
Links between Mental and Physical Health Issues
The patient’s diagnosis of fibromyalgia may influence her mental health. According to Palagini et al. (2016), fibromyalgia often affects people’s sleep patterns, moods and levels of energy. Therefore, it is vital to address this problem in combination with all other diagnoses. Physical pain in the case of YW cannot be separated from other health-related issues. For instance, the patient’s difficulty in sleeping caused by PTSD may be enhanced with physical pain. The patient often feels distressed because of her inability to perform activities that could help her through tough periods.
A few years ago, she was able to clean her house as a way of distraction from negative thoughts. Currently, she is unable to do the same, which impacts her ability to cope with low mood. This physical health problem can be identified with such symptoms as pain, fatigue, persistent insomnia and disturbed sleep patterns (Macfarlane et al., 2017). The prescribed medication should also reflect this situation, as some types of drugs can be used to manage physical pain as well as mental health issues.
Desired Effects of Medication
Venlafaxine – This antidepressant may improve patients’ moods, increase their level of energy, and help manage pain. By adjusting the levels of serotonin and norepinephrine, this drug can help the patient to feel better (Paton et al., 2015).
Zolpidem – This is a sedative that is used to help people treat insomnia. It is a short-term working medication. It has muscle relaxing properties, which may assist YW with falling asleep.
Doxazosin – It is a psychotropic that is used for treating PTSD. In this case, it is expected to help YW with nightmares (Smith and Koola, 2016). The evidence shows that treatment with Doxazosin results in fewer trauma-related nightmares during sleep and improved quality of life during the day.
Lorazepam – This medication is usually used to treat anxiety disorders. Here, it is prescribed with an intention to reduce YW’s levels of agitation (Silk, 2015). As the patient has to take Lorazepam during a moment of panic, it should lead to the fast management of severe anxiety.
Tramadol and Paracetamol – These medications are used to reduce physical pain and discomfort. As YW’s symptoms are improving, she does not take Tramadol anymore and uses Paracetamol occasionally.
Unwanted Effects of Medication
Venlafaxine – This antidepressant has many adverse effects directly connected to YW’s mental health issues. The possible risk of increasing YW’s suicidal thoughts and behaviours is especially notable as the patient has expressed fewer suicidal ideations in the last few months (NICE, 2017). Thus, a higher dose of Venlafaxine may lead to negative outcomes. Moreover, the increased probability of self-harm is another alarming effect of this drug.
Zolpidem – Such side effects as a headache, dizziness, chest pain, and depression are rather common among people that take Zolpidem. This drug may also negatively affect the patient’s sleep and her ability to perform various tasks during the day.
Doxazosin – Dizziness in the most probable unwanted effect. Shortness of breath and confusion can also affect the patient and limit her ability to function. Other adverse outcomes, such as swelling, fainting, and blurred vision, are less common. The risk of hypotension from this medication is lower than its analogues (Smith and Koola, 2016).
Lorazepam – Low blood pressure as an effect of Lorazepam can negatively affect YW’s health. Cognitive problems can occur, along with opposite reactions such as increased excitement. Suicidal thoughts and memory problems are also among the unwanted effects.
Tramadol and Paracetamol – The occasional dosage of Paracetamol should not have many adverse effects on the patient. However, an overdose may cause liver damage, breathing problems, and skin reactions.
Adherence/Concordance Strategies
The patient benefits from taking the prescribed medications as they help her with various parts of her daily life. Therefore, it is vital to show her that adhering to the proposed treatment plan leads to positive outcomes. Stressing the goal to be able to increasingly participate in the life of her son and her friends can be used to motivate YW to continue taking her medication. The concordance between physician and patient can be achieved by providing the patient with all necessary information regarding the medication. YW already positively responds to treatment, and she has experience with various types of drugs. Thus, it may be easier for her to recognize that some medications work efficiently and are useful for her well-being.
Interventions for Health Promotion
As YW has already made some steps on her path to recovery, it is important to acknowledge this progress and focus on the patient’s strengths. YW is no longer taking medication for pain, and she can participate more in her son’s life. However, the patient still experiences occasional physical discomfort, and it is vital to address this before trying to focus on mental health issues. Theadom et al. (2015) note that mindfulness and relaxation therapies can have some positive effects on patients with physical pain.
YW has stopped taking medication for pain management, and now one can suggest some mindfulness training for her. A programme involving stretching and breathing exercises can help YW feel better and be more active during the day. YW’s sleeping patterns may also improve with these practices, but here the role of medication is important as well.
Conclusion
YW is a person that has engaged with various types of treatment and achieved significant progress as a result. There is much to be done, but the patient continues to try hard to get better. This case study shows that the issues of physical health can affect one’s mental state. However, within their treatment, all aspects of the person’s well-being should be considered. YW’s case shows that she is in the process of dealing with both physical and mental problems and that her ability to progressively gain control over her life positively affects all her diagnoses.