You are a Psych NP working in an outpatient clinic. You have been seeing Maria, a 34 year old Hispanic female for the last 6 months. She initially presented with severe Major Depressive symptoms and you have been treating her with Zoloft and have titrated up to 150 mg a day.
Her last visit last month she was not depressed had no anhedonia, no suicidality, and was sleeping well.
BP 110/70, pulse 70. BMI 23 with a family history of diabetes and hypertension. CBC, comp panel, thyroid panel were WNL. The LDL was elevated at 150.
Today, you get a phone call from Maria’s husband that she went out and bought a $60,000 car and has been driving recklessly for the last week. He tells you that she has been sleeping about 2 hours each night for the last week, cleaning the house, staining the garage, painting the house at all hours.
You bring her in and she and her husband recall that she had an episode like this last year when she wasn’t on any medication, when she didn’t sleep for about a week, spent about $30,000 in “stuff” on her credit card, was very irritable, thought she could do no wrong, and was talking and texting “fast”. They also recall (and never told you before) that she was on lithium at one time about 4 years ago for a few months but stopped it because of the weight gain.
Today she is irritable, stating she was thinking that she wished she was dead because she “can’t think straight”. She denies any active plan to kill herself. She is easily distractible, is not as cooperative as in most visits, talking rapidly, loud, and thoughts are disorganized. You had to redirect her on multiple occasions. She did sleep for 4 hours last night and has not lost any weight. Her husband also notes that he has noticed Maria has been drinking alcohol, about 3-4 glasses of wine at night which is not her usual 1-2 glasses a week. Maria denies any drug use.
4. What would lead you to believe that it was not alcohol induced mood disorder?
5. What are some things you would express to her about her drinking related to these risks and related to medications?
6. If Maria is unwilling you participate in further assessment, what method will you use to help her?
What is marriage? To numerous marriage is a point of reference achieved through the span of their life, and once accomplished, giving them the sentiment of being "finished". To others, marriage is the thing that makes their relationship "official" in a way and is the thing that keeps them monogamous to each other. Where a major gathering, wedding cake, and wedding rings are what make a couple no longer accessible to any other individual yet their companion. In better terms, the meaning of marriage is a "lawful" or "formal" perceived association of a man and a ladies or even same sex-as accomplices in a strong relationship. It appears that the whole idea of marriage has dependably been here, there, and all around. In the wake of exploring recordings and material expounded on marriage, it is obvious to see that there are numerous points of view on the theme. Despite the fact that numerous individuals advocate marriage and lecture all that it remains for. Others then again are battling and contend to dispose of marriage through and through. On one of the recordings that was partaken in class called, "Drop Marriage" comprised of a long video where Merav Michaeli dove deep into characterizing marriage and the genuine importance behind "spouse" and "wife". Spouse at last diverted out to source from "householder" or "proprietor", while "wife" is gotten from the expressions "disgrace" and "vulva". It influences you to address why from the earliest starting point of marriage, a wedded couple who have kids were just ready to convey the dads name. To go facilitate in to detail and truly have a superior comprehension behind marriage in todays' general public, as a class we were all to work together among ourselves to assemble an overview in which we could use as an instrument to talk with five couples-ten people. The errand was constrained and the survey indicated twenty-four special and strong inquiries that the people asked could either answer or decline to reply. Each inquiry comprised of either short answer reactions and even long ones. We were told not to record any names and keep all answers given to us classified and unknown. Once every one of us had the chance to put our last overview survey to utilize, we tallied the responses to each inquiry and conveyed the aggregate to class. A portion of the inquiries engaged with the poll where, "Do you regard your life partner?", "Do you ever consider separate?", and "What is your mystery for maintaining your marriage? Clarify." Most likely that the outcome got from the last overview survey were charming however the exercises gained from the reactions and the occasion out and out was what we as a whole left with. A few exercises about the study technique that despite the fact that we as a whole had our own particular inquiries as a top priority to contribute, it took a while for the overview to be assembled and finished. The exercise behind this battle instructed us to consider unheard of options and be available to other people groups' perspectives. The exercise took in the point emerged to us since marriage is something that has entered our thoughts at any rate once previously and we discovered that despite the fact that you may not identify with a subject since you are not hitched, does not mean you can't interface with the theme and cooperate to discover answers. Obviously, a considerable lot of us could take away imperative factors that add to a solid research process. In the event that asked what exercise I gained from the exploration part of this task, was just the meeting part to it. I was distrustful on the best way to approach moving toward ten people and get some information about their wedded life. Despite the fact that in class we were told to approach everybody and present ourselves as understudies and request that the subject help with our task. This appeared to be harder said than done. Exercise learned here was that despite the fact that you may have done fantastic and broad research on the subject at some point the real demonstration of finding solutions might be hardest part. With this stated, an exercise that I found out about myself are a couple. Initially, I discovered that it is fine to not generally know how to approach a hard theme that you can't relate with on the grounds that it doesn't relate to you, however this could be transformed into a surprisingly better motivation to handle it on in any case just to be more mindful on the issue. Another exercise I found out about myself originated from the subjects that I interfaced with and how everybody you experience knows something that you don't have a clue. Toward the finish of every poll I could have a satisfying feeling of achievement since I was holding data about individuals who I either knew or didn't have even an inkling, and with this errand done I could have an alternate point of view on the subject of marriage and people.â I discovered that I have particular talent with addressing individuals and in spite of being persuaded that moving toward others isn't my solid suit, I did for my first time. The exercise I took away about myself was to give myself more credit when looked in these circumstances and search constantly for answers regardless of what my inward voice may contrarily say to myself. Everything considered, the aggregate of answers set up together as a class was not under any condition to stunning. Marriage appeared to be separated into a demonstration that really established from affection and the other half appeared to have occurred so as to profit by what we know as "The Marriage Premium" which included bliss, wellbeing, and financial security. In spite of the fact that in general, there was much fulfillment from the relational unions we reviewed, despite everything I remain with my own perspectives on the issue. Marriage was a foundation set aside a few minutes where ladies had positively no status under the watchful eye of the law and were happily "property". Why is that today in 2016, where we live in a modernized world with present day ladies and men, that regardless we have such an establishment as this, to the point that still exists. At the point when this foundation was made, its sole design was for a lady to bring home the bacon and have the capacity to stand up alone, in this manner, a lady couldn't bear the cost of not to get hitched. All things considered, marriage to me is an understanding that keeping in mind the end goal to climb in life I should turn into a spouse and be marry to a man. I don't get tied up with this at all when we experience a daily reality such that ladies are proceeding to battle for level with pay and rights. This to me is confirmation that marriage is a fantasy so as to shield ladies from ascending to control and eventually their actual potential. Marriage to me measures up to control, and in the event that I've picked up anything about the administration framework in the U.S; it is that control implies a considerable measure to the individuals who acquire it and that is the reason the legislature for all intents and purposes pushes the populace to wed with a specific end goal to keep the control. This can undoubtedly be demonstrated by the way that administrations give cash and visas in view of marriage. Marriage is a default alternative that must be brought down. To total up, marriage is one of the numerous organizations pushed among us that must be teared down so as to fabricate something new. In the event that circumstances are changing so should our thoughts and the ways we approach things that will profit everybody not only certain people who consent to remove a portion of a foundation that does not cover everybody.>GET ANSWER