Coping.us



TEMPLATE: So What Say You?

Problem Solve Behavioral Health Interventions for

Patients in Integrated Medical Settings

Case 1 Rita: High Cholesterol

Rita is a 33 year old woman whose mother died from heart disease at the age of 55. Rita currently has 2 children and is planning a pregnancy in the near future. On evaluation, blood pressure is 130/80mm Hg and body mass index is 27. Her fasting lipid profile of 300 mg/dL, the high-density lipoprotein (HD) level is 40 mg/dL and the triglyceride level is 200 mg/dL. Fasting blood glucose is 110 mg/dL. Her LDL level is more than double the 100 mg/DL recommend clinical level. The HDL level is low and below the cutpoint of 40 mg/dl. Her family history of heart disease further increases her own risk for coronary heart disease. Since she is planning a pregnancy soon, she was not given statins. Instead she was encouraged to work on a low-fat diet and replace butter with a margarine. She was also encouraged to increase her activity level with daily exercise such as walking.

|Case 1 Rita: TEMPLATE |

|What are the risk factors you see in Rita’s check-up results? |

|Rita’s blood pressure of 130/80mm Hg is at the prehypertension level. Her triglyceride level of 200 mg/dl at a High level along with her LDL |

|level being more than double the recommended clinical level puts Rita at risk for coronary heart disease. Since she is planning on getting |

|pregnant she is not a good candidate for statin to lower her LDL levels. She needs a lifestyle change for a healthy pregnancy, delivery and |

|birth of a child. |

| |

|What would you use to assess her current mental health status? |

|DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure—Adult to get an overall view of Rita’s Mental and Emotional Functioning to determine if|

|she is stable enough to follow the directions of her medical team. |

| |

|What tools would you use to help her compliance with Diet and Exercise as advised by her physician? |

|Group Work: |

|Invite her join the OB/GYN “Strategies for Success in Health Management” Psychoeducational Support Group offered in your clinic which include |

|specifics on exercise and diet management for a healthy pregnancy |

|Handouts: |

|Have her monitor anxiety over her health with: Health Anxiety Thought Record and bring it in next time |

|Have her record her Physical/Exercise Activity on a daily basis with: CBT Daily Activity Diary: |

|Have her do a daily record of her dietary intake until you meet again |

|Apps: |

|PumpUp-Health & Fitness Community. |

|My Fitness Pal |

|Units from Strategies for Success in Health Management: |

|#1 What do these Terms Mean? |

|#5 Rationale for Exercise and Weight Management |

|#4 Introduction to Exercise in your life |

|#2 Tips from Drink Eat and Be Healthy |

| |

|What would you be looking for on Rita’s next visit to the clinic? |

|Did she attend your weekly support group for women who are pregnant, wanting to get pregnant or who have recently had a baby called and find |

|out why she decided to come or not come to the meetings and see if you can encourage her to come in |

|Level of anxiety over the time since last seen |

|Has there been an increase in her Physical/Exercise Activity over this time |

|Has she been good about limiting her fat intake in her diet management |

|How committed is she to making life style changes to lower her risk for coronary heart disease and to have a healthy pregnancy |

|Will she commit to be open to join your weekly OB/GYN Strategies for Success in Health Management support |

Case 2 Dorothy: Obesity

Dorothy is a 40-year-old woman who had gained over 50 pounds within the last 10 years. Tired of being overweight and being told she had no willpower, was weak, or that she needed to change her lifestyle – eat less and exercise more, she sought out medical treatment to help her lose weight and thus prevent health risks that could cause serious illness or even death. The physician explained to her that he would not recommend starting weight-loss medications until she followed a diet subsequent to seeing a nutritionist. He said that she should follow-up with his office in 3 months for a re-assessment of her lifestyle changes (e.g., healthy eating, and regular physical activity).

