THE AIR BEHIND OUR PRISON WALLS- Prisons and rights - Free Essay Example

Sample details Pages: 10 Words: 3148 Downloads: 2 Date added: 2017/06/26 Category Law Essay Type Research paper Did you like this example? THE AIR BEHIND OUR PRISON WALLS Introduction We all have for long taken for granted ways of punishing which have relieved us the burden of thinking deeply about punishments, as a results we narrowly formulate ideas and channels of effecting this process which eventually later we fail our target of deterrence and reform for which penal systems are meant to achieve. I want us to address the punitive process and particularly its purpose for which it is meant to achieve and still in a particular way observe trial and judicial process which as result penal systems are based upon. For decades the fate of offenders have been always falling in the hands of the state. Don’t waste time! Our writers will create an original "THE AIR BEHIND OUR PRISON WALLS- Prisons and rights" essay for you Create order The state has a developed judicial system which justice is entrusted to serve. Upon apprehension of an offender majority suspects of crime are remanded to await trial for conviction or acquittal to that effect if the suspect does not afford or meet cash bail constraints. CASUALTIES OF EUROPEAN PRISONS Noticeably Africans inherited prisons from their colonial masters, structurally and penal frameworks which as well has a fundamentally European origin. Our legends for African liberations being our great grandparent, grandparents, and our elderly living were victim of the first African prisons. The best definition for torture can be best defined by the despicable prospects of European prisons our men faced during the fight for freedom. My big question is; after our liberation from the whites, did we by any chance inherit the same the current prison system was subsumed as other administrative and political arena took African control retaining European face. If Maumau movemen t for example would be re-established, the target would be leaders of our own who unfortunately have served and continues to serve with disguised European prospects where their colour have concealed their ridiculed iniquities. We must at all cost make sure our political systems serve humanity without any speck of hypocrisy, have leaders who keeps the interest of all people at heart. I know it is much to ask from the new millennium era à ¢Ã¢â€š ¬Ã‹Å"digital eraà ¢Ã¢â€š ¬Ã¢â€ž ¢ but anyway failure to comply will in all days raise criticism and we who have seen a shred of hope will be activist for this fundamental reforms. Today my concern target our prisons extensively after realization of fundamental rights which have been for a long time undermined despite international convections which we are signatory to and our newly promulgated constitution 2010 which guarantee rights to persons put in custody, detained or awaiting trial. More importantly since pan Africanism and Afr ican liberation there are no noticeable developments within our penal system or prison structures despite the fact that they have been adopted from our colonial masters. We at all times celebrate our national freedom without the realization of the existence of our own self colonialism which we suffer from by embracing neocolonialism and facilitating European colonial à ¢Ã¢â€š ¬Ã‹Å"landmarksà ¢Ã¢â€š ¬Ã¢â€ž ¢. Our prisons are the living evidence. Without mentioning Hague proceedings which have ambushed our only leaders and in addition and what appear more disturbing the despicable torture of our own liberation legends by our own leaders at Nyayo chambers. I understand some inequity is us Africans to blame but also Europeans have always with their disguised strategies manipulated our African ideals by all means. PRISONS AND RIGHTS To begin with; our penal system and prison system being a central subject in identifying African decency and free will in self Governance should be r eformed and assume new structural development and new penal system which are effective to our African heritage for practicability and humane and dignity accountancy as guaranteed by our constitution 2010 article 28. It is of vital importance to address the fate of a remandee whose individual liberties and human life features are deprived. Being a remandee/prisoner makes one eligible to be treated as a homogeneous group in a solitary confinements worthless of the society. It is irrevocable that this is the least status that a human being can acquire. Prisons are institutions which to their capacity limit most of the fundamental rights [1]which include locking up offenders for a lengthy period of time against their will during pendency of their criminal proceedings. A wide range of constraint are placed on their freedoms on what they can and cannot do. There are a few questions which we need to explore concerning individual rights of people faced with criminal charges. It is not in dispute that offenders have got their rights which are warranted by our constitution and other international humanitarian organization which we are signatories. Justice to be served to the accused the presumption of innocence until proven guilty is a prerequisite measure thus every prisoner who awaits trial in a solitary confinement with his fundamental rights deprived has his rights infringed. Constitution of Kenya 2010 Article 49-51 3(b[2]) seek humane treatments of persons detained, held in custody, or imprisoned. This include a good dietary, shelter, and clothing and conducive favorable environment for that purpose. This havenà ¢Ã¢â€š ¬Ã¢â€ž ¢t been met by our penal system despite our Kenyan constitution fundamentally expressly guaranteeing its practicability in our constitutional reforms. This is a constitutional bleach and contravention of its provisions which need to be observed to the latter. All these rights are forsaken at the first sight in our legal judicial p rocess, to my knowledge our Kenyan prison structures are the least tolerable one as far as hygiene, health decency and sanitations are concerned. In addition international convections on civil and political rights as adopted by general assembly in international standards and regulationsà ¢Ã¢â€š ¬Ã¢â€ž ¢ under article 10 stated that all persons deprived off their liberties shall be treated with humanity and with respect for the inherent dignity of the human person. Stale prison developments; There have been numerous developments in all realms of lives in our globalized economy; politics, social and scientific revolutions which have taken numerous drifts in all continents which have made the whole world a global village. Unfortunately prisons have been held dormant in their structural and operational framework since its inception, despite the fact that they are serving humans in a globalized settings. Our penal systems rarely embrace other penal procedures effectively, th is explains why our prisons are overcrowded beyond control. It have been a failure made by our penologists persistently made indeed forming the current dysfunctional characterized modern prisons.[3] Lawrence stone in addressing the problems of punishments today characterize twentieth- century prisons as à ¢Ã¢â€š ¬Ã‹Å"vestigial institutions which are less useful for system maintenance than an appendix in an individualà ¢Ã¢â€š ¬Ã¢â€ž ¢ [4] twentieth century prisons existence; à ¢Ã¢â€š ¬Ã‹Å" they have simply survived because they have taken on a quasi-independent life of its own, which enables them to survive the overwhelming evidence of their social dysfuntionalà ¢Ã¢â€š ¬Ã¢â€ž ¢ [5]in addition he re-establish this problematic prisons as the contemporary intuition that à ¢Ã¢â€š ¬Ã‹Å"nothing worksà ¢Ã¢â€š ¬Ã¢â€ž ¢ extends with the slightly less force to probation, fines and community corrections[6]. We consider how best to run prisons, organize probation or enforce fines, rathe r than question why these measures are used in the first place. There havenà ¢Ã¢â€š ¬Ã¢â€ž ¢t been any active researchers to categorically work on the effective results of our punitive systems, whether the research methods and data collected illuminate truth isnà ¢Ã¢â€š ¬Ã¢â€ž ¢t my concern today since the existence of these research programs are questionable in the first place, all we have to note is that our system treat offenders like aliens, outcast, deviants losers etc. this notions and perceptions existed in early 15th -gt;centuries. We still hold some of the arbitrary draconian and orthodoxy extreme measures of crime control[7]. Our systems predominantly have always been focusing on the offence and not the offender. The reforms which were essentially adopted during the neoclassical era, Holmes describe offenders as morally diseased and wicked and as a general cause of crime who deserve segregated confinement. We still hold this sentiments of our early penologist to serve a different crime structure. This are merely the ill-fated strategies of crime control. Other different authors have taken notice too that the new era prisons has most of the continuing crisis and disruption in their penal systems which has no longer been taken seriously the rehabilitative values and ideologies upon which it was originally based upon. PURPOSIVE PUNITIVE SYSTEM There have been numerous proposals for advancement for new penal policies in the past which seek to reform prison framework and penal policies of sentencing; the humane containment, conception of imprisonment, probation and community service. These all policies have different purpose for which they are meant to achieve which include; moral reform, training, treatments, correction, rehabilitation, deterrence and incapacitation among others. This makes it clear that a prison provide an opportunity for reform and thus should be decent and austere.[8] It have been evident that our current system makes our p unitive system the most remote process to achieve deterrence. It is of much doubt that any of practical punitive procedures that we embrace now is meant to achieve any of the above purpose. The whole system have failed to consider the main objective for which any penal policies are meant to achieve which makes the whole process dysfunctional. It is dysfunctional to have two primary objectives which are not compatible due to poor functional and structural set up. It is not possible to maintain a balance between the object of deterrence which implies a punitive coercive environment with that of rehabilitation which need not adverse sanctions but rather a simple re-correction formula. In fact as result of this coercive punitive measures; it makes the offender tolerant to this unbearable environment which build resistance to change. Tallack defines offenders as morally responsible individuals worthy of a chance to reform and thus there is need for them to be treated with respect and humanity.