Hello Marie,
You gave an extensive assessment, which is very effective in addressing the complex issue of
major depression, substance misuse, and psychological issues of post-stroke disability. A very
significant issue in this case is the patient's feeling of being a burden to her family. This sense,
along with unprocessed grief, limitations in functioning and non-compliance with medications
seems to have been a major driving force in her suicidal acts. I know that her recent intentional
overdose with heroin has put her in a very high risk position of making another attempt, but at
the moment she says that she is not having suicidal thoughts.
The patient needs inpatient psychiatric care, which is recommended, due to the need for 24-hour
surveillance, psychiatric stabilization, and comprehensive treatment of her opioid use disorder.
Also thanks for your focus on starting MAT with Suboxone. Buprenorphine-naloxone treatment
is linked to decreased mortality rates and better chances of achieving a remission from opioid use
disorder, according to Paul et al. (2024). If you're also suffering from depression, you need to
treat both of these conditions, or one could be a serious trigger the other.
Patient's history of stroke, and physical restrictions are also important. As a psychiatric mental
health nurse practitioner, I would also recommend that she include rehabilitation services and OT
in her treatment plan. An increase in functional independence can decrease helplessness,
perceived burdensomeness (Lee et al., 2024). Furthermore, there should be a structured family
therapy and caregiver education to encourage the involvement of the family with the patient and
ensure that patient autonomy is maintained.
Another area that I would continue to stress is creating a collaborative suicide prevention plan
prior to discharge. This should involve limiting access to medicines and other substances that can
be lethal, making appointments for psychiatric and drug treatment services that are available on
an outpatient basis and providing crisis resources (Taylor & Samet, 2022). An evidence-based
collaborative safety plan would be more appropriate, rather than a no harm contract.
In general, your assessment highlights the need for a holistic, patient-centered and multi-faceted
approach to psychiatric instability that includes biological, psychological and social factors.
References
Taylor, J. L., & Samet, J. H. (2022). Opioid use disorder. Annals of Internal Medicine, 175(1),
ITC1-ITC16.
Lee, Y. K., Gold, M. S., Blum, K., Thanos, P. K., Hanna, C., & Fuehrlein, B. S. (2024). Opioid
use disorder: current trends and potential treatments. Frontiers in public health, 11, 1274719.
You gave an extensive assessment, which is very effective in addressing the complex issue of
major depression, substance misuse, and psychological issues of post-stroke disability. A very
significant issue in this case is the patient's feeling of being a burden to her family. This sense,
along with unprocessed grief, limitations in functioning and non-compliance with medications
seems to have been a major driving force in her suicidal acts. I know that her recent intentional
overdose with heroin has put her in a very high risk position of making another attempt, but at
the moment she says that she is not having suicidal thoughts.
The patient needs inpatient psychiatric care, which is recommended, due to the need for 24-hour
surveillance, psychiatric stabilization, and comprehensive treatment of her opioid use disorder.
Also thanks for your focus on starting MAT with Suboxone. Buprenorphine-naloxone treatment
is linked to decreased mortality rates and better chances of achieving a remission from opioid use
disorder, according to Paul et al. (2024). If you're also suffering from depression, you need to
treat both of these conditions, or one could be a serious trigger the other.
Patient's history of stroke, and physical restrictions are also important. As a psychiatric mental
health nurse practitioner, I would also recommend that she include rehabilitation services and OT
in her treatment plan. An increase in functional independence can decrease helplessness,
perceived burdensomeness (Lee et al., 2024). Furthermore, there should be a structured family
therapy and caregiver education to encourage the involvement of the family with the patient and
ensure that patient autonomy is maintained.
Another area that I would continue to stress is creating a collaborative suicide prevention plan
prior to discharge. This should involve limiting access to medicines and other substances that can
be lethal, making appointments for psychiatric and drug treatment services that are available on
an outpatient basis and providing crisis resources (Taylor & Samet, 2022). An evidence-based
collaborative safety plan would be more appropriate, rather than a no harm contract.
In general, your assessment highlights the need for a holistic, patient-centered and multi-faceted
approach to psychiatric instability that includes biological, psychological and social factors.
References
Taylor, J. L., & Samet, J. H. (2022). Opioid use disorder. Annals of Internal Medicine, 175(1),
ITC1-ITC16.
Lee, Y. K., Gold, M. S., Blum, K., Thanos, P. K., Hanna, C., & Fuehrlein, B. S. (2024). Opioid
use disorder: current trends and potential treatments. Frontiers in public health, 11, 1274719.
