Role: Psychiatric Social Work Intern. Assessment; psycho-education; advocacy; exploring risk-protecting factors; exploring PIE factors; exploring ecological barriers; collaboration with other treatment members and providers; inform client's rights; service referrals.
Client: 16 year-old teenager.
Context: Group Home.
Presenting psychiatric symptoms: depression; complaints of lethargy, low appetite, insomnia, low sex drive, meaninglessness in life.
Treatment services: individual and family therapy, CBT and IMPACT integration to target depression. Family has a history of depression in father and brother. Intern is locating services in community for the client to address his interests in basketball.
Co-morbidity: None. Client is a healthy teenager. No substance abuse history. No prior history of physical/emotional/sexual abuse.
Drug treatment of choice: Prozac.
Client's concerns/resistance to pharmacological treatment: only "crazy kids" take psychotropic medication, medication will make the client "crazy" as well, and medication will "mess" with his libido.
Pharmacological treatment plan: starting Prozac at a low dosage to help the client ease into treatment. Prozac is relatively cheap, has long half-life, and needs only to be taken once a day. This addresses the client's concern of having to take too many medications and also have friends seeing the medication being taken at school, as medication can be taken in the morning.
Medication adherence: staff monitoring, tools suggested to client for self-efficacy such as setting up repeat reminders in cellphone, free apps such as MediSafe or Nightingale, and Intern will check on the client via phone to ensure that medication is being taken consistently.
Efficacy: It is stressed to the client that he is taking important steps toward treating his depression, as therapy + medication have been shown to be very effective in alleviating depression. It is also emphasized that medication must be taken consistently in order for it to be effective, and it takes around 4-6 weeks for the client to notice improvement in symptoms (somatic [first], cognitive, affective).
Side Effects: upset stomach, diarrhea, reduced sex drive/sexual dysfunction, serotonin syndrome, anxiety and black box warning of suicidality.
Treatment for side effects: GI side effects tend to subside over a couple of weeks, and PRN is described to help. Sexual-related side effects are framed as cost vs. benefit, with the client's recovery from depression and not being currently sexually active worth the risk of this side effect. Serotonin syndrome: avoid any other drugs that increase serotonin as well, such as MAOI, TCA, cocaine, LSD, ecstasy. Black box warning: contact intern and psychiatrist immediately, Prozac might have to be adjusted or switched.