[9] It is also important to understand the distinction of the two results (deterrence and reform) and the other irrelevant results which seem morally right but irrational among them being retribution for vengeance which solve a criminal act with another as a pay back. Eventually as a result the outcome which is being aimed at is wrong in the first place, then improving the process will simply mean that one achieves the wrong outcome more effectively. When the offender serves and completes his jail term, the friendly welcoming environment there after upon release will have no significance to his social life change, moreover the offender will treat every individual with bitterness for vengeance due to adverse irrational punitive procedures. Detention and complete segregation alone serve no purpose except physically lifting opportunities of perpetuating acts of crime which ultimate results does not met the purpose for which this punitive measure are meant to achieve. The institution of punishments conveniently provide us with narrowly construed answers to questions which crime in our society would otherwise evoke with haste. At this juncture this systems fails to address any long-term major problem that may arise in solving a subsequent minor problem. Our institutions are shallow, they tell us what criminality is and how should be sanctioned, how much punishment is appropriate and what emotions can be expressed, who is entitled to punish and where in lays the authority to do so. The major problems nevertheless are ignored or authoritatively settled or overshadowed. Our penal system in its very existence as a result end up helping us to forget that other answer exist to these problems and their settlements are possible and coherent to our overwhelming developments plans and strategies for change. And good prison institution is one which protect the ideal, personality and respect for human dignity and conscious and as well main good order in priso ns, Provide prisoners with opportunities to develop their personalities talents and skills in a positive manner, encourage prisoners to face up to the consequences of their actions in a manner which recognizes the harm which they have committed and which makes it less likely that they will act in a similar way in future and to that effect the system must also prepare prisoners for integration in to society upon release. Better prison structures which protect rights to privacy thus not converging inmates in a warehouse groupings which promote cruelty within prisons unlike secured cubicles which promote mutual trust and sense for respect and dignity. This does in anyway change the punitive prospects of the prisons since seclusion and confinements as well as cheap labor is equally punitive. There is a depth of untapped potential in our prisons which could be realized for the benefit of our communities and for reform purposes those ensuring crime control is effective at its beneficia l limits which include engaging prisoners in meaningful work;- Teesside university 2003;4à ¢Ã¢â€š ¬Ã‚ ¦..researchers reported after a project to evaluate the work carried out by three prisons in north- east of England to help Middlebrough council renovating a large Victorian park in the middle of the town that prisoners work best where they serve the community among them being the family of the prisoners which as a result buys trust and sense of pride and achievements. The pride does not only arise from the quality of work only but also because of who the beneficially of such projects would be, e.g. orphans, the poor, family and the entire society.[10] Justice at stake In our Kenyan criminal trials, it is evident that criminal proceedings takes at least 2rys to commence. Appeals situation is despicable; appeals takes at least 5yrs. At these level the scale of justice tilt at all material time is contested but in the long run ità ¢Ã¢â€š ¬Ã¢â€ž ¢s the jury whose hands are tie d by law deliver à ¢Ã¢â€š ¬Ã‹Å"justiceà ¢Ã¢â€š ¬Ã¢â€ž ¢ based on witnesses, evidence and material facts presented before honorable court. Witness summoning by the prosecution in criminal cases have been the baseline for the ultimate delay of criminal proceedings, office of the D.P.P have been blamed for this hiccups which on the other hand the offender is the one who feel the pinch. Eventually these becomes a long-term investments to the judicial staffs and advocates who are the beneficiary of this delay. In addition to all above miseries our courts layouts are limited, improperly furnished with their structural settings squeezed to the edge. The offender at all material times are crowded and squeezed together; à ¢Ã¢â€š ¬Ã‹Å"the ill-fated onesà ¢Ã¢â€š ¬Ã¢â€ž ¢ to compete for their last breathe of freedom until the commencement of their trial. At this level we all agree that justice can fit a better definition and thus it is our initiative to re-evaluate prisonersà ¢Ã¢â€š ¬Ã¢â€ž ¢ social status. It is irrevocable that the prison warden too who spend more time within the prison walls with prisoners; significantly for a longer period of time than the majority of the prisoners thus are more effectively encroached within the same poor prison structural and environmental settings. This environs based on the poor sanitations are hazardous to both prison staff and inmates as well, this answer the question why ità ¢Ã¢â€š ¬Ã¢â€ž ¢s the profession that attract the least public interest. The profession credentials are way too low to serve the least knowledgeable crew. This is as a result of inhumane and intolerable working environment which most graduates are not willing to bear. Our environmentalist rarely overstretch their duties to serve prisons which is an initiative NEMA should take to improve prison hygiene and sanitations which marks as one of the most cherished humane features. Revolution for change There have been humanitarian reform movement s which connect with classical criminology and some of the foundations of eugenic ideology as further classified by William Tallack and Thomas Holmes who were at different time secretaries to these movements. [11]Tallack acknowledged poverty as a significant contributory factor to crime and underlines the need for a thoughtful and discerning use of penal discipline.[12] Alongside other movements, Church of England temperance society had a remarkable stake in introduction of probations in United Kingdom as an alternative punitive measure for minor offences. John Augustus is referred to as the first probation officer whose initiative for probation inception cannot be watered-down. Our penal system has a quite wide range of penal procedures which on application would give a glowing face to our justice system and our crime control units. Thus there would be no justifications of our overstretched prison population for that matter. Prison reforms and sentencing strategies need to be revived to embrace other penal measures and relieve imprisonment which have been totally dominant for decades. It is possible for us to change this unbearable prison system to achieve the same purpose but in a favorable humane way. Most offenders are individuals with carriers; formal skills which can be utilized in a prison setup. I do understand it have been in practice for a good while but it have not been effected to its exhaustion. Our prisons do not provide a wide range of varieties of practical skills in jail. most prisoners as forced to abandon their formal skills to learn and adopt others which are outdated and least dependable skills despite the fact that there are prisoners who have adorable skills which are not recognized at this level. A good prison structure is that that accommodates individuals of all levels with humanity, treat them with respect and dignity, honor their opinions religious believes, political affiliations, their rational judgments and warrant th eir fundamental right. Their freedom limits should be exercised with austerity. The system should help prisoners To use their expertise to serve the nation as a payback for their actions;- Teachers, engineers, drivers, architect, medical practitioners and other formal or informal skills to be utilized to the maxim; it is the best way penal system can achieve its main purpose of reform and deterrence more effectively. This will make all remandees/prisoners a resourceful asset and not a liability to our economy and a more rational and socially fitting and dependable being. I may not have addressed every penal process and explored its lucrative results but essentially it is important to note that, even though imprisonment is a punitive measure of last resort.it is necessary we embrace other punitive and reform methods and honor right of individuals in custody because ità ¢Ã¢â€š ¬Ã¢â€ž ¢s a prerequisite tool to administer justice within and outside prisons. Suppose our institutions are meeting normal expectations and overall directions or basic legitimacy are unchallenged then there wouldnà ¢Ã¢â€š ¬Ã¢â€ž ¢t be such failures in our penal systems and if there would be any, no great consequences would be eminent. [1] David Gurland; punishment and the modern society(1990) pg 5 [2] Constitution of Kenya 2010 Article 49-51 3(b) [3] Michel Foucault [4] Lawrence stone(London 1987)failure of punishments [5] Lawrence;-D.Rothman à ¢Ã¢â€š ¬Ã‹Å"prisons; failure model.(1974) .pg 647 [6] David Gurland; punishment and the modern society(1990) pg 5 [7] Classical theory criminologist; Cesare Beccaria and Jeremy Bentham(Taylor 1973) [8] General report of the general board of directions of prisons in Scotland 1840,pg23 [9] William tallack (1882). [10] The crisis in crime and punishment and the search for alternatives;-Cayley, D [1998] [11] Peter Raynor and Maurice Vanstone; à ¢Ã¢â€š ¬Ã‹Å"understanding community penaltiesà ¢Ã¢â€š ¬Ã¢â€ž ¢ (2002) pg 25. [12] Tallack à ¢Ã¢â€š ¬Ã‹Å"in a paper presented to a meeting of American prison officers in New Yorkà ¢Ã¢â€š ¬Ã¢â€ž ¢. (1871)

Prescription Medications And Illicit Drugs Essay - 1706 Words

Drugs in the United States are a complex issue that ranges from legal, over-the-counter and prescription medications to illicit substances that are highly addictive. While many people have a legitimate need for medication to function on a daily basis, there are also many incidences where these potentially helpful drugs are abused. When legal medications are abused, they cause the same personal, social and economic problems as illicit substances. This paper will look at the use of both prescription medications and illicit drugs to see who is taking drugs, who is susceptible to drug addiction, the social and economic impact of drug abuse, and, finally, a few remedial solutions for drug abuse in the United States. Drugs in the United States Introduction â€Å"We awake to the kick of caffeine, soothe our nerves with tobacco, ease our tension headaches with aspirin, wind down the day with alcohol, and swallow an antihistamine to help us sleep – all perfectly legal, respectable, and even expected† (Kuntz, 2001, p. 195). Nowadays it seems that everyone is looking for the magic pill to fix all of his woes. Is it any wonder that 67.2% of physician’s office visits in the United States involve either ordering new prescription drugs or adjusting current prescriptions? (U.S. Center, 2012, table 23). This hunt for the easy fix has led to a society in which the majority of the United States population is using drugs for either medical or recreational use. Drugs are definedShow MoreRelatedSubstance Abuse Is A Problem That Has Over Time Dogged Institutions Of Higher Learning1259 Words   |  6 PagesData 4 3.2 Analysis of Data 5 4. Implications and Recommendations 9 References 11 â€Æ' Background Substance abuse is a problem that has over time dogged institutions of higher learning. There is a cause for alarm based on the recent misuse of prescription medication as well as the legalization of marijuana in certain states. This is a cause of concern for businesses because it affects the future supply of graduates. It is estimated that 46 per cent of U.S. college students have in one way or the otherRead MoreAbuse Of Prescription Stimulants : An Annotated Bibliography868 Words   |  4 PagesAbuse of Prescription Stimulants in College Students: An Annotated Bibliography Arria, Amelia, Ph.D. Nonmedical Use of Prescription Stimulants What College Administrators, Parents, and Students Need to Know. Center on Young Adult Health and Development, n.d. Web. 6 Dec. 2015. The use and abuse of prescription stimulants is not only focused on one specific level of students it affects as young as 8th graders in high school who wish to accomplish a high level of academic performance to reach theRead MorePrescription Drugs Are Making Parents More Overwhelmed Than Ever Before1456 Words   |  6 PagesPrescription drugs are making parents more overwhelmed than ever before about their teenaged child! Why must they worry so much about their teenaged child? â€Å"When you can stop you don’t want to, and when you want to stop, you can’t†¦Ã¢â‚¬  (Davies). This quote signifies that adolescents and adults have the option to quit or not try the drug when being introduced, but when they get started on the drug and they are thinking abouting quitting, they cannot because of the addiction they have on the drug. EachRead MoreWhat Term Should be Used to Describe Alcholism?1465 Words   |  6 Pages The majority of people hearing the term addict or addiction drugs are probably the first thing that comes to their mind. Fewer may think of alcohol because, although people who chronically abuse alcohol are also addicts, the term alcoholic or alcoholism is used more often in reference to those people. A growing number of people will imagine a person sitting in front of a poker machine, flashbacks of a certain president admitting to being a sex addict, or a teenager with a PlaystationRead MoreEssay on Prenatal Substance Abuse954 Words   |  4 Pages Substance abuse during pregnancy can have a negative force on the health and wellness of not only the fetus, but that of the mother. The harmful effects of medications, alcohol and illegal drugs on an unborn child can be devastating and can have significant consequences to its use. Sometimes the effects can be faced and treated, and other times the outcome is a lifelong challenge. During the prenatal period, it is importan t that new mothers are informed of the different types of abuseRead MorePrescription Drug Abuse : Drug And Free World1508 Words   |  7 Pages12 to 17 abuse a prescription pain reliever for the first time (â€Å"Prescription Drug Abuse Statistics – Overdoes Deaths – Drug-Free World,†n.d.) A 2007 survey in the United States found that 3.3% of 12 to 17 years olds and 6% of 17 to 25 year olds had abused prescription drugs in the past month (â€Å"Prescription Drug Abuse Statistics – Overdoes Deaths – Drug-Free World,†n.d.) Prescription drug abuse causes the largest percentage of deaths from drug overdoses (â€Å"Prescription Drug Abuse StatisticsRead MoreDrug Abuse Within The Elderly Population1135 Words   |  5 Pagesof prescriptions written for controlled substances (those with an addictive quality) has increased more than 150% since 2008. Until recently, the social issue of drug abuse within the elderly population has not been widel y understood or addressed. Because this is an issue affecting an ever-growing number of the country’s population, the focus of our practice based research project will be based primarily on the increasing number of older adults who are becoming addicted to prescription drugs. ToRead More Cost of Drug Abuse on Society Essay923 Words   |  4 PagesDrug abuse is a rampant problem in the United States. Drugs can be abused in a variety of different ways by people from every walk of life. Most of us have been affected by drug abuse either directly or indirectly. Drug abusers harm themselves, as well as their families and communities. Drug abuse takes an enormous toll on our society at many levels. The cost of drug abuse on our society is astronomical, not only financially but also personally, emotionally, socially and professionally. Read MoreThe Epidemic Of Opioid Addiction1678 Words   |  7 Pages The United States currently faces an unprecedented epidemic of opioid addiction. This includes painkillers, heroin, and other drugs made from the same base chemical. In the couple of years, approximately one out of twenty Americans reported misuse or abuse of prescriptions painkillers. Heroin abuse and overdoses are on the rise and are the leading cause of injury deaths, surpassing car accidents and gun shots. The current problem differs from the opioid addiction outbreaks of the past in thatRead MoreDrugs : The Most Addictive Comes From Opium814 Words   |  4 Pagesus suffer from additions. These additions range across a very wide spectrum, People can be addicted to books, coffee, sex, work, alcohol, drugs, and the list goes on. Some are addicted to multiple things, such as alcohol and drugs. Although some of things have ingredients, which are prone to forming addiction, others are solely self-generated. In the case of drugs, one of the most addictive comes from opium. We know that opium has been around for a very long time; however, we have only dealt with

Case Analysis of Mdd, Gad, and Substance Use Free Essays

string(98) " shown that the presence of a comorbid anxiety disorder may make MDD harder to resolve or manage\." Case Analysis of Comorbid Major Depressive Disorder, Generalized Anxiety Disorder, and Substance Abuse Nicole Gapp University of Minnesota School of Nursing Case Analysis of Comorbid Major Depressive Disorder, Generalized Anxiety Disorder, and Substance Abuse Major Depressive Disorder (MDD) is a mood disorder with symptoms that greatly affect the life of the individual. MDD could in fact be called a public health crisis, as it is projected that it will soon overtake heart diseases as the major worldwide health concern (Boyd, 2008). Diagnostic criteria for MDD are depressed mood or loss of interest or pleasure in nearly all activities, present for at least 2 weeks. We will write a custom essay sample on Case Analysis of Mdd, Gad, and Substance Use or any similar topic only for you Order Now Findings and behaviors associated with MDD are disruption of sleep, suicidal ideation, feelings of worthlessness and hopelessness, and fatigue and loss of energy. MDD is also associated with a high impairment in occupational, social, and physical functioning, causing as much disability and distress as chronic medical disorders (United States Department of Health and Human Services, 1999). MDD has been shown to be associated with increased medical illnesses. MDD can make everyday living a challenge, as research shows that depressive symptoms are associated with impaired everyday problem-solving ability directly and indirectly mediated through learning and memory, and reasoning (Yen, Rebok, Gallo, Jones, Tennstedt, 2011). It is important for MDD to be identified and treated early on, as MDD that is not treated appropriately results in recurrent depressive episodes, with each successive episode increasing in severity. As MDD is highly associated with suicidal ideation and suicide, it is imperative that MDD be treated to ensure patient safety. Risk factors for MDD are a prior episode of depression, lack of social support, lack of coping abilities, medical comorbidity, substance use, and presence of life and environmental stressors. In addition, major depression may follow adverse or traumatic life events, especially those that involve the loss of an important human relationship or role in life. Social isolation, deprivation, and financial deprivation are also risk factors (APA, 2002). Genetics play a role in the development of MDD, and deficiency or dysregulation of neurotransmitters are also thought to play a part in its etiology. Psychological theories of MDD hypothesize that an early lack of love and warmth may be involved with the development of depressive symptoms, while developmental and family theorists have proposed that parental loss, emotionally inadequate parenting styles, or maladaptive patterns in family interaction may contribute to the etiology of MDD. Women are twice as likely as men to be diagnosed with MDD, though it is believed that the incidence in men is under-diagnosed. Prevalence rates are unrelated to race (Boyd, 2008). Nursing responses to MDD should involve interventions to treat symptoms within the biologic domain, such as changes in appetite, weight, sleep, or energy, as well as symptoms within the psychological domain, such as changes in mood and affect, thought content, suicidal behavior, and cognition and memory. Many types of interventions are used to treat the varied effects and symptoms of MDD. Pharmacologic interventions, such as selective serotonin reuptake inhibitors, tricylic antidepressants, monoamine oxidase inhibitors, and other classes of antidepressants may be used to decrease or manage depressive symptoms. Medication should be continued for at least six months to a year after complete remission of depressive symptoms. Lifestyle patterns, such as good sleep hygiene, activity and exercise, and adequate intake of well-balanced meals should also be encouraged, as these patterns help the client move toward a healthy daily routine that supports remission or recovery. Psychotherapy, such as cognitive therapy, behavior therapy, and interpersonal therapy, has been shown to be effective