The facilitating group posted discussion prompts on somatization disorder, depression, and the link between social media use and depression in adolescents. For somatization disorder, they asked how therapeutic interventions would be formulated and how success would be evaluated. For depression, they asked how views on living with depression may have changed after watching a video, what interventions and resources would be used and how treatment success would be evaluated. For social media and adolescent depression, they asked for non-pharmacological interventions and an appropriate medication choice along with important patient education. A peer responded by discussing screening and treatment of somatization disorder including psychotherapy and medications. For depression, the peer discussed the neurobiology, diagnostic criteria, treatment options of

1. Due: Facilitating group to post by Day 1; all other students post
to discussion prompt by Day 4 and one other peer initial
discussion prompt post by Day 7
Initial Post: Created by Facilitating Group ( I am not in the
facilitating group)
This is a student-led discussion.
· The facilitating group should choose one member from their
group who will be responsible for the initial post.
· On Day 1 of this week, the chosen group member will create
an initial post that is to include the group's discussion prompts,
resources, and the instructions for what your classmates are to
do with the resources.
· During this week, each member of your group is to participate
in the facilitation of the discussion. This means making certain
that everyone is engaged, questions from students are being
answered, and the discussion is expanding.
· It is the expectation that the facilitating group will address all
initial peer response posts by Day 7.
Reply Posts: Non-Facilitating Students
· If you are not a member of the facilitating group, you are to
post a discussion prompt response according to the facilitating
group's instructions by Day 4. Your reply posts should include
substantive reflection directed to the presenters.
· You are also expected to respond to at least two other peer's
initial discussion prompt posts.

2. Facilitating Group’s Post (to be replied)
Depression and Somatization Disorders
Barry Lynne, Brittany Stoken, and Jessica Murphy
NU664C: Psychiatric Mental Health Care of the Family I
November 1, 2021
Depression and Somatization Disorders
Hello Class,
Group 1 is assigned Depression and Somatization
Disorders to further discuss. Failure to adjust and modify
emotions cognitively while experiencing stress can ultimately
present an outcome of exaggerated physiological and behavioral
responses and amplify susceptibility to somatic disorders, such
as somatization (Davoodi, et al., 2019). Somatization Disorder
is the presentation of recurrent and multiple somatic complaints
of several years duration for which medical attention has been
sought but which do not derive from a specific physical disorder
(Swartz, Blazer, & George, 2012).
Please respond to the following questions:
1. When caring for a patient with somatization disorder, what
therapeutic interventions would you formulate (Allen,
Woolfolk, Escobar, Gara, and Hamer, 2006)?
2. How would you evaluate the success of your interventions
for a patient living with somatization?
Depression is an extremely serious mood disorder that effects
how you think, feel, and act. Symptoms range from mild to
severe including, feeling sad, loss of interest or pleasure,
change in appetite, trouble sleeping or getting too much sleep,
feeling worthless, difficulty concentrating, and thoughts of
death or suicide (American Psychiatric Association, 2021). To

3. be diagnosed with depression, symptoms must last at least two
weeks and present a change in level of functioning (National
Institute of Mental Health, 2021).
Please respond to the following questions:
1. After watching the short video, discuss what you’ve learned
about depression and has it changed your thoughts on what it is
like to live with depression?
2. What interventions and resources would you use for this
patient? How would you evaluate success of treatment?
3. What are a few ways to educate and reduce the stigma
around depression, so that individuals living with depression
receive the help when symptoms first present?
Adolescents are experiencing depression at a rapidly growing
rate and the use of psychopharmacology and therapy has not
slowed this increase (Henjie Blom et al., 2016). Although there
are many potential causes for this increase, one of the primary
causes is the increased prevalence of social media and its
popular use amongst teens. Research has shown a direct link
between social media and depression and suicidality in
adolescents (Vidal et al., 2020). Though social medical has been
linked to depression within this population, just simply
decreasing the use and frequency of social media can have a
positive impact and greatly decrease psychological distress
(Radovic et al., 2017).
1. What additional non-pharmacological interventions would
you recommend for the adolescent patient with depression?
2. Which medication would be the appropriate choice for this
patient? What important patient education would you provide?
References
Allen LA, Woolfolk RL, Escobar JI, Gara MA, Hamer RM.
Cognitive-
Behavioral Therapy for Somatization Disorder:
A Randomized Controlled Trial. Arch Intern
Med. 2006;166(14):1512–
1518. doi:10.1001/archinte.166.14.1512
American Psychiatric Association. (2021). What is

4. depression? https://www.psychiatry.org/patients-
families/depression/what-is-depressio
Davoodi, E., Wen, A., Dobson, K. S., Noorbala, A. A.,
Mohammadi, A., & Farahmand, Z. (2019).
Emotion Regulation Strategies in Depression and
Somatization Disorder. Psychological
Reports, 122(6), 2119–
2136. https://doi.org/10.1177/0033294118799731
Henje Blom, E., Ho, T. C., Connolly, C. G., LeWinn, K. Z.,
Sacchet, M. D., Tymofiyeva, O., Weng, H.
Y., & Yang, T. T. (2016). The neuroscience and context
of adolescent depression. Acta
paediatrica (Oslo, Norway : 1992), 105(4), 358–365.
National Institute of Mental Health
(2021). Depression. https://www.nimh.nih.gov/health/topics
/depression
Radovic, A., Gmelin, T., Stein, B. D., & Miller, E. (2017).
Depressed adolescents' positive and
negative use of social media. Journal of adolescence,
55, 5–15.
Swartz, M. S., Blazer, D., & George, L. (2012). Somatization
disorder in a community population.
American Journal of Psychiatry, 143, 1403–1408.
Vidal, C., Lhaksampa, T., Miller, L., & Platt, R. (2020). Social
media use and depression in
adolescents: a scoping review. International review of
psychiatry (Abingdon, England),
32(3), 235–253.
Peer Post 1 (To be replied)
Week 10 Assignment: Respond to Group 1

5. Jeffrey Pham
November 2, 2021
1. When caring for a patient with somatization disorder, what
therapeutic interventions would you formulate (Allen,
Woolfolk, Escobar, Gara, and Hamer, 2006)?
2. How would you evaluate the success of your interventions
for a patient living with somatization?
Somatization disorder presents a challenge to healthcare as the
complaints of bodily distress have no objective or identifiable
cause (Kumar & Jahan, 2020). The The intervention for this
type of client should begin my ensuring that the somatizati on
disorders are distinguished from actual medical symptoms so
that intervention can be accurately implemented to address the
problematic issues. According to DSM-5, the diagnostic criteria
for somatization disorder are as followed: somatic symptoms are
persistent and lasts longer than 6 months, one or more somatic
distress symptoms that cause significant impairment in
functioning, and one or more excessive behaviors, thoughts
and//or feelings that is associated with somatic symptoms or
associated with various health problems (Henningsen, 2018).
The severity of this disorder is on a continuum from mild to
severe, depending on the numbers of somatic complaints and on
the DSM-5 diagnostic criteria; having multiple somatic
complaints and having multiple DSM-5 criteria met for
somatization lead to more severe form of the disorder
(Henningsen, 2018). To manage this condition appropriately,
first requires screening for it. The PHQ-15 is a screening tool to
detect for risk for somatic symptom disorder and have been
demonstrated to effectively screen and monitor for the disorder
(American Psychiatric Association, 2013). Antidepressants,
such as Tricyclic has been demonstrated to have some moderate
efficacy over newer antidepressant in treatment of somatization
while multimodal psychotherapy program has been shown to
significantly improve and manage somatic symptoms (Kumar &

6. Jahan, 2020; Henningsen, 2018). Interventions of somatic
symptoms management can be evaluated by using the PHQ-15 to
initially screen for and then to evaluate for any improvements in
symptoms from baseline (Kocalevent et al., 2013).
1. After watching the short video, discuss what you’ve learned
about depression and has it changed your thoughts on what it is
like to live with depression?
2. What interventions and resources would you use for this
patient? How would you evaluate success of treatment?
Depressive symptoms are associated with long duration and
presence of sadness, irritability, or anhedonia (Kaltenboech &
Harmer, 2018). According to Stahl (2013) major depressive
disorder is formulated when a client has prolonged periods of
depressed mood or loss of interest and with greater or equal to
at least 4 additional symptoms, such as suicidal ideation, sleep
disturbances, appetite changes, fatigue, guilt, and executive
dysfunction. The development of depression is complex, and
neuro-research has related to abnormalities of certain
monoamines, which include serotonin, noradrenaline and
dopamine, to the pathogenesis of depression (Kaltenboech &
Harmer, 2018). Brain imaging has shown that there is
decreased serotonin transmission activity in certain parts of the
brain in depressive individuals while increasing serotonergic
activity by administering antidepressants help relieve those
symptoms and support the monoamine theory as relate to
depression (Kaltenboech & Harmer, 2018). Given the fact that
untreated depression is associated with functional impairment,
such as poor quality of life and loss of work productivity and
increased risks for suicide, it is extremely important to treat
depression (Culpepper et al., 2015).
While the goal of treating depression is to achieve full
remission, the task begins by identifying depression,
administering treatment, and finally evaluating treatment
response. There are several tools available to aid in identifying

