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I’m working on a health & medical discussion question and need the explanation and answer to help me learn.

A 23-year-old biracial (Black Asian) female arrives at the clinic for an evaluation. She has lost 30 pounds in 6 weeks without trying. She complains of feelings of guilt about her symptoms and everyday sadness that does not go away.  She also states she is not able to stay asleep and has difficulty concentrating.  Her family is Jamaican and has used herbal teas, not a psychiatrist in the past to treat these symptoms.

Discuss how the principles of good prescribing should be applied to this case.  

Describe a cultural consideration that may affect medication adherence for this patient.

Expert Solution Preview

Introduction:
In this case, we are presented with a 23-year-old biracial female who is experiencing significant weight loss, feelings of guilt, persistent sadness, insomnia, and difficulties with concentration. It is important to analyze this case through the lens of good prescribing principles and consider any cultural considerations that may impact medication adherence.

Answer:

Application of Principles of Good Prescribing:
1. Comprehensive Assessment: The first principle of good prescribing involves conducting a thorough assessment of the patient’s medical history, current symptoms, and psychosocial factors. In this case, it is important to evaluate the patient’s physical health, mental health, and any relevant sociocultural factors. Additionally, a review of the herbal teas that have been used in the past should be taken into account, as they may interact with any prescribed medications.

2. Diagnostic Accuracy: In order to provide appropriate treatment, it is essential to accurately diagnose the patient’s condition. This may involve ruling out any underlying medical conditions or substance use that could contribute to the symptoms. In this case, the patient’s weight loss, persistent sadness, insomnia, and difficulty concentrating may indicate a possible depressive disorder, which needs to be validated through clinical assessment and diagnostic criteria.

3. Individualized Treatment: The principles of good prescribing emphasize tailoring treatment plans to suit each patient’s unique needs. In this case, the patient’s biracial background and cultural heritage may influence the choice of medication or treatment approach. It is important to discuss and consider the patient’s preferences and beliefs when determining the most suitable treatment options.

4. Patient Education: Good prescribing involves providing comprehensive and understandable information to the patient about their condition, treatment options, potential side effects, and expected outcomes. In this case, it is crucial to address any stigma or misconceptions related to mental health within the patient’s cultural context. Patient education should focus on enhancing the patient’s understanding of the importance of professional psychiatric care and the potential benefits of prescribed medication.

5. Monitoring and Review: Good prescribing necessitates regular monitoring of the patient’s response to treatment, including efficacy, tolerability, and side effects. Close follow-up is crucial to ensure the medication is effective and to make any necessary adjustments. Given the patient’s insomnia, concentration difficulties, and weight loss, close monitoring of both physical and mental health status is vital to assess treatment response and adjust the medication regimen accordingly.

Cultural Consideration Affecting Medication Adherence:
Cultural beliefs and practices can significantly impact medication adherence. In the case of this patient, a Jamaican cultural background may influence her attitudes towards mental health treatment and medication. There can be a preference for traditional remedies such as herbal teas rather than seeking professional psychiatric help. This cultural preference may pose a challenge to medication adherence as the patient may feel skeptical or resistant to taking prescribed medication.

To address this cultural consideration, it is crucial to establish open and non-judgmental communication with the patient. Exploring and understanding her cultural beliefs related to mental health treatment can help in building a therapeutic alliance. It may be helpful to involve the patient’s family members to provide support and guidance in explaining the benefits of psychiatric medication and addressing any concerns or misconceptions. Utilizing culturally sensitive educational materials and involving an interpreter if necessary can also enhance medication adherence in this case.