in individuals with MDD, and a combination of psychotherapy and pharmacotherapy is recommended for patients with severe or recurrent MDD as a strategy to prevent relapse (Boyd, 2008). In addition, electroconvulsive therapy has been shown to be an effective treatment for MDD, especially severe MDD that has not responded to medications. Major depression frequently occurs in conjunction with ther psychiatric disorders, such as anxiety or substance use disorders, which can also affect antidepressant responsiveness. In such cases, the co-occurring mental health problem should be treated in addition to major depression (President and Fellows of Harvard College, 2011). The patient described in this case analysis has comorbid diagnoses of generalized anxiety disorder and substance abuse. Generalized Anxiety Disorder is a psychiatric disorder characterized by excessive worry a nd anxiety with an insidious onset. The anxiety of GAD persists for at least six months, with excessive anxiety and worry occurring for more days than not, and for some individuals, persisting daily. Risk factors for GAD are thought to be unresolved conflicts, cognitive misinterpretations, and multiple stressful life events (Boyd, 2008)). Few studies have examined the genetic basis of GAD, but it is thought to be moderately heritable. In clinical settings, the incidence of GAD is equally distributed in women and men. However, in wider studies GAD is twice as common in women. In no studies has the prevalence of GAD been related to race (Boyd, 2008). Patients with GAD often have associated depressive symptoms, and MDD is a common comorbid disorder. For this reason, there has been debate surrounding whether GAD is a separate disorder than MDD, or if GAD symptoms are part of the course of MDD. However, research shows that many patients with GAD do not present with a distinct MDD symptom profile. This does not support the hypothesis that co-morbidity between MDD and GAD is artificially inflated because of the similar symptom criteria required by the current diagnostic system. Instead, MDE and GAD may be thought of as two distinct diagnostic entities that frequently co-occur because of a shared underlying trait (Sunderland, Mewton, Slade Baillie, 2010). Current diagnostic criteria state that GAD exists when the excessive worry does not occur exclusively during a mood disorder, psychotic disorder, or pervasive developmental disorder. For example, a patient who experiences persistent excessive anxiety but has minimal or no depressive symptoms would be diagnosed with GAD (Boyd, 2008). However, research has shown that the presence of a comorbid anxiety disorder may make MDD harder to resolve or manage. You read "Case Analysis of Mdd, Gad, and Substance Use" in category "Essay examples" One particular study comparing individuals with MDD and individuals with MDD and a comorbid anxiety disorder showed that after adjusting for the severity of depression, those in the anxious depression group had significantly younger onset age, had been suffering from depression for a longer period, were more likely to experience a recurrence, and obtained lower scores on a scale assessing quality of life. The anxious depression group was also characterized by a significantly higher proportion of individuals reporting significant suicidal ideation and previous suicide attempts (Seo, Jung, Kim, T. , Kim, J. Lee, Kim, J. Jun, 2011). Patients with GAD are often highly somatic, with many complaints of physical symptoms. One study concluded that painful physical symptoms in patients with GAD are twice as prevalent as in the control group, which consisted of individuals with neither GAD nor MDD. The presence of comorbid MDD was associated with a significantly higher prevalence of painful p hysical symptoms. Painful physical symptoms were significantly associated with functioning and health status impairment both in GAD alone and in GAD and comorbid MDD compared with controls (Romera, Fernandez, Perez, Montejo, Caballero, F. Caballero, L. , Arbesu Gilaberte, 2010). In addition, those with GAD also often experience poor sleep habits, irritability, and poor concentration. Patients with GAD often feel frustrated, demoralized, and hopeless. They often feel restless and on edge and experience clinically significant distress or impairment of functioning resulting from anxiety, worry, or physical symptoms. GAD has a significant negative impact on work functioning, although smaller than the effect of MDD (Plaisier, Beekman, de Graaf, Smit, van Dyck Penninx, 2010). Interventions addressing symptoms of the biologic domain include eliminating caffeine, diet pills, amphetamines, ginseng, and ma huang, which have all been shown to be anxiety-producing substances (Boyd, 2008). In addition, good sleep hygiene should be promoted, as a common symptom of GAD is sleep disturbances. The nurse should teach the patient breathing control and progressive muscle relaxation as calming techniques, help the patient identify other positive coping strategies, and educate the patient on time management. Pharmacological interventions, such as the use of benzodiazepines, certain antidepressants, and other non-benzodiazepine anxiolytics may be effective in reducing anxiety. Roughly 75% of those with GAD have at least one additional current or lifetime psychiatric diagnosis, with MDD being one of the more common comorbidities. Alcoholism is also a significant problem associated with GAD. Patients may use alcohol, anxiolytics or barbiturates to relieve anxiety, and this may lead to abuse and dependency. Such is the case of the patient described in the case analysis, who also has a substance-related disorder. The DSM-IV-TR defines substance abuse as a maladaptive pattern of substance use leading to clinically significant impairment or distress. This impairment may be manifested by recurrent use, resulting in failure to fulfill major role obligations at work or home, recurrent use in situations that are physically hazardous, recurrent substance related legal problems, or continued use despite feeling persistent or recurrent effects of the substance. To constitute substance abuse, three or more of these manifestations must be present within a 12-month period. In general, men consume more alcohol and abuse drugs more than women, though women are more likely to abuse prescription medication. Substance abuse and dependency are not correlated so much with gender as with an early age of initiation of substance use (Boyd, 2008). Comorbid mental disorders occur often with substance dependence and abuse. For some, comorbid mental disorders are byproducts of long-term substance abuse. Other people have mental conditions that predispose them to substance abuse, with substance abuse becoming a comorbid problem as they use drugs and/or alcohol to self-medicate existing mental illnesses. There is a well-documented association between depression and alcohol abuse and dependence which cannot be explained solely by the random overlapping of these two conditions. A systematic review of 35 studies estimated the prevalence of current alcohol problems in depressed patients to be 16%, as compared to 7% in the general population. The three most commonly described causal hypotheses for this comorbidity are as follows: 1) an independent depressive episode (e. g. he self-medication theory), 2) alcohol induced depressive symptoms and 3) the existence of shared biological and environmental factors that predispose persons to both (Cohn, Epstein, McCrady, Jensen, HunterReel, Green Drapkin, 2011). In addition, men with at least four heavy drinking occasions were found to be 2. 6 times as likely to be classified as being depressed as men who drank heavily less than four times in the previous 28  days (Levola, Holopainen Aalto, 2011). Specific substances that have been abused by th e patient who is the subject of this analysis are alcohol, cocaine, heroin, and the prescription drugs oxycodone and Valium. At the time of admission, the patient was no longer regularly using drugs or alcohol, but his history of substance abuse, including overdose, is extensive. Thus, although the patient is already withdrawn from drugs and alcohol, his long-term substance use has significant physical and mental consequences. The depression of the central nervous system by alcohol causes relaxed inhibitions, heightened emotions, mood swings, and cognitive impairments such as reduced concentration and attention, and impaired judgment and memory. In particular, this patient engages in periodic binge drinking, drinking up to 15 drinks in one evening. This alcohol use would result in several days of intoxication, which were interspersed with periods of sobriety. The amount of alcohol consumed in an episode of binge drinking can cause severely impaired motor function and coordination difficulties, emotional lability, stupor, disorientation, and in extreme cases, even coma, respiratory failure, or death. Long-term abuse of alcohol can adversely affect all body systems, and research has shown a connection between alcohol dependence and increased risk for diabetes mellitus, gastrointestinal problems, hypertension, liver disease, and stroke (Smith Book, 2010). Cocaine users typically report that cocaine enhances their feelings of well-being and reduces their anxiety. However, long-term cocaine use leads to increased anxiety. Severe anxiety, restlessness, and agitation are all symptoms or cocaine withdrawal. Withdrawal causes intense depression, craving, and drug seeking behavior that may last for weeks (Boyd, 2008). Valium, a benzodiazepine, is a prescription drug that this patient abused. Patients who abuse benzodiazepines often feel hyperactive or anxious after using them. Often, patients who abuse these drugs combine them with alcohol, putting the patient at risk of coma or death. Symptoms during benzodiazepine withdrawal include anxiety rebound, such as tension, agitation, tremulousness and insomnia, as well as symptoms of autonomic rebound, sensory excitement, motor excitation, and cognitive excitation, such as nightmares and hallucinations (Boyd, 2008). Opiates are powerful drugs that can quickly trigger addiction when used improperly. Heroin is an opiate that was abused by this patient. Heroin is the most abused and most rapidly acting of all opiates. It can be injected intravenously, and such was the method of delivery for this patient. Heroin produces profound degrees of tolerance and physical dependence. Withdrawal from opiates should be tapered, and if abruptly withdrawn from someone dependent on them, severe physical symptoms may occur, along with nervousness, restlessness and irritability (Boyd, 2008). In addition to heroin use, the patient attempted to commit suicide by overdosing on oxycodone, a