How would you specifically adjust your treatment plan

Reference no: EM133439184

CASE STUDY The patient is a 28-year-old married man with significant combat history, documented mild traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), and severe symptoms of irritability and depression He deployed to a combat theater approximately 3 years ago; since then, he has suffered from: Significant irritability Somewhat labile mood with severe depression Baseline anxiety Paroxysms in response to certain triggers Significant hypervigilance Exaggerated startle response Avoidance Nightmares 2-3 times per week Insomnia (sleep maintenance) Intrusive recollection, although he denies any significant flashbacks There is no evidence of mania or hypomania. He also reports having had at least 3 concussions, 2 in the combat theater and one due to a motorcycle accident, with subsequent daily headaches, difficulty concentrating, memory problems, and other cognitive symptoms. The patient has been treated with multiple first-line antidepressant medications with only partial improvement. After 6 months of treatment, he continues to suffer from significant symptoms of depression and PTSD, including depressed mood, irritability, anhedonia, insomnia, anergia, poor concentration, and hypervigilance. He has just taken the Patient Health Questionnaire 9 (PHQ-9) and scored 22, indicating significant depression His current medications include gabapentin 300 mg 3 times daily, duloxetine 90 mg/day, and hydroxyzine50 mg 4 times.

He is in therapy and has seen some benefit with respect to his symptoms of PTSD, but his depression remains little changed

He also suffers from chronic headaches and musculoskeletal pain and was recently prescribed acetaminophen/hydrocodone by his primary care physician (1 tablet every 4-6 hours as needed)
He and his family are concerned that he is being "overmedicated" (i.e., treated with too many medications)
The patient denies any history of auditory or visual hallucinations and is neither suicidal nor homicidal

QUESTIONS

1. What would you do first?

a. Adjust treatment to address PTSD.

b. Adjust treatment to address depression.

c. Adjust treatment to address pain.

2. Based on your response to question 1, how would you specifically adjust your treatment plan? Be very specific!

3. What non-pharmacological treatments would you recommend and why?

Reference no: EM133439184

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