Ms. Yasmin has done an amazing analysis of the case study and extensively covered all aspects of the case in relation to dementia. The level of detail provided in each section is exceptional, as seen for instance in the description of current medications. The expectation was to see an examination of the different medications and possible drug interactions with them. However, Yasmin has provided even more detailed analysis of the appropriateness of the different medications, which I think is important since the objective of the therapist is to improve the health-related quality of life and one of the approaches for achieving this is by ensuring that medications administered to patients can result in the intended outcome.
One of the areas in which Ms. Yasmin has done a really good job is in the analysis of the risk factors and the patient assessment. As part of the risk factors, Yasmin has effectively linked observed patient behaviors to literatures that indicate the probability of dementia. For instance one of the risk factors identified is the mini mental state exam score of 23, which indicates the probability of dementia as reported by Kilgus, Maxmen and Ward (2016). This extensive description of risk factors and use of authoritative supporting references makes the diagnosis reliable and the analysis a credible source of information on the patient’s condition. Additionally, the actual assessment of the patient addresses several aspects of well-being, and the fact that Ms. Yasmin has provided a detailed connection between observed symptoms and the DSM-V classification of mental health conditions enables a reader to understand the case and the rationales for the diagnosis and the treatment.
The subject of medication compliance is one of the issues of concern in the treatment of mental health diseases. Ms. Yasmin has touched on this subject in spite of the absence of adequate information regarding BT’s status of compliance. This mention is an indication of emphasis on patient wellbeing and understanding of factors that contribute to positive patient outcomes, as well as attention to detail. Other factors such as adverse effects of medication and dosages, which are important determinants of treatment outcomes in mental health issues, are also presented.
Another area in which Ms. Yasmin’s analysis is exceptionally presented is on the short and long term treatment goals. According to Harvey and Gumport (2015), the treatment of mental health diseases requires collaboration between the therapists and the patients, and defining the goals upfront creates a common vision for the two to work towards. Moreover, the description of goals is excellent because it focuses not only on the goals to the end of treatment but also on those that the client will continue working with to sustain the achieved improvements such as maintaining function and cognition and continuing with non-pharmacological measures for the long-term.
I also think that the treatment plan developed for BT by Ms. Yasmin is well-thought out and effectively presented. The justification for combining non-pharmacological with pharmacological treatments is clearly stated with sufficient evidence from existing literature. Specifically, practices such as providing supportive and educational therapy and involving family in the treatment process are mentioned as part of the non-pharmacological therapy. The importance of social support from family and friends is extensively discussed by Carrion, Folkvord, Anastasiadou, and Aymerich (2018), who emphasize that such support is essential towards enhancing memory. In the pharmacological treatment, I feel that Ms. Yasmin has provided sufficient detail regarding the prevalence of multiple morbidities among patients with dementia and the need to choose medications that address cognitive impairments without interfering with other body functions or the functioning of other medications.
In describing the prescriptions, I commend the method used by Ms. Yasmin. She has considered both new and current medications as part of the overall treatment plan, and provided dosages and utilization schedules that are likely to reduce the probability of medication interactions. The rationale for the different medications is clearly understood based on the descriptions of the biological and clinical features of dementia as well as the links between various pathological mechanisms such as that of dementia and that of Alzheimer’s disease as described by Stahl (2017). I agree with the recommended starting dosages of both Donepezil (Aricept) and Atorvastatin at 5 mg/day and 10 mg daily, respectively, since the patient symptoms indicate mild dementia. The recommended dosage adjustment plans are also reasonable given that they are accompanied with detailed treatment objectives, which can function as the measurement yards for patient improvement. Since the patient is already under some medications, I also think that including the current medications as part of the pharmacological treatment plan is brilliant because many patients with mental health issues such as dementia tend to forget their medications, especially due to the burden of drug loads, which reduces compliance.
Overall, I think Ms. Yasmin’s case analysis is quite well-done. Besides the content, the general organization from the problem statement to the treatment plan is quite impressive and easy to follow. The treatment plan is very well presented and touches on all essential elements of the treatment process including the parameters, treatment goals and methods, and medication alteration plans where necessary. Such a plan can facilitate the realization of intended treatment outcomes within a shorter period of time due to ease of monitoring and reporting.
Carrion, C., Folkvord, F., Anastasiadou, D., & Aymerich, M. (2018). Cognitive therapy for dementia patients: A systematic review. Dementia and Geriatric Cognitive Disorders, 46, 1-2. https://www.karger.com/Article/FullText/490851
Harvey, A. G., & Gumport, N. B. (2015). Evidence-based psychological treatments for mental disorders: Modifiable barriers to access and possible solutions. Behavior Research and Therapy, 68, 1-12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4395546/
Kilgus, M., Maxmen, J., & Ward, N. (2016). Essential psychopathology and its treatment. (4th ed.). Norton & Company, Inc.
Stahl, S. M., (2017). Prescribers Guide: Stahl’s Essential psychopharmacology. Cambridge: Cambridge University Press.