prescription opiate. Overcoming substance abuse and preventing relapse can be especially difficult as denial is common in substance abusing patients. Denial is defined as the patient’s inability to accept his loss of control over substance use, or to accept the consequences associated with the substance use (Boyd, 2008). Because many patients find it difficult or impossible to believe they have a serious problem with drugs and alcohol, many do not seek treatment, or stop treatment prematurely. Motivation is a key predictor of whether individuals will change their substance abuse behavior. Several effective modalities are used effectively to treat addiction, such as 12-step programs, social skills groups, psychoeducational groups, group therapy, and individual and family therapies. Depending on the individual, different treatment techniques will be more or less helpful. History of Present Illness The patient is a 58-year-old Caucasian male who was participating in a partial hospitalization program (PHP) at Hennepin County Medical Center (HCMC) for the treatment of severe major depressive disorder. He has been involved in PHP since his last discharge from the HCMC psychiatric inpatient unit in early March. The patient was cooperative with treatment and medication compliant. He was put on a 72-hour hold after becoming angry and hostile during the PHP group and threatening to hang himself that evening when he got home from PHP. He eventually committed himself voluntarily to the HCMC psychiatric inpatient unit. Upon introduction, the patient appears to be clean, casually dressed, and of normal weight. He is alert and oriented. His attention, cognition, and abstract reasoning are intact, and his thought content is appropriate and organized. In conversation, he is pleasant and cooperative, exhibiting a stable mood and a slightly blunted affect. The patient will talk to staff members but interacts minimally with peers and does not attend groups unless encouraged by staff. The patient has a normal gait but moves quite slowly. In addition it appears that his thought processes are slowed, as he is slow to respond during conversation and seems to have difficulty finding the words to express what he wants to say. The patient appears to have intact recall, short-term, and long-term memory. He appears to be an adequate historian though he exhibits poor judgment due to his depressive and anxious symptoms, as evidenced by his extensive history of drug and alcohol abuse and dependency. The patient has psychiatric diagnoses of severe and recurrent major depressive disorder, generalized anxiety disorder, and polysubstance abuse. The patient has been suffering from MDD with chronic suicidal ideation since age 15. His first suicide attempt was at age 15, and he began abusing drugs and alcohol at approximately the same time. His extensive history of substance abuse includes use of alcohol, cocaine, and IV heroin. His alcohol abuse as a teenager led to a DWI charge. He has participated in mental health outpatient treatment and has undergone chemical dependency treatment numerous times. He completed high school without apparent difficulty. The patient seems to be of average intelligence, though his IQ is not listed in the record. He does not have a history of violent or sexual crime. He has a history of five suicide attempts. He began smoking as a teenager and currently smokes one pack of cigarettes per day. In 1983, the patient married and remained so until his wife died 25 years later, in 2008. He had no children. According to the patient, he was happily married, and he called his relationship with his wife â€Å"the best thing that has ever and will ever happen to me. † While he was married, he got completely clean from drugs and alcohol, remaining drug free and sober for 12 years. Though he struggled with episodes of depression and suicidal ideation, he was able to manage his symptoms with medication and mental health outpatient treatment. Most of my problems faded into the background,† said the patient. During this time, he and his wife bought a condo, and the patient was employed as a janitor and handyman, working at the Minneapolis-Saint Paul airport. He remained at this job for over a decade and was promoted to the position of supervisor. He had, as he said â€Å"everything I ever wanted. † In 2007, his wife became very ill and eventually died in 2008 after co mplications from a surgery intended to prolong her life. The patient reports that as his wife got sicker, he became increasingly depressed. Unlike in the previous 12 years, medication and outpatient treatment did not seem to manage his symptoms. In addition, he started experiencing extreme and persistent anxiety, feeling â€Å"like I was always one second away from a panic attack. † He was diagnosed with generalized anxiety disorder and was prescribed benzodiazepines to manage this condition. As his wife got sicker, he slowly began to self medicate with alcohol and admitted to â€Å"popping an extra pill† occasionally to decrease his anxiety. When his wife died, the patient became so depressed and anxious that he was unable to concentrate at work. He had to give up his job as a supervisor, and said, â€Å"I couldn’t even manage myself, how was I supposed to handle anyone else. † As his depression and anxiety got worse, he turned increasingly to alcohol and drugs. He reported binge drinking, consuming up to 20 drinks in one evening. He would remain intoxicated for several days, and would switch to using drugs as the alcohol cleared his system. He reported being either drunk, high, or both almost every day. Although he used cocaine and heroine, which were the drugs he used as a teenager, he also became dependent on prescription benzodiazepines to manage his increasingly severe anxiety. The increase in anxiety may be explained by his cocaine use, which, though it reduces anxiety while high, causes increased anxiety with long term use. Additionally, though proper use of benzodiazepines decreases anxiety, benzodiazepine abuse or dependency results in increased anxiety levels. When his request for more prescription benzodiazepines was denied due to drug seeking behavior, he gained possession of Valium illegally and continued abusing them. He was arrested for illegal Valium possession in 2009, and received two DWIs between 2008 and 2011. His medical record notes that he has a history of antisocial behavior, though it does not expand on this statement beyond the mention of his previous arrests. With no income coming in and increasing amounts of money used to fuel his drug and alcohol addiction, he lost his condo and all of his savings and was living at the Salvation Army homeless shelter by June 2008. His depression grew in severity as the major life losses piled up and his substance dependency problem worsened. In 2008, he lost consciousness due to heroin intoxication. In August of that year, the patient overdosed on oxycodone, intending to kill himself. He was brought to HCMC, and for the past several years has experienced being in and out of the psychiatric inpatient. In 2010, he moved from the homeless shelter to Alternative Homes in Minneapolis. Following his latest psychiatric hospitalization in March, he began the partial hospitalization program at HCMC. Upon discharge from the current hospitalization, he will be returning o Alternative Homes and participating again in the PHP program. A common finding associated with a diagnosis of either MDD, GAD, or substance abuse is the presence of sleep disturbances. Such is the case with the patient described. These sleep disturbances may present themselves as difficulty falling asleep, trouble maintaining sleep, or waking up too early (National Insititute of Health, 2005). This patient currently experiences insomnia, getting only 3-4 hours of sleep per night. Reportedly, this insomnia has been a chronic issue. The insomnia the patient experience sets him up for a negative cycle. Because of his depression and anxiety, it is difficult for the patient to sleep. This lack of sleep, in turn, exacerbates his anxiety and depressive symptoms. As his symptoms progress in severity, he turns to substances to self medicate. The use of substances results in a worsening of his insomnia. Thus, finding a way for the patient to get adequate sleep is important. He has tried a variety of medications to promote sleep, but none have been effective. He can no longer be prescribed many of the medications for insomnia because of his history of abuse and overdose using prescription drugs. Thus, the options available to him for sleep promotion lie in the realm of sleep hygiene promotion. The patient might also consider participating in a sleep study, as this may reveal additional factors that prevent him from getting the sleep he needs. In addition to his mental illnesses, the patient also has significant medical problems. He has been diagnosed with hypertension, hepatitis C, diabetes mellitus, osteoarthritis of the left shoulder, and acid reflux. Research shows that diabetes mellitus, gastrointestinal problems, hypertension, liver disease are correlated with substance abuse (Moffitt, Caspi, Harrington, Milne, Melchior, Goldberg Poulton, 2010). Indeed, the patient’s hepatitis C is a direct consequence from his use of street drugs. Interestingly, multiple studies have revealed that not only are depressive symptoms a risk factor for the development of type 2 diabetes, but they have also been shown to contribute to hyperglycemia, diabetic complications, functional disability and mortality among diabetic patients (Moffitt et al. 2010). Also, as previously discussed, patients with GAD and MDD report more painful physical symptoms than the general population, and the patient’s osteoarthritis pain could well be exacerbated by the presence of these psychiatric conditions. Thus, it is possible that with improved management of his psychiatric conditions, his medical problems may improve as well. Family and Social History The patient’s social and family history is somewhat lacking. The patient was adopted at a young age. He has three non-biological brothers and he reports that he is estranged from all of them, and is not willing to contact them until he has â€Å"my life back together. † In addition, both of his adoptive parents are dead. The patient was not keen on discussing his adoptive family or his childhood and adolescence, but stated that this adoptive family â€Å"were good people, and tried hard to give me everything I needed. † He denies any history of physical, emotional, or sexual abuse. According to the social history, there is no history of mental illness in his adoptive family. This does not mean that environmental or social factors play no role in the etiology of his mental illness, but