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Compare your response to two of your peers. Do you agree with their decision making? What are the pros and cons of their choices? What other suggestions might you offer?

Your response should include evidence of review of the course material through proper citations using APA format.

Week 6 Discussion 1: Depression Scenario

NU-643-01

Tiffany Audlin

Regis College

The medication I chose for Allison was Sertraline (Zoloft) 50mg po qd (Hirsch & Bimbaum, 2018). If she is having no response to the medication, I will need to see how long she has been on this and review her symptoms. Sleep, energy, and appetite may show some improvement within the first week or two. An early sign that the medication is working is improvement in physical symptoms. Depressed mood and lack of interest in activity may need about six to eight weeks to really see an improvement (NAMI, 2019). With this being said, I would increase Allison’s Sertraline. Patients not responding to a 50 mg dose may benefit from dose increases. Dose changes should be made in steps of 50 mg at intervals of at least one week, up to a maximum of 200 mg/day. Changes in dose should not be made more frequently than once per week given the 24-hour elimination half- life of sertraline (EMC, n.d.). There are no specific medical tests required before starting an SSRI (Hirsch & Bimbaum, 2018). In a study done by Kesim, et al., 2011, blood glucose, insulin, high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), and triglyceride values were all measured in patients before, and at the 4th, 8th and 12th weeks after treatment with sertraline. The results of this study showed no changes in the physical exam, (blood pressure, BMI, body weight, height, waist circumference) and laboratory findings (glucose, HDL-C, LDL-C, HOMA-IR and HbA1C levels) at twelve weeks compared to pretreatment values. However, there was a significant increase in insulin levels at the fourth, eighth and twelfth week and triglycerides levels rose in the eighth and twelfth week compared to pretreatment values. With this being said, sertraline-treated patients should to be followed up for blood insulin and triglyceride levels to prevent possible metabolic changes. I do not feel a referral is needed at this time as I would plan on continuing with weekly psychotherapy for Allison and her family. Therapy would include cognitive therapy (for Allison) which usually lasts between six to eighteen weeks. This type of therapy helps people learn to turn negative patterns of thinking into more positive ones, thus improving their mood (Keitner, 2019). I would also include family and couple’s therapy for Allison’s children and her partner. Studies have shown that these types of therapy can improve dysfunction in those families dealing with a member who is depressed. Plus, support from a family member or partner has been shown to decrease the frequency of depression following a stressful life event (Keitner, 2019).

If Allison’s mood has lifted but her energy and motivation was still poor and she was only having a partial response to the Sertraline, I would first need to make sure she was compliant with her treatment regimen before considering augmenting, combining or switching medications (Thase, 2009). This can be done by having the patient complete the Patient Medication Adherence Questionnaire (PMAQ). Another thing that needs to be considered is whether or not she may have some underlying medical condition like hypothyroidism that is not being treated (Gaynes, 2009). Many patients with depression that respond to treatment continue to have significant symptoms. The standard of care in a situation like this is to switch or add an antidepressant or augment with other types of agents (Marin & Menza, 2004). Fatigue is not only a common complaint in primary care, it is a common symptom in depression, a predictor of future depression and a common symptom in treated depressive patients (Marin & Menza, 2004). Serotonergic agents can be a cause of fatigue especially if fatigue was not present or not really an issue at the start of treatment. Managing low energy and motivation can be done by ruling out certain causes like medical issues or medication, looking at certain lifestyle changes, acknowledging fatigue and developing a treatment plan, through regular exercise and if necessary, medication management (Marin & Menza, 2004). In Allison’s case I would prescribe Bupropion XL (Wellbutrin) initial dose of 150 mg once daily in the morning and then increase dose to 300 mg after four days (Stahl, 2017, p. 109), as this medication has an alerting affect, has been proven useful in attention deficit disorders and does not seem to affect the psychomotor performance (Marin & Menza, 2004). Polypharmacy and augmentation have its advantages over-dose increases and switching (monotherapy) strategies. It avoids the loss of therapeutic benefits from the first line agent as well as any risk of withdrawal symptoms that could occur with switching (Papakostas, 2009). Another advantage of augmenting is that it may help resolve depression and depressive symptoms and also target the effects of the first-line agent. Augmenting with an atypical like Bupropion has been the best studied and an effective strategy for managing treatment resistant depression (Papakostas, 2009). Bupropion XL does not require any routine lab testing. The only recommendation is to monitor blood pressure prior to starting medication and periodically during treatment (Stahl, 2017, p. 108). Again, as stated above I do not feel a referral is needed at this time as I would plan on continuing with weekly psychotherapy for Allison and her family.

