Brandon: HIV/HCV Co-Infected, Undetectable CD4 Load Cell Count - Essay Sample

Introduction

Brandon, a 50-year-old American male who has been co-infected both with HIV and HCV, presents himself in healthcare for the daily routine medical appointments. Although the patient seems to have been incarcerated in the past three years, he tends to be so relaxed to take other pills. Brandon is prescribed a two by one daily regimen for the Combivir and Kaletra respectively, and the tests have shown that the patient's level of CD4 load cell count has dramatically arisen to undetectable levels of about 750cells/mm3. Moreover, despite the available shreds of evidence indicating that Brandon has a history of using heroin and cocaine, the patient vibrantly denies any instance of psychotropic medication trials done to him. Also, the mother died three months ago, and Brandon has severely suffered recently, as he a complaint of challenges such as depression, consistent variation in moods, frequent anger and case of insomnia. The patient also admits that he had been having early morning awakening thoughts about pushing him to commit suicide.

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Assessment Tools and Expected Outcome

The most important health indicators in the case scenario are depression and thoughts of death. Several assessment tools and measures would be evaluated as effective corrective and care plans for this health meant illness complication in Brandon. First, patient safety would be given more consideration. I would suggest that necessary resources and tools be put in place to help in placing Brandon under serious suicidal precautions and monitoring. Nevertheless, the past suicidal records, the current intentions of harming himself and his level of anxiety should be reassessed or revisited during the formulation of the safety management plan for the patient. Comprehensive probing of such factors would help me in evaluating (using the evidence-based approach) whether the patient is presently at risk of committing suicide or not.

After considering patient safety, the second assessment would be discussing the aspect of depression. According to nursing guidelines, bereavement would highly contribute to Brandon's differential diagnosis. However, I would eliminate these chances because the extent of the effects and longer duration of their encountering proves that the impacts are linked to depression and not grief. Most scholars and researchers have based their analysis on the treatment measures for depression as a result of HIV/AIDS. Studies have shown that individuals who have HIV/AIDS are likely to experience an estimated lifetime depression of 50%.

Moreover, most medication management plans for their depression cases usually extend up to a period of four to eight weeks with 60-70 result response and an additional 8-12 weeks for reemission. Also, the health care team and Brandon would have expectations of positive outcomes. It has also been found that the use of antidepressants may be more straightforward with the HIV patients compared to the rest of the psychotropic categories. Nevertheless, the use of selective serotonin reuptake inhibitors (SSRIs) and tricyclics (TCAs) has been categorized with the same efficacies and side effects to every individual (Anderson, I. M. (2000).

Besides, it should be noted that efficacy is equally important while evaluating the spectrum of antidepressants (Rosenzweig-Lipson et al., 2007). Therefore, interrogation of formulary availabilities and its side effects should be handled in a balanced scoreboard to help Brandon. For this patient, nine-month antidepressant medication should be proposed immediately after his remission of 8-12 weeks for the depressive symptoms (Rosenzweig-Lipson et al., 2007). The next assessment would be monitoring of the patient to assess the efficiency and effectiveness of the entire developed side effects and treatment plans offered during the antidepressant therapy (Gill & Hatcher, 2000). I would then suggest for a further follow up for 3-4 months to ascertain that all the treatment therapy procedures were standard.

Finally, it is vital to note that selecting a drug is not an essential process or step during an assessment of mental illness disorder. Still, the theme of treatment duration should be overemphasized. Also, complications might arise if a dual diagnosis of depression is offered to the patient to address HIV related and HCV related symptoms. However, research shows that the interferons which are often used to treat HCV infections might trigger the depression in a patient. As a result, addressing the depressive symptoms that are associated with HIV in Brandon may be enough, because there is interlinkage in the neural system of the mental disorders. Introducing two different drugs may trigger mental disorders and further lead to total mental or memory loss.

Biological, Psychological and Social Factors Present in the Case

The patient has HIV, which can genetically be inherited. He has also faced cases of physical illness which may be one of the biological causes of depression. Moreover, the patient is ageing, and this might be contributing to his depression symptoms. This is because as individual ages, he/she become weak in the mental tissues to undertake pain. The case highlights that the patient just lost his mother about three months ago. He must have found it uneasy about accepting the pain, due to the generally weak tissues at the age of 50 (George, 2011).