that these factors may be less obvious. Information on the patient’s biological mother and family history is unavailable. The patient was given up for adoption at birth, and remained a ward of the state, living in various foster homes, until he was adopted at age 3. As the patient was given up for adoption and adopted at such a young age, he has he has no recollection of his biological family or his time in the foster care system. Any instances of abuse, neglect, or trauma in his early years are thus unknown. Because there is no available family history, it is impossible to know if any of the patient’s first-degree relatives suffered from mental illnesses, or if the biological mother used drugs or alcohol during her pregnancy. This lack of information is unfortunate, as it is impossible to conjecture whether, or to what degree, the patient’s mental disorders have a basis in genetics or in disturbed fetal development. Because MDD, GAD, and substance abuse have all been shown to have a moderate to high degree, of heritability, it is very plausible that mood, anxiety, or substance related disorders were present in his biological family. The patient seems to have very limited social support, as he is estranged from his adoptive siblings and has no communication with his biological family. The patient also has a history of limited social interactions and close friendships. He reports that he has felt disconnected from others for as long as he remembers, and that he had few close friendships throughout his childhood, adolescence, and adulthood. In addition, the patient reports that most of the relationships that he would call the closest have been with people who have substance abuse problems, as he spent â€Å"years and years running with the wrong crowd. † The basis of most of these relationships was a shared interest in drug and alcohol use, and he does not think that these friends would be of any support to him in pursuing and maintaining recovery. During the time that he was sober, he states that his wife was â€Å"the only friend I really needed† and as a result, he did not form many close friendships with his peers. He states that he currently has no supportive relationships. Furthermore, he has little desire to form such relationships. Application of Developmental Theories Viewing the patient and his family and social history through the lens of attachment theory provides a possible framework for viewing the patient’s development of mental illnesses. Attachment theory, a biologically based framework first proposed by John Bowlby in the mid 1950s, is the theoretical approach used to describe the importance of stable and secure relationships of all infants, especially those in foster care (Bruskas, 2010). This theoretical approach reasons that infants and children have a need to belong and to experience secure relationships with a small number of consistent â€Å"preferred† primary caregivers in order to successfully develop into normal healthy adults who can actively and emotionally participate in social life (Boyd, 2008). In particular, a child should receive the continuous care of this single most important attachment figure for approximately the first two years of life. If the attachment figure is broken or disrupted during the critical two year period the child will suffer irreversible long-term consequences of this deprivation, which might include delinquency, reduced intelligence, increased aggression, depression, and affectionless psychopathy–an inabilityto show affection or concern for others. Research, such as the Adverse Childhood Experiences Study, correlates untreated childhood adversity with an increased risk toward poor developmental health and other major diseases seen later in life such as cardiac disease, depression, and even premature death (Felitti Anda, 2010). Studies reveal that infants in foster care are among the most vulnerable because of their complex and immense brain development, and the importance of attaining developmental milestones. The onset of brain development begins soon after conception and will continue to mature well into adulthood, but the most abundant and dramatic time of growth is during the first few years of life, specifically within the first three years. The primary and most important developmental milestone for any infant is to establish a relationship, especially one with a primary caregiver. This period presents sensitive â€Å"windows of opportunity† for the development of particular parts of brain structure and circuitry influenced and dependent on social experiences for optimal brain development (Bruskas, 2010). The majority of children entering foster care are infants, and the impact of not addressing mental health needs of preverbal children can have deleterious effects (National Research Council Committee on Integrating the Science of Early Childhood Development, 2000). Although an infant may not be able to articulate losses because of their preverbal age, they nonetheless experience grief and loss, and for many, these experiences will be forever embedded in their memory (Felitti Anda, 2010). Moreover, the consequences of unresolved losses have a much more devastating affect in infancy than adulthood because of the potentially permanent psychological impact on the developing brain of an infant or child (Bruskas, 2010). Infants and children in foster care who are not afforded supportive primary caregivers to help them develop an internal ability to regulate their own will continue to use whatever coping methods they can. Under stress-provoking adversities such as abuse, neglect, and relationship disruptions, children’s coping strategies to manage such circumstances may present as hostility, frustration, and anxiety with underlying feelings of fear, abandonment, and powerlessness (Bruskas, 2010). The relationships infants and children develop while in foster care are crucial; relationships characterized by trust and commitment help an infant or child become more resilient toward the challenges and obstacles that all humans face in life; conversely, a lack of such relationships in life can result in long-term dysfunction socially and physically. Attachments and â€Å"templates† of the world are significantly developed by the time a child reaches a year old (Bruskas, 2010). Efforts to address behavioral problems later in life may prove to be more difficult and costly as brain structure becomes permanent and behavior becomes more difficult to change. Due to the patient’s experience of foster care as an infant and toddler, it is likely that he was unable to form a secure attachment with a primary caregiver. Although this disruption in attachment is not the sole contributor to his problems with depression, anxiety, and substance abuse, it is very possible that the chaotic structure of his early years play a large role in the development of these conditions. Applying the concepts of Erikson’s model of psychosocial development allow for a greater understanding of the patient’s current state. Because of the disruption of relationships early in life, the patient may not ever have resolved the developmental conflict of basic trust vs. mistrust, which is often resolved in infancy. This may be one reason behind his feeling of disconnectedness from others. According to Erikson, this inability to resolve this developmental conflict results in a decreased sense of drive and hope. It is also likely that the patient was able to resolve the developmental conflict of autonomy vs. hame and doubt, which is often resolved in toddlerhood (Boyd, 2008). This may explain the patient’s reliance on his wife as the sole supportive relationship in his life, as well as his fast descent into previous behaviors after his wife’s death. As the patient was never able to develop a sense of autonomy, it seems that he became extremely emotion ally dependent on his wife. Because of this relationship, he was able to progress at his job and maintain his recovery. However, with the death of his wife, he was brought back to the conflict of autonomy vs. shame and doubt. Really, it was through the presence of his wife that he was able to take initiative, be industrious, and have an intimate relationship, all of which are successful outcomes of developmental conflicts. The marriage provided him with hope, purpose, a sense of devotion and fidelity, as well as affiliation and love. In short, it seems that his wife was his mental and emotional anchor. The recurrence of symptoms of his mental disorders after the loss of the anchor of his life threw him back into the early developmental conflicts that he was unable to resolve due to his unstable childhood. According to Erikson, in order for the patient to move forward from his regressed state he must tackle and resolve the conflicts of trust vs. mistrust, autonomy vs. shame and doubt, initiative vs. guilt, industry vs. inferiority, identity vs. role diffusion, and intimacy vs. , isolation to reach the adulthood stage of generativity vs. stagnation. Ultimately, with the resolution of all these conflict, the patient will reach a mature state in which he is able to attain ego integrity instead of falling into despair. Patient Prognosis and Treatment Recommendations It is important to remember that the patient was seeking help and trying to recover prior to his most recent hospitalization. He was enrolled in and regularly attending the partial hospitalization program. In addition, he was no longer abusing drugs or alcohol. PHP staff report that he had been medication compliant, cooperative, and was motivated to change. The patient’s recent hospitalization was precipitated by a change in drug dose and type. He reported that it was only after the medication change that the suicidal ideation intensified. Thus, an important goal for this patient is to find the drug types and dosages that will successfully manage his depression and anxiety. However, because the patient has such an extensive history of addiction, primary care providers are hesitant to prescribe large dosages of often highly addictive medications. This hesitation is especially understandable given the patients past abuse of prescription drugs, including an overdose with the intent to commit suicide. However, the types and dosages of the drugs he is currently receiving are not enough to manage his symptoms. The severity of the patient’s depression and anxiety necessitates the use of powerful antidepressants and anxiolytics, but his past substance abuse and dependency make the prescription of these drugs a last resort. Appropriate pharmacotherapy is also complicated by the fact that this patient has tried various classes and types of drugs to manage his symptoms, but no drug therapy has been effective enough to prevent the periodic recurrences