Primary Care of the Psychiatric Mental Health Client II

PMHNP Treatment Plan PTSD

PMHNP Treatment Plan for 49-Year-Old Latinx Female with PTSD and Alcohol Use Disorder

Patient Profile:

• Age: 49 years
• Gender: Female
• Ethnicity: Latinx
• Diagnosis: Post-Traumatic Stress Disorder (PTSD) and Alcohol Use Disorder (AUD)

Treatment Plan Components:

1. Assessment and Diagnosis
   • Initial Assessment:
     • Comprehensive psychiatric evaluation.
     • Detailed history of trauma, including duration, frequency, and nature of traumatic events.
     • Assessment of alcohol use patterns, quantity, frequency, and any previous attempts to quit.
     • Evaluation of comorbid conditions such as depression or anxiety.
     • Cultural considerations and impact on treatment.
     • Social support systems and living environment.
   • Diagnostic Tools:
     • PTSD Checklist (PCL-5)
     • Alcohol Use Disorders Identification Test (AUDIT)
     • Clinician-Administered PTSD Scale (CAPS)
     • Lab tests: Liver function tests, CBC, metabolic panel.
2. Establishing Treatment Goals
   • Short-term Goals:
     • Reduction of PTSD symptoms.
     • Reduction in alcohol consumption.
     • Improve overall functioning and quality of life.
   • Long-term Goals:
     • Achieve and maintain sobriety.
     • Manage and reduce PTSD symptoms effectively.
     • Develop coping mechanisms for trauma and stress.
     • Improve physical health and repair alcohol-related damage.
3. Pharmacotherapy
   • PTSD:
     • Selective Serotonin Reuptake Inhibitors (SSRIs):
       • Sertraline (Zoloft) 25 mg daily to start, titrating up to 50-100 mg daily.
       • Paroxetine (Paxil) 20 mg daily.
     • Prazosin: For nightmares and sleep disturbances, starting at 1 mg at bedtime and titrating up.
   • Alcohol Use Disorder:
     • Naltrexone: 50 mg daily, to reduce cravings and the reinforcing effects of alcohol.
     • Acamprosate: 666 mg three times daily, to maintain abstinence (consider if naltrexone is not suitable).
     • Disulfiram: 250 mg daily, only if the patient is highly motivated and fully informed of potential risks.
   • Adjunct Medications:
     • Gabapentin: For anxiety and withdrawal symptoms, starting at 300 mg three times daily.
     • Benzodiazepines: Short-term use for acute withdrawal under close supervision.
4. Psychotherapy
   • Trauma-Focused Cognitive Behavioral Therapy (TF-CBT): To address trauma-related thoughts and behaviors.
   • Eye Movement Desensitization and Reprocessing (EMDR): For processing traumatic memories.
   • Motivational Interviewing (MI): To enhance motivation to quit alcohol.
   • 12-Step Facilitation Therapy: Encourage participation in Alcoholics Anonymous (AA) or similar support groups.
5. Integrated Care Approach
   • Coordination with Primary Care Provider: To monitor physical health and manage any comorbid medical conditions.
   • Referral to Substance Use Specialist: For additional support and specialized treatment.
   • Social Services Referral: For assistance with housing, employment, and financial issues.
6. Support Systems and Community Resources
   • Family Therapy: Involve family members to support the patient and address family dynamics.
   • Cultural Considerations: Incorporate culturally sensitive practices and potentially involve community leaders or faith-based support if appropriate.
   • Support Groups: Participation in PTSD and AUD support groups.
7. Monitoring and Follow-Up
   • Regular Follow-Up Appointments:
     • Weekly for the first month, then biweekly to monthly as progress is made.
     • Monitor medication adherence, side effects, and efficacy.
     • Ongoing assessment of PTSD and AUD symptoms.
     • Periodic reassessment using PCL-5 and AUDIT.
   • Relapse Prevention Plan:
     • Develop a plan for managing potential triggers and cravings.
     • Establish a crisis intervention plan for potential relapse or severe PTSD episodes.
8. Patient Education
   • Education on PTSD and AUD:
     • Understanding the nature of both conditions.
     • Educating on the impact of alcohol on PTSD symptoms and overall health.
   • Medication Adherence:
     • Importance of taking medications as prescribed.
     • Discuss potential side effects and what to do if they occur.
   • Healthy Lifestyle Choices:
     • Nutrition, exercise, and sleep hygiene.
     • Stress management techniques such as mindfulness, yoga, or meditation.
9. Evaluation of Treatment Effectiveness
   • Outcome Measures:
     • Reduction in PTSD symptoms as measured by PCL-5.
     • Decrease in alcohol consumption and improvement in liver function tests.
     • Improved quality of life and social functioning.

Conclusion

This comprehensive treatment plan addresses the complex needs of a 49-year-old Latinx female patient with PTSD and Alcohol Use Disorder, focusing on culturally sensitive, integrated care to promote recovery and improve overall well-being. Regular follow-ups and a robust support system are crucial for sustained recovery and symptom management.