On the other hand, the case also included psychological factors that propagated the case of depression and its similar symptoms. Again, the stress in one of the significant prominent factors that can be evidenced in Brandon's scenario. The past medical history of the patient stated that he was suffering from normal sadness and irritability. Sadness in an individual is usually caused whenever the hormones for happiness goes down below a certain level. Scholars have also outlined in the past the grief may readily cause stress, which is a psychological factor in depression. Finally, there are also social factors in the case. They include age, insomnia and sleep disorder as stipulated in the case study (George, 2011). The patient experiences strange nightmares, making him wake up early unnecessarily. His suffering for insomnia is also a significant social factor of depression.

Cognitive Behavioral Theory Interventions

Cognitive-behavioural theorists usually suggest that depression can only result from a set of distorted thoughts and judgments. The theory further suggests that depression is a socially caused illness, and therefore can be avoided by merely teaching on the essential social skills. Theorists often use an example of children whose parents are dysfunctional (Rector & Beck, 2001). They will grow with anticipations and questions as they compare themselves to other children, and this continued stress and dissatisfaction with their current state will impart them with the depressive symptoms such as insomnia, sleep disorder or threats of committing suicide. In the case provided, the theory is relevant because the cause of depression can be traced back to the stress resulting as a result of takings drugs twice a day to prevent the severe symptoms of HIV/AIDS (Rector & Beck, 2001). It can be depicted using the CBT technique that Brandon decided to get into substance use was as a result of thoughts and judgments on himself. Perhaps, he suffered from self-esteem, another vital social cause of depression.

The rationale of the CBT theory argues that individual thoughts are usually transformed into feelings and then behaviours. Psychoeducational and motivational techniques were used to chose this intervention. Moreover, it offered a real understanding of the case than other theories or interventions. According to CBT, the challenge of depression and substance use would be addressed by engaging Brandon in social skills training SST programs and training him in the possible coping skills to enable him to avoid the symptoms in lonely places like while at home after her end of the treatment duration (Rector & Beck, 2001). Various SST programs may include empathy, verbal and written communications, coordination and cooperation techniques, listening skills and non-verbal communications. They are essential to enable the patient to build a stronger relationship with the therapist.

Good inter-relations between client and therapist and collaboration of the patient in offering response are, in fact, some of the crucial principles of CBT. Therefore, SST programs will allow the patient to communicate easily with the therapist concerning any severe health implications during the treatment plan. Because the theory requires close patient-client relationship, the setting could be when both are within the health care and also when the patient has been discharged using the various communication devices like the phone.

To reiterate, CBT majors on the social factors, because it assumes that depression is caused by behaviours which are derived initially from thoughts and judgements. The outcome of this intervention would ensure that the symptoms are significantly reduced after the monitoring time of 12 months, but reappeared after this time. As a corrective mechanism, the theory also stresses on the need for undertaking relapsed prevention with patients suffering from a mental disorder to ensure that the symptoms do not reappear after a specific duration (Epstein et al., 2002). It also helps the patient in case to completely stop using substances such as cocaine and heroin. This stage is vital in the CBT intervention because, otherwise, all the symptoms and addictive behaviours will get back to their usual way, and the patient may suffer from severe depression.

References

Anderson, I. M. (2000). Selective serotonin reuptake inhibitors versus tricyclic antidepressants: a meta-analysis of efficacy and tolerability. Journal of affective disorders, 58(1), 19-36.

Epstein, N., Baucom, D. H., & Baucom, D. H. (2002). Enhanced cognitive-behavioural therapy for couples: A contextual approach (Vol. 1). Washington, DC: American Psychological Association.

George, L. K. (2011). Social factors, depression, and ageing. In Handbook of ageing and the social sciences (pp. 149-162). Academic Press.

Gill, D., & Hatcher, S. (2000). Antidepressants for depression in medical illness. Cochrane Database of Systematic Reviews, (3).

Rector, N. A., & Beck, A. T. (2001). Cognitive-behavioural therapy for schizophrenia: an empirical review. The Journal of nervous and mental disease, 189(5), 278-287.

Rosenzweig-Lipson, S., Beyer, C. E., Hughes, Z. A., Khawaja, X., Rajarao, S. J., Malberg, J. E., ... & Schechter, L. E. (2007). Differentiating antidepressants of the future: efficacy and safety. Pharmacology & Therapeutics, 113(1), 134-153.