of major episodes of depression and anxiety. To manage his depression, the patient has tried typical and atypical antipsychotics, anticonvulsants, tricyclic antidepressants, monoamine oxidase inhibitors, and selective serotonin reuptake inhibitors, as well as other classes of antidepressants, such as Serotonin Norepinephrine Reuptake inhibitors, Norepinephrine Dopamine Reuptake Inhibitors, Alpha-2 Antagonists, and Serotonin-2 Antagonist/Reuptake Inhibitors. Although the apparent failure of all these drugs to manage his depression might cause one to suspect that he is exhibiting purely drug seeking behaviors, the depressive symptoms he xperiences impair and affect him so severely that a denial of the reality of these symptoms would be unsafe and unethical. Electroconvulsive therapy has been recommended to treat his depression, but the patient has refused to undergo this treatment modality. The patient’s anxiety is more easily managed than his depression, and benzodiazepines have proven effective. However, his past abuse o f benzodiazepines make his primary care providers reluctant to give them to him, and they have prescribed non-benzodiazepines, such as Buspar and Zolpidem, instead. Unfortunately, these medications have not been effective in controlling the patient’s anxiety. As a result, the patient has been asking repeatedly for benzodiazepines, while promising that he will use them responsibly. Ultimately, for the patient to achieve effective maintenance of his comorbid mental disorders, he must be able to take medications as prescribed. Due to his history of substance abuse and his still unstable depression and anxiety, it is unlikely that the patient will be able to take his medications as prescribed. It is recommended that a staff member have control of his drugs while he is attending the PHP, and that once discharged, a home health nurse be sent to administer his medication. This would reduce the potential for abuse. In addition, the use of coping mechanisms besides substance abuse may help the patient adhere to the prescribed drug regimen, as well as decrease his depression and anxiety. Coping skills the patient has identified as helpful are watching television and spending some quiet time alone. However, interaction with others should also be encouraged, as too much time spent alone will only reinforce depressive symptoms of isolation. An increase in the quantity and quality of sleep will also aid the patient in his recovery, as sleep deprivation is positively correlated with depressive symptoms and anxiety levels. The patient’s prognosis is one of cautious hopefulness. Though the patient has experienced severe recurrences of MDD, GAD, and substance abuse in recent years, the patient had maintained a long period of sobriety prior to this, during which he was happy, productive, and high functioning. The patient’s ability to achieve remission from his mental illnesses during his marriage to his wife shows that investing in a supportive relationship is an important and powerful coping skill for this patient. Thus, if the patient is able to form and maintain new supportive relationships, his chance of recovery will improve substantially. It is also important to remember that he was doing very well until his wife died. According to the Holmes and Rahe Index, the death of a spouse is the number one most stressful event that occurs in the life of an individual (Perry Potter, 2009). It is not an exaggeration to say that with his wife’s death, life as he knew it ended. Many people experience periods of long and severe depression following the death of a loved one. For this patient, his descent into depression, combined with the resurgence of his anxiety sent his life into a complete tailspin. Under the severe stress of not only his wife’s death but also his inability to keep working, he returned to his former coping mechanisms of drug and alcohol abuse. These habits detracted him from working through the grief of his wife’s death, and furthermore caused him to lose his house and his savings, thus increasing his depression and anxiety, thus perpetuating the substance abuse. Now that the patient has withdrawn from drugs and alcohol and is in a safe environment, he can continue his grief work. As a result, his depression may begin to subside, and he may be able to get closer to his previous level of functioning. DSM-IV-TR Axis I: Major Depressive Disorder, Generalized Anxiety Disorder, Polysubstance Abuse Axis II: Cluster B traits Axis III: Hypertension, Hepatitis C, Diabetes Mellitus, Type 2, Osteoarthritis of the left shoulder, Acid Reflux, Bilateral hearing loss Axis IV: Chronic mental illnesses, chronic medical conditions, death of spouse, family estrangement, lack of social support, unemployment, financial insecurity, acute hospitalization, Axis V: 35 (current), 75 (potential) Patient Goals: †¢ I want to find medications that will help my depression and anxiety †¢ I want to keep from abusing my medications †¢ I want my grief over my wife’s death to get better †¢ I want to take one day at a time †¢ I want to feel less alone †¢ I want to get better sleep Nursing Goal: Patient will be safe during hospital stay. Interventions: †¢ Assess for suicidal ideation every shift. †¢ Perform rounds every 15 minutes to ensure patient safety. †¢ Ensure that the patient has no access to potentially harmful objects and/or substances. †¢ Observe, record, and report any changes in mood or behavior that may signify increasing suicide risk and document results of regular surveillance checks. Nursing Goal: Patient will seek help in dealing with grief-associated problems. Interventions: †¢ Develop a trusting relationship with the client by using empathetic therapeutic communication (Eakes, Burke Hainsworth, 1998). Educate the client that grief resolution is not a sequential process and that the positive outcome of grief resolution is the integration of the deceased into the ongoing life of the griever (Matthews Marwit, 2004). †¢ Identify available community resources, including grief counselors and community or Web-based be reavement groups. †¢ Focus on enhancing coping skills to alleviate life problems and distressing symptoms such as anxiety and depression. Nursing Goal: Patient will practice social and communication skills needed to interact with others. Interventions: †¢ Discuss causes of perceived or actual isolation. Assess the patient’s ability and/or inability to meet physical, psychosocial, spiritual, and financial needs and how unmet needs further challenge the ability to be socially integrated. †¢ Use active listening skills to establish trust one on one and then gradually introduce the patient to others. †¢ Provide positive reinforcement when the patient seeks out others. †¢ Encourage the client to be involved in meaningful social relationships and support personal attributes (Gulick, 2001). Nursing Goal: Patient will use effective coping strategies instead of abusing drugs and alcohol. Interventions: †¢ Assist the client to set realistic goals and identify personal skills and knowledge. †¢ Use verbal and nonverbal therapeutic communication approaches including empathy, active listening, and confrontation to encourage the client to express emotions such as sadness, guilt, and anger, verbalize fears and concerns, and set goals. †¢ Offer instruction regarding alternative coping strategies (Christie Moore, 2005). †¢ Encourage use of spiritual resources as desired. Nursing Goal: Patient will identify actions that can be taken to improve quality of sleep. Interventions: †¢ Obtain a sleep-wake history, including history of sleep problems, changes in sleep with present illness, and use of medications and stimulants. †¢ Encourage the patient to develop a bedtime ritual that includes quiet activities such as reading, television, or crafts. †¢ Encourage the patient to use soothing music to facilitate sleep (Lai Good, 2005). †¢ Teach the patient sleep hygiene guidelines for improving sleep habits (ie. go to bed only when sleepy, avoid afternoon and evening naps, use the bed only for sleeping, get up at the same time every morning). Use relaxation techniques to decrease anxiety before going to sleep. †¢ Refer to a sleep center if interventions are ineffective. Analysis of Interaction Before interacting with the patient, I read the patient’s medical record and notes. I paid particular attention to ways the patient said he learned best, which for my patient was one on one conversation. Prior to approaching the client, I asked myself if I had any beliefs, biases, or limitations that would affect my interaction with the patient or prevent the formation of a therapeutic relationship. In order to set the tone of a professional therapeutic relationship, I introduced myself to the client, saying that I was a student nurse and shaking his hand. I made some small talk with him about such topics as sports and the patient’s hobbies in order to show interest in the patient and develop rapport. During this conversation, the patient grew more visibly at ease. His face became less taut, his answers became longer and less forced, and he moved from an erect posture so a somewhat more relaxed position in his chair. The patient spoke slowly and eemed to have difficult finding the words he wanted to use. Such a speech pattern is characteristic of depression, one of the patient’s psychiatric diagnoses. This first conversation was punctuated with the start of morning group. After morning group, I gave the patient some space, as I did not want him to feel overwhelmed or threatened by my questions. About a half hour later, I asked the patient if we could continue the c onversation we were having that morning, and he agreed without hesitation. In this second interaction, I began with a few open-ended questions about how group had been. I then started asking the patient some more questions about his readmission into the hospital and precipitating events. I asked open-ended question, and often responded to his answers by asking further open-ended questions. For example, after asking the patient if he was having suicidal thoughts, he responded that he did not want to hurt himself right now. I replied with the open-ended question, â€Å"So are you feeling safe? † using reflection to redirect the idea back to the patient and allow him to explore whether or not he felt safe. I focused on actively listening to the patient, following the patient’s lead and sometimes asking clarifying questions. Because of the patient’s slower rate of response, I employed the use of silence to allow him to gather his thoughts and proceed at his own pace. As the patient told me more about recent events in his life, including the death of his wife, the loss of his job and his descent into substance abuse, he