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Case study example:
Student completed a case study on an 80 year old male, two
months after patient's admission into a nursing home. Patient
came to facility directly from an evaluation in an acute psychiatric
unit where he had been referred after a six day acute hospital
stay.
Patient was prescribed anti-depressant, remeron. At the time
of the student's evaluation, the patient had a Mini
Mental Status Exam score of 28 and a Cornell
Scale for Depression score of 15, indicating the presence
of depression. His threats to kill his wife and son frightened
the staff.
The student recommended a re-evaluation of his medication
management, given the possibility of side effects with remeron
and its potentiality for contraindication with other drugs.
She also recommended consideration of a low dose anti-psychotic.
The student did not believe that the patient, who was physically
debilitated, was capable of acting on his threats. She believed
instead, that his threats were a manifestation of his anger
regarding his placement in a nursing care facility.
Patient was transferred to a nursing home that housed a gerontology-psychology
program and an on-site psychiatrist. He received medication
management and individual and family psychotherapeutic intervention.
Student Comments on Self-Evaluations:
"Although I was not sure I needed the specific course,
I have a much better understanding of how to assess depression,
dementia, and delirium in older adults. Also, I am more comfortable
using the DSM-IV."
"I wish I'd had this course last semester, so that I
could use what I learned sooner. I am paying much more attention
to mental health concerns when assessing and working with
older patients. I also can provide different kinds of care
than I did before and I understand the reasons for certain
behaviors."
"It was good to get some more specific information about
psychiatric medication management for older adults. Also it
was helpful to examine recent research which shows that older
adults can respond to therapy and that activities like exercise
can promote older people's mental health."
"I now know what cognitive therapy is."
"I was uncomfortable coming into class because of some
family history of psychiatric problems. As a result of being
in class, I've grown more comfortable, and I think I will
be better able to evaluate problems in older adults and help
them to get the help they need."
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