|Case 2 Dorothy: TEMPLATE |

|What are the risk factors you see in Dorothy’s check-up results? |

|Dorothy is overweight and realizes it and thankfully wants help to turn her health around. |

| |

|What would you use to assess her current mental health status? |

|Since she is looking for a “quick fix” with weight-loss medications there is a great chance that she is very depressed. You could use either |

|one or both of the following tools to assess her depression: |

|PROMIS Emotional Distress—Depression—Short Form |

|Severity Measure for Depression—Adult (Patient Health Questionnaire [PHQ-9]) |

|And then to get an overview of her mental health function you could use: |

|DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure—Adult |

| |

|What tools would you use to help her compliance with Diet and Exercise advised by her physician? |

|Group work: |

|Invite her join the “Tools for a Balanced Lifestyle: Support Group for a Guilt Free System of Healthy Living” Psychoeducational Support Group |

|offered in your clinic which include specifics on exercise and diet management for a healthy lifestyle offered specifically to patients |

|needing an ongoing program of support to control their food intake, increase their daily exercise program and receive emotional support to |

|deal with the stressors which have led to their problems with obesity |

|Based on Rita’s initial response you can use any or all of the following Handouts, Apps or Units of the Strategies for Success in Health |

|Management program. |

|Handouts: |

|Have her do a daily diary of her dietary intake |

|Have her complete a daily diary of her level of physical exercise each day |

|Have her utilize a personal journal to address her emotional response to her attempts to make life changes |

|Apps: |

|PumpUp-Health & Fitness Community. |

|My Fitness Pal |

|Lose It!-Weight Loss Program and Calorie Counter |

|Units from Strategies for Success in Health Management: |

|#1 What do these Terms Mean? |

|#5 Rationale for Exercise and Weight Management |

|#4 Introduction to Exercise in your life |

|#2 Tips from Drink Eat and Be Healthy |

|#39. Diabetes: Facing It Head On! |

| |

|What would you be looking for on Dorothy’s next visit to the clinic? |

|Was she attending regularly the Balanced Lifestyle Program why or why not? And if she did was she an active participant and how does she feel |

|about the benefit of participating in this group |

|Was she successful in changing her dietary intake |

|Was she successful in implementing an increased and rigorous physical exercise program on a daily basis |

|If she had made no progress and had not attended any of the support group meetings, questions would arise as to her potential compliance in |

|taking weight loss medications and insist on the contingency that she still work on her diet management, physical exercise program and attend |

|the support group in order for her to be given the weight loss medication. Insist on a daily weekly check in to the clinic which involved |

|review of her food and exercise diaries and her attendance to the support group. |

Case 3 Roberta: Obesity-Side Effect of Insulin for Diabetes

Roberta, 52-year-old woman with obesity and a 9 year history of type 2 diabetes presents with complaints of fatigue, difficulty losing weight, and no motivation. She denies polyuria (excessive urination), polydipsia (excessive thirst), polyphagia (excessive hunger), blurred vision, or vaginal infections. She notes a marked decrease in her energy level, particularly in the afternoons. She is tearful and states that she was diagnosed with depression and prescribed an antidepressant that she chose not to take. She states that she has gained an enormous amount of weight since being placed on insulin 6 years ago. Her weight has continued to increase over the past 5 years, and she is presently at the highest weight she has ever been. She states that every time she tries to cut down on her eating she has symptoms of shakiness, diaphoresis (profuse sweating), and increased hunger. She does not follow any specific diet and has been so fearful of hypoglycemia (low blood sugar) that she often eats extra snacks. Her health care practitioners have repeatedly advised weight loss and exercise to improve her health status. She complains that the pain in her knees and ankles makes it difficult to do any exercise. Her blood glucose values on capillary blood glucose testing have been 170–200 mg/d1 before breakfast. Before supper and bedtime values range from 150 mg/dl to >300 mg/dl. Her current insulin regimen is 45 U of NPH (Neutral Protamine Hagedorn insulin such as Humulin or Norvolin ) plus 10 U of regular insulin before breakfast and 35 U of NPH plus 20 U of regular before supper. This dose was recently increased after her A1c, was found to be 8.9% (normal ................
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