7. and evaluating treatment response and/or resistance, such tools
include the 17-item Hamilton Rating Scale of Depression
(HAM-D) and the Patient Health Questionnaire-9 (PHQ-9)
(Culpepper et al., 2015). While treatment remission is
considered less or equal to 7 score on the Ham-D and less than
5 on the PHQ-9, full recovery is met when the client is in full
remission though the treatment has been discontinued
(Culpepper et al., 2015).
While the neurobiological monoamine theory of depression
includes a deficient or dysfunction in certain neurotransmitters,
it is logical to replace these neurotransmitters where it is
impaired or deficient (Stahl, 2013). A group of medications
known as SSRIs can provide more of the neurochemicals in the
synaptic cleft in order to bind with the post-synaptic neurons to
improve mood and depressive thoughts (Stahl, 2013). While
medications have been shown to effectively treat depression,
psychotherapeutic has been linked to increased resilience,
improvements in mood and physical and cognitive functioning
(Eddington et al., 2017). While medications may be helpful,
some may benefit from psychotherapeutic alone or as an adjunct
therapy to medications.
Additionally, Given the different profiles of antidepressants,
when approach with treatment option for an individual who has
clinical depression, there are factors to consider upon selecting
the antidepressant medications, such as but not limited to
tolerability, current medicine with consideration for drug-drug
interactions, psychiatric/medical comorbidities, efficacy of
prior treatments and cost of the medications (Culpepper et al.,
2015).
3. What are a few ways to educate and reduce the stigma
around depression, so that individuals living with depression
receive the help when symptoms first present?
The ways to educate and reduce the stigma around depression
are to first understand how stigma is defined and how it is

8. socially constructed, and in what ways has it created barrier to
accessing care for depression. According to Stuart (2016),
stigma is created when there are several parts interacting: first a
particular human is distinguished as different; second,
distinguished difference is attached to unwanted features,
creating a biased that apply to every person of that member;
third, they are seen as different from the dominant culture;
fourth, the biased or stigmatized members are devalued and
systematically disadvantaged, creating a disadvantaged group
that leads to their poor health outcomes.
There are several research and methods to help combat
stigma in mental health. Some of them include literacy
education to improve education about mental health; protest to
object and denounce stigma, to attempt to change organizational
behaviors; advocacy to support strategies aim at tackling
inequities designed by social structures that limit rights of
people with mental health issues (Stuart, 2016). These are just
some interventions that may be used to advocate for the mental
health population.
1. What additional non-pharmacological interventions would
you recommend for the adolescent patient with depression?
2. Which medication would be the appropriate choice for this
patient? What important patient education would you provide?
Just as in adult, an adolescence with mild to moderate
depressive symptoms may benefit from psychotherapy initially
(Gautam, 2017). CBT and interpersonal therapy have been
shown to be the most efficacious for managing depression,
however, the types of therapy that are most effective is
contingent upon how the client is responding (Gautam, 2017).
In moderate to severe depression, SSRIs are considered first
line for treating children and adolescents’ depression;
specifically, fluoxetine has the most evidence for use in
children and adolescents depression and it is also FDA approved
to treat children 8 years and older (Mullen, 2018).

