Tiffany is a 16-year-old teenager who has obsessive-compulsive disorder and continually washes her hands until they are cracked and bleeding. She was placed on the inpatient unit on a 5150 after a recent suicide attempt in which she overdosed on her mother’s sleeping pills in the medicine cabinet. She is medically stable. You are her assigned nurse, and when you approach her room, you hear her in the bathroom washing her hands.Tiffany describes the ending of her relationship with her boyfriend as “ghosting.” He just “stopped calling me after a year of going out.” Important cognitive behavioral approaches for her lack of self-esteem and anxiety may be (select all that apply):
Reframe “all or nothing” thinking and that it is all “her fault.”
Have her identify self-soothing activities for decreasing anxiety.
Reframe self-criticism and give positive feedback for insightful comments during group therapy.
Tell her she “has her entire life ahead of her and shouldn’t be worried about her former boyfriend.”
Correct Answer : A,B,C
Choice A reason:
Reframing “all or nothing” thinking and that it is all “her fault” is an important cognitive behavioral approach. This technique helps Tiffany recognize and challenge irrational thoughts that contribute to her low self-esteem and anxiety. By learning to see situations in a more balanced way, she can reduce feelings of guilt and self-blame.
Choice B reason:
Having Tiffany identify self-soothing activities for decreasing anxiety is another effective cognitive behavioral approach. Self-soothing activities, such as deep breathing, listening to music, or engaging in hobbies, can help her manage anxiety and reduce the urge to engage in compulsive behaviors like handwashing.
Choice C reason:
Reframing self-criticism and giving positive feedback for insightful comments during group therapy can help Tiffany build self-esteem and develop a more positive self-image. Positive reinforcement encourages her to recognize her strengths and achievements, which can counteract negative self-perceptions.
Choice D reason:
Telling Tiffany she “has her entire life ahead of her and shouldn’t be worried about her former boyfriend” is not a cognitive behavioral approach. While it may be intended to provide reassurance, it does not address the underlying cognitive distortions or provide strategies for managing anxiety and low self-esteem.
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Correct Answer is A
Explanation
Choice A reason:
Expressing an active suicide ideation by stating, “I will take an overdose if I return to the dorm room,” meets the criteria for a 5150 involuntary hold for “Danger to Self.” This statement indicates a clear and immediate risk of self-harm, which warrants immediate intervention to ensure Edward’s safety.
Choice B reason:
Starting to cry when discussing his grandfather’s death is a normal emotional response to grief and does not meet the criteria for a 5150 involuntary hold. While it indicates emotional distress, it does not suggest an immediate risk of self-harm.
Choice C reason:
Refusing to take antidepressant medication is concerning and may indicate non-compliance with treatment, but it does not meet the criteria for a 5150 involuntary hold unless it is accompanied by behaviors that indicate an immediate risk of self-harm.
Choice D reason:
Admitting to feeling hopeless but agreeing to return to the clinic in the morning escorted by his classmate who will stay with him does not meet the criteria for a 5150 involuntary hold. While feelings of hopelessness are serious, the plan to return to the clinic with support indicates that Edward is not an immediate danger to himself.
Correct Answer is A
Explanation
Choice A reason:
Duloxetine (Cymbalta) is an SNRI antidepressant commonly used for both chronic pain and depression. It works by increasing the levels of serotonin and norepinephrine in the brain, which helps improve mood and alleviate pain. Duloxetine is often prescribed for conditions such as fibromyalgia, diabetic neuropathy, and chronic musculoskeletal pain, in addition to its use in treating major depressive disorder.
Choice B reason:
Sertraline (Zoloft) is an SSRI antidepressant used primarily to treat depression, anxiety disorders, and other mood disorders. While it is effective for these conditions, it is not specifically indicated for chronic pain management.
Choice C reason:
Fluoxetine (Prozac) is another SSRI antidepressant used to treat depression, anxiety disorders, and certain eating disorders. Like sertraline, it is not typically used for chronic pain management.
Choice D reason:
Citalopram (Celexa) is also an SSRI antidepressant used to treat depression. It is not indicated for chronic pain management and is primarily used to improve mood and alleviate symptoms of depression.