began to look away more and more. This decrease in eye contact might be the result of the patient feeling ashamed, embarrassed, or guilty about his feelings and behaviors. In order to maintain connection with the patient and assure him of my nonjudgmental view of his situation, I used empathy and restatement, saying, â€Å"It sounds as though you have had a very difficult past couple of years. † Upon saying this, the patient looked up, maintained eye contact, and agreed. He then began to expand on his current feeling of hopelessness, saying, â€Å"I wonder if life is worth living, and sometimes I just want to go to sleep and not wake up. † As he explored and expanded on his feelings I alternated between using silence and validating what he said. The silence allowed him to express intense feelings without interruption, while statements of restatement and interpretation, such as â€Å" It sounds like you have been feeling pretty hopeless,† demonstrated empathy and a nonjudgmental attitude toward what the client was feeling. At one point, the patient put his head in his hands, saying â€Å"I had so much going for me, and after my wife died, everything went to pot. † I felt that in this moment, what the client needed was neither a cheery reassurance that things would get better, nor dispensation of advice, but rather a person to understand and acknowledge his current misery. I replied that sometimes life gets you down, and sometimes when it rains it pours, and it’s ok to be sad about that. The patient seemed appreciative of the acknowledgment of his pain and the justification of his sadness. I sat silently with him for 2-3 minutes, as I felt it was important for him to feel, sit with, and process these emotions for a short period of time. During these periods of silence, I continued to lean forward slightly, as I had done throughout the interaction, to show that I was still interested and engaged despite the lack of verbalization. Because I had acknowledged the patient’s hardships and thereby connected with him, I felt that I was in a good position to explore with him goals he had for the future, and ideas that could help him reach these goals. I made sure to approach this topic not by giving advice or suggestions, but by asking him open-ended questions about what things made him feel less sad or anxious and what things he wanted to work on during his stay. These open ended questions elicited the response of his goals for the future, and his verbalization that he needed to find better coping mechanisms, because his old ones didn’t seem to work. He also stated that he knew he needed to â€Å"continue grieving my wife, because the drugs and alcohol kept me from doing that. † I thought that this realization of substance abuse as inhibitory to his grief process was very insightful, and told him so. He made a small smiling expression and responded that he wanted to â€Å"get back on the straight and narrow† and take his medications â€Å"the way I’m supposed to—no more, no less. † The patient’s elucidation of his goals and his insight into helpful and hindering coping devices was a very positive outcome of this therapeutic conversation. The patient seemed less burdened after the opportunity to talk about his recent losses in life, and more hopeful after verbalizing his goals and ways to meet them. References Ackley, B. J. Ladwig, G. B. (2008). Nursing Diagnosis Handbook (7th ed. ). St. Louis, Missouri: MOSBY Elsevier. American Psychological Association. (2002). Boyd, M. A. (2008). Psychiatric nursing: contemporary practice (4th ed. ). New York: Lippincott Williams Wilkins. Bruskas, D. (2010). Developmental health of infants and children subsequent to foster care. Journal of Child and Adolescent Psychiatric Nursing, 23(4), 231-241. doi:http://dx. doi. org/10. 1111/j. 1744-6171. 2010. 00249. x Christie, W. Moore, C. (2005). The impact of humor on patients with cancer. Clinical Journal of Oncology Nursing, 9(2), 211-218. Cohn, A. M. , Epstein, E. E. , McCrady, B. S. , Jensen, N. , HunterReel, D. , Green, K. E. , Drapkin, M. L. (2011). Pretreatment clinical and risk correlates of substance use disorder patients with primary depression. Journal of Studies on Alcohol and Drugs, 72(1), 151-157. Eakes, G. G. , Burke, M. L. Hainsworth, M. A. 1998). Middle-range theory of chronic sorrow. Image Journal Nursing Scholar, 30, 179. Felitti, V. J. Anda, R. F. (2010). The Relationship of Adverse Childhood Experiences to Adult Medical Disease, Psychiatric Disorders, and Sexual Behavior: Implications for Healthcare. Cambridge University Press. Gulick, E. (2001). Emotional distress and activities of daily living functioning in persons with multiple sclerosis . Nursing Resolutions, 50(3), 147-154. Lai, H. L. Good, M. (2005). Music improves sleep quality in older adults. Journal of Advanced Nursing, 49(3), 234-244. Lawrence, A. E. , Liverant, G. I. , Rosellini, A. J. , Brown, T. A. (2009). Generalized anxiety disorder within the course of major depressive disorder: Examining the utility of theDSM-IV hierarchy rule. Depression and Anxiety, 26(10), 909-916. Levola, J. , Holopainen, A. , Aalto, M. (2011). Depression and heavy drinking occasions: A cross-sectional general population study. Addictive Behaviors, 36(4), 375-380. doi:http://dx. doi. org/10. 1016/j. addbeh. 2010. 12. 015 Matthews, L. Marwit, S. (2004). Complicated grief and the trend toward cognitive-behavioral therapy. Death Studies, 28, 849-863. Moffitt, T. E. , Caspi, A. , Harrington, H. , Milne, B. , Melchior, M. , Goldberg, D. , Poulton, R. (2010). Generalized anxiety disorder and depression: Childhood risk factors in a birth cohort followed to age 32 years. Diagnostic issues in depression and generalized anxiety disorder: Refining the research agenda for DSM-V (pp. 217-239). Washington, DC, US: American Psychiatric Association; US. National Institute of Health. (2005). National Research Council Committee on Integrating the Science of Early Childhood Development. (2000). Perry, A. G. , Potter, P. A. (2009). Fundamentals of Nursing (7th ed. ). St. Louis, Missouri: MOSBY Elsevier. Plaisier, I. , Beekman, A. T. F. , de Graaf, R. , Smit, J. H. , van Dyck, R. , Penninx, B. W. J. H. (2010). Work functioning in persons with depressive and anxiety disorders: The role of specific psychopathological characteristics. Journal of Affective Disorders, 125(1-3), 198-206. doi:http://dx. doi. org/10. 1016/j. jad. 2010. 01. 072 President and Fellows of Harvard College. (2011). Harvard Mental Health Letter. Harvard Health Publications. Retrieved from http://www. health. harvard. du Romera, I. , FernandezPerez, S. , Montejo, A. L. , Caballero, F. , Caballero, L. , Arbesu, J. A. , . . . Gilaberte, I. (2010). Generalized anxiety disorder, with or without co-morbid major depressive disorder, in primary care: Prevalence of painful somatic symptoms, functioning and health status. Journal of Affective Disorders, 127(1-3), 160-168. doi:http://dx. doi. org/10. 1016/j. jad. 2010. 05. 009 Seo, H. , Jung, Y. , Kim, T. , Kim, J. , Lee, M. , Kim, J. , . . . Jun, T. (2011). Distinctive clinical characteristics and suicidal tendencies of patients with anxious depression. Journal of Nervous and Mental Disease, 199(1), 42-48. doi:http://dx. doi. org/10. 1097/NMD. 0b013e3182043b60 Smith, J. P. , Book, S. W. (2010). Comorbidity of generalized anxiety disorder and alcohol use disorders among individuals seeking outpatient substance abuse treatment. Addictive Behaviors, 35(1), 42-45. doi:http://dx. doi. org/10. 1016/j. addbeh. 2009. 07. 002 Sunderland, M. , Mewton, L. , Slade, T. , Baillie, A. J. (2010). Investigating differential symptom profiles in major depressive episode with and without generalized anxiety disorder: True co-morbidity or symptom similarity? Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 40(7), 1113-1123. doi:http://dx. doi. org/10. 1017/S0033291709991590 United States Department of Health and Human Services. (1999). Yen, Y. , Rebok, G. W. , Gallo, J. J. , Jones, R. N. , Tennstedt, S. L. (2011). Depressive symptoms impair everyday problem-solving ability through cognitive abilities in late life. The American Journal of Geriatric Psychiatry, 19(2), 142-150. doi:http://dx. doi. org/10. 1097/JGP. 0b013e3181e89894 Case How to cite Case Analysis of Mdd, Gad, and Substance Use, Essay examples

Leadership in Organization Pros and Cons free essay sample

The leader’s leadership styles play a very important role in achieving goals of the organization. The leader’s ability to adapt to internal and external environment changes and working with followers together is the key to success. Moreover, I should mention that many causal modeling revealed that leadership style has a direct, rather than indirect, effect on task performance. Highly complex and stress-laden workplaces present challenges to organizational leaders as they are faced with the task of managing the workforce while concurrently maintaining commitment and morale. Leaders can often be in the middle source of stress among employees in the workplace (Basch Fisher, 2000; Sosik Godshalk, 2000). As the distinctiveness of work changes, so must change the roles and tactics of all leaders. The Leader promote supportive relationships, elicit motivation along with assistants/followers, make possible more positive and less negative emotions along with assistants, and stimulate more kind evaluations of stressful tasks among assistants may be more effective than the more conventional leaders who usually tend toward task-directive methods. We will write a custom essay sample on Leadership in Organization Pros and Cons or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page These leadership elements based on relation, motivation, and emotion are customary with transformational leadership styles (Bass, 1998; Yukl, 1998). Despite a considerable body of literature suggests that leaders based on transformational are effective, there is a small number of experimental research that has discovered how transformational leaders may impact subordinates/followers during stressful business deals. Taking into above mentioned I am to deal with transformational and transactional leadership styles their influence on different subordinate including emotional and motivational experiences. The effects of leadership style based on stressful task performance were examined (by Joseph B. Lyons, Tamara R. Schneider 2009) as potential mediators, further. 2. 0 The Nature of Leadership and Job Stress 2. 1 Leadership Style In the field of organizational behavior the leadership is really an important subject. Leadership is one with the most dynamic effects during individual and organizational interaction. In other words, whether a management is able to execute â€Å"collaborated effort† depends on leadership capability.