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QUESTION: Provide a different approach to the treatment plan. Provide a recommendation for a different medication and therapy and discuss your reasons for choosing this approach. Include 2 in text APA citations History of Present Illness (HPI) The patient is a 24-year-old male who has presented for a psychiatric evaluation following a recent combat deployment. Ron experienced a horrific incident during his deployment when he was driving, and several members of his unit died in an explosion. Ron’s family practice provider first diagnosed him with depression after deployment, and he was prescribed Bupropion. In addition to the symptoms he had reported not improving with Bupropion, he now experiences intrusive thoughts about the explosion and battle, nightmares, and flashbacks. He now stays away from driving after having a panic episode behind the wheel. His PCP recommended him for a psychiatric assessment and prescribed Ativan to treat the panic episodes. Ron states that his symptoms have been worse during the last six weeks. He was very depressed at first, but he is becoming more irritable and withdrawn now. During his mission, he also suffered two traumatic brain injuries (TBIs). Assessment Post-Traumatic Stress Disorder (PTSD): Symptoms of PTSD include avoidance behaviors, intrusive thoughts, panic attacks, nightmares, and flashbacks (Association, 2022). Ron’s symptoms after the stressful events during deployment are consistent with this diagnosis, and it is causing disturbances in his life. Major Depressive Disorder (MDD): initial depressive symptoms, including irritability and withdrawal, persist, suggesting ongoing depression (Association, 2022). His diagnosis of PTSD may compound these symptoms. Mild neurocognitive disorder due to traumatic brain injury, with behavioral disturbance: does have two traumatic brain injuries, and he also has a behavioral disturbance with depressive symptoms (Association, 2022). R/O depressive disorder due to traumatic brain injury, with depressive features. Plan Stop Bupropion due to worsening symptoms. Continue Ativan on a short-term basis as needed for panic attacks. Benzodiazepines should be used cautiously due to the risk of dependence and should not be a long-term solution (Stahl, 2020). Start Sertraline 25 mg PO daily for one week, then increase to 50 mg PO daily (Stahl, 2020). The plan is to reassess the patient in two weeks. Refer the patient to Cognitive Behavioral Therapy (CBT). CBT involves addressing trauma-related thoughts and beliefs and developing coping strategies (Wheeler, 2020). Refer the patient to Eye Movement Desensitization and Reprocessing Therapy (EMDR). Bilateral stimulation (BLS) is one of the processes and protocols that the therapist uses to assist the patient in processing affective, cognitive, and somatic material during an EMDR session (Wheeler, 2020). Encourage patient to attend support groups for veterans and individuals with similar experience to provide peer support and reduce isolation (Wheeler, 2020). A follow-up appointment in 2 weeks to assess the effectiveness of medication and therapy.

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