Allison now has sexual side effects that are interfering with her quality of life. In this situation, I would add another agent because her mood has improved on the Sertraline. I would prescribe Bupropion XL (Wellbutrin) initial dose of 150 mg once daily in the morning and then increase dose to 300 mg after four days (Stahl, 2017, p. 109). Bupropion’s mechanism of action involves blocking the reuptake of norepinephrine and dopamine. Drugs that may improve sexual side effects secondary to SSRIs include bupropion and phosphodiesterase-5 inhibitors (Hirsch & Bimbaum, 2019).Patients with SSRI induced sexual dysfunction do not respond to lower doses or watchful waiting (Hirsch & Bimbaum, 2019). It is suggested to switch antidepressants rather than augment in those that have had considerable benefit from SSRI therapy but have severe sexual dysfunction, or with modest benefit from SSRI therapy and moderate sexual dysfunction (Hirsch & Bimbaum, 2019). Patients treated with SSRIs who obtain substantial relief from the depressive syndrome like in Allison’s case and suffer only moderate sexual dysfunction are typically managed by augmenting the SSRI with a second drug, like phosphodiesterase-5 inhibitors or bupropion. For women with sexual dysfunction, bupropion is recommended at higher doses rather than a phosphodiesterase-5 inhibitor which is a recommended treatment for men with erectile dysfunction (Hirsch & Bimbaum, 2019). Bupropion XL does not require any routine lab testing. The only recommendation is to monitor blood pressure prior to starting medication and periodically during treatment (Stahl, 2017, p. 108). I would continue psychotherapy with Allison and her partner twice a month as needed. The role of this type of therapy is to help them explore their sexual concerns and help them communicate their needs to each other. With certain lifestyle changes such as good sleep practices, reducing stress, exercise and encouraging them to establish regular date nights that they can spend away from family responsibilities, it is possible to have a satisfying sex life while keeping the depression under control (Shifren, 2019).

Peer Response one (E.H)

 

Five Factor Personality Test

The Five Factor Personality Test (FFPT) is a test with which I am somewhat familiar as having taken in previous classes. The test and its associated factors provide a potential snapshot of an individual’s interpersonal functioning (Buchanan, N.D.). On the FFPT, my scores are largely indicative of how I view my overall personality and how I interact with others.

Scores

Specifically on the test, my scores indicate that I am relatively extraverted and often seek out social interactions. Further, in such situations, I am relatively agreeable and get along well with others, but this is average in comparison with my peers. With respect to conscientiousness, based on my scores, I usually identify and stick to a task until its completion.

Additionally, my neuroticism, or propensity to experience negative thoughts and emotions is relatively low in comparison with this aforementioned peer group. Further, it is indicated in my scores on the FFPT, that I am generally open to new experiences and am interested in activities such as art and culture. Again, these scores are not surprising and very much correlate to how I perceive my own identity and functioning.

Influences on Personality Development

Looking back, I see a number of influences that have contributed to my personality development and potentially the scores on this measure. I believe that one major influence was my relationship with my paternal grandmother growing up. As both my parents worked, my grandmother took on a major role in raising me. From her, I learned that the world is relatively safe place and to be friendly with nearly all that you encounter. Additionally, I learned to appreciate the arts, particularly music and film.

Another major influence in my personality development were/are my social relationships. While my school environment was not always the safest and most pro-social with respect to behavior, I was fortunate to also have friends who made better choices. Further, these individuals were open and accepting. Thus, I did not have to engage in inauthentic behavior in an attempt to fit in or gain acceptance. This aforementioned openness also allowed me to reciprocate when interacting with new persons in my life, helping me to form friendships.

