Chapter Fourteen
Summary
In the typical practice, patients present with a host of psychological and physical concerns. These patients
are likely to present with unexplained symptoms to their primary care physicians. Depression has been shown to be
a factor for declining health, and declining health increases or worsens one’s mental illness. In fact, having a serious
physical condition or disease like cancer, HIV or diabetes, results in a two-fold increase in the risk for developing a
depressive or anxiety disorder. Further, it has been shown that 40-65% of those who experience a heart attack also
suffer from depression. In general, 25% of cancer patients also report depression.
As we discussed in Chapter 13, substance abuse and mental illness often go hand–in-hand, but we also see
that 50-75% of those with an eating disorder may also have a history of major depression. The presence of an Axis
II condition, further complicates and hinders the treatment of an Axis I condition.
Pain management is often a tricky endeavor as there is no typical pain patient. There is often a collage of
both physiological and psychological factors that necessitate multidisciplinary cooperation and specifically tailored
services. While many pain patients resist psychotherapy, many therapy patients who present with chronic pain have
conditions like major depression, GAD, PTSD, panic disorder or a substance abuse disorder. Further, unresolved
issues such as grief, sexual abuse, physical abuse and chronic anger complicate treatment by influencing one’s
perception of pain.
Specific Discussion Questions:
1. Explain how physical illness affects mental illness and vise versa.
2. Why would communication between various professionals be so critical when treating the mentally ill -pain
patient?
3. Explain the role of medications in the treatment of bulimia and anorexia.
4. Why do medications that increase norepinephrine levels affect pain?
5. Which form or type of psychotherapy has been shown to be most effective with chronic pain patients?
Possible True/False Questions:
1. There is a two-fold increase in the risk of having a depressive or anxiety disorder when the patient also has
another physical illness/disease such as cancer, diabetes or HIV.
2. It is estimated that nearly 20% of those with an eating disorder also have a history for depression.
3. Roughly 25% of cancer and stroke patients also experience depression.
4. Elavil, Effexor and Neurontin are commonly used in pain management.
5. SSRIs work equally well for anorexic and bulimic patients.
6. Medications tend to play more of a significant role in the maintenance/ weight restored phase of treatment.
7. The use of medications that increase both serotonin and norepinephrine are typically more effective than the
medications that enhance serotonin alone.
Multiple Choice Questions:
1. It is estimated that about ____% of eating disorder patients also have a history of depression.
a. 15-20%
b. 29-30%
c. 50-75%
d. none of these
2. All of the following have been used to treat Anorexia Nervosa except:
a. antipsychotics
b. benzodiazepines
c. lithium
d. zinc
3. While the use of medication in anorexia patients has had less than promising results, the use of ___________
has been shown some success in stimulating weight and reducing concerns about size and shape.
a. Nardil
b. Ativan
c. Wellbutrin
d. Zyprexa
4. Patients with BED or Binge-eating Disorder tend to respond well to:
a. TCAs
b. SSRIs
c. anti-obesity medications
d. All of the above
5. Research on comorbid pathology suggests that as many as ____ % of patients with bulimia also have a
personality disorder.
a. 40
b. 50
c. 60
d. none of these
6. Which type or school of psychotherapy has been found to be especially helpful for pain management patients.
a. Psychodynamic
b. Cognitive-behavioral
c. Rational Emotive
d. Person-centered
7. Chronic gambling has been shown to be successfully reduced with which of the following medications?
a. Anti-psychotics
b. Benzos
c. Neltrexone
d. None of these
Case Vignette Discussion Questions:
1. What is the major pathology or diagnosis presented in the case?
2. Is there another disorder that may apply or should be ruled-out?
3. Do you agree with the medication suggestions made in this case?
4. Any other medications that might be considered…what is the rationale?
5. If you were asked to follow-up on this case as the treating therapist, would you offer any additional
suggestions or approaches?
Case Vignettes -Chapters Fifteen through Nineteen:
Chapters fifteen through nineteen present several clinical cases designed to demonstrate how to apply
pharmacology to common presenting issues across the developmental lifespan. Students and clinicians alike can
read and discuss these cases drawing similarities to cases they may experience in practice. Each of these cases is
based directly on real-life patients, and while most appear to have a satisfactory outcome, there are of course many
others who either did not respond, or left treatment prematurely. The authors believe that including such cases here
adds little to the learning process.
To assist the instructor and the students in making the best use of these vignettes, it is suggested that the
instructor use the following five questions for each of the cases. While these may be used as essay exam questions,
they are optimally designed to be used in the classroom for discussion purposes.
Case Vignette Discussion Questions:
1. What is the major pathology or diagnosis presented in the case?
2. Is there another disorder that may apply or should be ruled-out?
3. Do you agree with the medication suggestions made in this case?
4. Any other medications that might be considered…what is the rationale?
5. If you were asked to follow-up on this case as the treating therapist, would you offer any additional
suggestions or approaches?
Chapter Fourteen
Answer Key
True/False Questions:
Multiple Choice Questions: