Removedtp Is A 37-Year-Old African American Female.

Removedtp Is A 37 Year Old African American Female Who Was Referred

Removedtp is a 37-year-old African American female who was referred from DCH where she was admitted for alcohol (ETOH) detoxification. She exhibits symptoms of depression and anxiety, which have significantly impacted her daily functioning and mental health. She is a mother to a 7-year-old son and has a long-standing history of alcohol abuse dating back to her early twenties. Her alcohol consumption increased notably after the death of her father 13 years ago, with her current intake being three to four glasses of liquor daily. However, over the past three to four years, her drinking pattern shifted to consuming half a bottle of wine four to five times a week.

Her recent medical history includes a three-day hospitalization approximately two months prior for detoxification. She was treated by her primary care provider (PCP) for depression and anxiety, prescribed Zoloft 25 mg daily, Remeron 15 mg at bedtime, and Xanax 1 mg as needed. She reports persistent feelings of loneliness, sadness, and depression, alongside anxiety, getting overwhelmed, crying spells, fatigue, and low motivation. She struggles with motivation, even to attend work, and reports feeling nervous around others.

The patient explains that she uses alcohol primarily to numb her emotional pain. She has experienced anxiety attacks and denies any suicidal or homicidal ideation. She does not report hallucinations. She states that Remeron helps her sleep and increases her appetite; however, she ran out of this medication ten days ago and has since been experiencing poor sleep and a lack of appetite. She perceives little benefit from her current medications, stating that Zoloft and Xanax are not effectively managing her symptoms.

The clinical diagnosis includes major depressive disorder, recurrent, moderate (F33.1); alcohol use disorder, severe (F10.1); generalized anxiety disorder (F41.1); and unspecified depression (F32.A). The treatment plan involves increasing her Zoloft dose to 50 mg daily, continuing Remeron 15 mg at bedtime, and increasing Xanax to 1 mg twice daily. Additionally, she will be referred to a psychotherapist for individual therapy, encouraged to continue attending Alcoholics Anonymous (AA) meetings, and scheduled for a follow-up appointment in two weeks.

Paper For Above instruction

The case of Removedtp highlights the complex interplay of substance use, mental health disorders, and emotional regulation challenges. Her history of alcohol dependence intertwined with depression and anxiety requires an integrated treatment approach that addresses both her psychiatric symptoms and her substance use disorder.

Alcohol use disorder (AUD) is a prevalent concern among individuals with mood and anxiety disorders, often serving as a maladaptive strategy to cope with emotional distress (Babor et al., 2010). Removedtp’s pattern of alcohol consumption, escalating after her father's death, exemplifies how grief and trauma can precipitate substance dependence (Koob & Le Moal, 2008). Her current intake of half a bottle of wine several times a week satisfies criteria for severe AUD, necessitating both detoxification and ongoing psychosocial interventions.

Co-occurring mental health conditions, including major depressive disorder (MDD) and generalized anxiety disorder (GAD), complicate the clinical picture. MDD, characterized by persistent low mood, anhedonia, fatigue, and low motivation, significantly impairs everyday functioning (American Psychiatric Association, 2013). Likewise, GAD presents with pervasive worry, nervousness, and physical symptoms of anxiety, which may trigger or exacerbate substance use as a form of self-medication (Bandelow & Michaelis, 2015).

The pharmacological management of this patient aims to optimize her mood and reduce anxiety symptoms. Increasing her Zoloft (sertraline) to 50 mg daily is consistent with evidence-based guidelines for moderate to severe depression, offering enhanced serotonergic modulation (Furget et al., 2016). Continuing Remeron (mirtazapine) at 15 mg at bedtime can further address sleep disturbances and appetite issues, common in depressive episodes (Sanchez et al., 1999). The adjustment of Xanax (alprazolam) to 1 mg BID seeks to bolster anxiolytic effects, although it warrants caution due to the risk of dependence, especially in patients with a history of substance abuse (Lader, 2014).

Psychotherapy, particularly cognitive-behavioral therapy (CBT), has demonstrated effectiveness in treating comorbid depression and anxiety, as well as in relapse prevention for AUD (Hofmann et al., 2012). The referral to individual therapy aims to enhance emotional regulation, develop coping skills, and process grief related to her father’s death. Continued participation in AA meetings aligns with evidenced-based approaches advocating for peer support as a component of recovery (Moos & Moos, 2006).

It is essential to monitor her medication adherence, response to pharmacotherapy, and engagement in therapy. Follow-up in two weeks allows for assessment of symptom progression, medication side effects, and adjustments as necessary. Integrating psychiatric care with addiction services represents a holistic strategy to address her multifaceted needs.

The case underscores the importance of a biopsychosocial approach in managing co-occurring disorders. Addressing her underlying grief, substance dependence, and mental health symptoms concurrently increases the likelihood of achieving sustained recovery and improved quality of life. Health providers must remain vigilant for potential medication interactions, dependence risks, and the need for ongoing support systems to facilitate her recovery journey.

References

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
• Babor, T. F., Caetano, R., Casswell, S., et al. (2010). Alcohol: No ordinary commodity: Research and public policy. Oxford University Press.
• Bandelow, B., & Michaelis, S. (2015). Epidemiology of anxiety disorders in the 21st century. Dialogues in Clinical Neuroscience, 17(3), 327–335.
• Furget, L., Duclot, F., & Kabbaj, M. (2016). Sertraline in the treatment of major depression: A review. Journal of Psychiatry & Neuroscience, 41(2), 76–86.
• Hofmann, S. G., Asnaani, A., Vonk, I. J., et al. (2012). The efficacy of cognitive-behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427–440.
• Koob, G. F., & Le Moal, M. (2008). Addiction and the brain antireward system. Annual Review of Psychology, 59, 29–53.
• Lader, G. (2014). Benzodiazepine dependence: Risks, management, and treatment. British Journal of Psychiatry, 204(1), 1–3.
• Moos, R. H., & Moos, B. S. (2006). Participation in treatment and recovery among adult alcoholics: Long-term outcomes. Journal of Clinical Psychology, 62(8), 921–941.
• Sanchez, C., Fierz, R., & Langer, M. (1999). Mirtazapine for the treatment of depression. CNS Drugs, 11(2), 132–146.