Present Functioning

Presently, these aforementioned personality traits are largely stable. I continue to have a general openness to new experiences and new people. I also tend to be relatively extroverted, though within the past several years, I have begun to enjoy and gain a greater appreciation for alone time. Overall, I believe my openness has helped me not only in interpersonal relationships, but also in my clinical work. Further, I believe that it helps me in building and maintaining helping relationships, as I can avoid being judgmental and expressing acceptance to my clients (Broderick & Blewitt, 2015).

Broderick, P. C., & Blewitt, P. (2015). The life span: Human development for helping professionals (4th ed.). Upper Saddle River, NJ: Pearson Education.

Buchanan, T. (n.d.). Five factor personality test. Retrieved March 10, 2013 from http://www.personalitytest.org.uk/

Peer Response two (A.A.W)

 

The Five Factor Model of Personality describes five major domains or traits, which are extraversion, agreeableness, conscientiousness, neuroticism, and openness (Buchanan, n.d). The scores I received were 35 for extraversion, which is relatively high, 27 for agreeableness, which is about average, 38 for conscientiousness, which is relatively high, 26 for neuroticism which is relatively high, and 28 for openness which is about average (Buchanan, n.d). These scores are determined by comparing my results to other’s that have taken this test.

Accuracy

I have taken multiple personality tests and I expected this test to be very lengthy, which is was not and I like that about this test. I believe my results are accurate for the most part. Having a high score for extraversion, conscientiousness, and neuroticism I feel really describes me because I am very outgoing but there are times where I like to stay to myself and I am always working hard to achieve my goals. I am also very insecure with myself and I have severe anxiety. I scored about average for agreeableness. I agree with my score for agreeableness because I tend am a friendly person but there are times when I am not as trusting so I feel that scoring about average is a good balance for this domain. The openness domain and my results for this is the only area I feel is inaccurate. I am very open to new things and I love learning about other cultures and art. I also have also described myself as creative and imaginative so I feel I should have scored relatively high for this trait. Personality traits are stable patterns in individuals and these help to distinguish individuals from one another (Specht,Egloff, & Schmukle, 2011). Learning about my own personality traits from this test gave insight into how I compare to others in these domains.

Two Influences

The first event that influenced me was the death of my grammy. This was a very hard time for me because I felt like I could have done more to prevent her from passing away so this has caused me a lot of anxiety. Although this happened years ago, it still affects me because I am afraid that I will miss signs from someone else important to me or that I have not helped someone as much as I could have. Trauma can affect one’s personality traits and it is important for an individual to learn ways to cope with their trauma in order to be more self-efficient (Broderick, & Blewitt, 2015).

The second event that influenced me was joining the military and going through basic training. Basic training helped me to see that I am strong and achieve anything I set my mind to. I developed amazing relationships with so many different people while in training and this has helped me to continue to explore new cultures and meet new people in my life today.

Personality Traits Manifestation

When it comes to my career goals my personality traits, as well as events in my life, have influenced who I am today. Having anxiety due to my trauma and other life events have made me want to pursue a career in counseling because I want to help people that have gone through what I have. Being outgoing and open minded has helped me in my relationships because I feel it is easy for me to start up a conversation and discuss a range of topics without being judgemental. “A general sense of self-efficacy, optimism, self-esteem, personal control over important goals, and social support are among the characteristics that are associated with greater physical and emotional health and well-being “ (Broderick, & Blewitt, 2015, p. 544). Although I have anxiety and doubt myself at times, I am still very optimistic about my career and personal goals and I feel that I have a good support system in my life.

Summary

I enjoyed taking The Five Factor Model of Personality because it was short and I feel it accurately described my personality traits with little information. This test provides insight into one’s personality traits and how these can affect an individual’s life from childhood to adulthood. It was nice to learn and understand the different life events that have influenced who I am today and my personality.

References

Broderick, P. C., & Blewitt, P. (2015). The life span: Human development for helping professionals (4th ed.). Upper Saddle River, NJ: Pearson Education.

Buchanan, T. (n.d.). Five factor personality test. Retrieved March 10, 2013 from http://www.personalitytest.org.uk/

Specht, J., Egloff, B., & Schmukle, S. C. (2011). Stability and change of personality across the life course: The impact of age and major life events on mean-level and rank-order stability of the Big Five. Journal of Personality and Social Psychology, 101(4), 862–882. Retrieved from the Walden Library databases.