9. When prescribing to this population, education regarding risk
for triggering suicidal ideation must be provided as there is an
FDA black box warning to all antidepressants that it may
increase the risk for suicidal ideation in children, adolescents,
and young adults (Mullen, 2018).
References
American Psychiatric Association. (2013). Diagnostic and
statistical manual of mental disorders (5th ed.) (DSM-5).
Washington, DC: APA Press.
Culpepper, L., Muskin, R. P., & Stahl, S. M. (2015). Major
depressive disorder: Understanding the significance of residual
symptoms and balancing efficacy with tolerability. The
American journal of medicine. 128 (9), 1-15. DOI:
https://doi.org/10.1016/j.amjmed.2015.07.001
Eddington, K. M., Burgin, C. J., Silvia, P. J., Fallah, N.,
Majestic, C., & Kwapil, T. R. (2017). The Effects of
Psychotherapy for Major Depressive Disorder on Daily Mood
and Functioning: A Longitudinal Experience Sampling
Study. Cognitive therapy and research, 41(2), 266–277.
https://doi.org/10.1007/s10608-016-9816-7
Gautam, S., Jain, A., Gautam, M., Vahia, V. N., & Grover, S.
(2017). Clinical Practice Guidelines for the management of
Depression. Indian journal of psychiatry, 59(Suppl 1), S34–S50.
https://doi.org/10.4103/0019-5545.196973
Henningsen, P. (2018). Management of somatic symptom
disorder. Dialogues in clinical neuroscience, 20(1), 23–31.
https://doi.org/10.31887/DCNS.2018.20.1/phenningsen
Kaltenboeck, A., & Harmer, C. (2018). The neuroscience of
depressive disorders: A brief review of the past and some
considerations about the future. Brain and Neuroscience
Advances. 2: 1-6. https://doi.org/10.1177/2398212818799269
Kocalevent, R. D., Hinz, A. & Brähler, E. (2013).
Standardization of a screening instrument (PHQ-15) for
somatization syndromes in the general population. BMC
Psychiatry 13,91. https://doi.org/10.1186/1471-244X-13-91

10. Kumar, R., & Jahan, M. (2020). Multimodal psychotherapy in
the management of somatization disorder. Industrial psychiatry
journal, 29(2), 205–212. https://doi.org/10.4103/ipj.ipj_11_17
Mullen, S. (2018). Major depressive disorder in children and
adolescents. The mental health clinician, 8(6), 275–283.
https://doi.org/10.9740/mhc.2018.11.275
Stahl, S. M. (2013). Stahl's Essential Psychopharmacology:
Neuroscientific Basis and Practical Applications. 4th ed. New
York, NY: Cambridge University Press.
Stuart, H. (2016). Reducing the stigma of mental illness. Global
mental health (Cambridge, England), 3, e17.
https://doi.org/10.1017/gmh.2016.11
Peer Post 2 (To be replied)
Deborah Penny
Thank you Group 1 (Barry, Brittany, and Jessica). Your
presentation about somatization disorder and depression, along
with the video, and references will elicit excellent discussion
points. Somatization Disorder (SD) is “characterized by the
patient experiencing numerous physical symptoms that are
unrelated to any specific disease state or organ system; usually,
symptoms are unrelated, multiple, and difficult to measure”
(Zakhari, 2021, p. 193). For example, on page 191 of Zakhari,
question #18 states, “A 50-year-old woman referred from the
surgical service is described as a “frequent flyer”. She reports
vague complaints that have no apparent cause or objective
clinical findings. Most recently she complains of vaginal pain,
headache, and stomachache. Upon interview she is tearful,
guarded, and withdrawn. What is the most likely psychiatric
diagnosis?”
A. Malingering
B. Conversion disorder
C. Somatization disorder
D. Factitious Disorder

11. The correct answer is C. Somatization disorder because the
patient presents with many unrelated symptoms, all without
objective findings. Without objective findings, it is impossible
to develop a treatment plan. For example, if a patient presents
with a subjective symptom of a fever, but the objective finding
of afebrile rules it out, the patient’s subjective symptoms cannot
be substantiated.
1. When caring for a patient with somatization disorder, what
therapeutic interventions would you formulate?
Prior to Cognitive-Behavioral Therapy’s (CBT) success for
treating patients with SD utilized a consultation letter.
According to Boland et al (2021), a brief “consultation letter”
intended for primary care physicians demonstrated effectiveness
in improving patients’ functional capacity and decreased their
utilization of health services, essentially using boundaries as
part of the treatment. The letter provided guidance on the best
practice for treating patients with SD by seeing patients only
during regular business hours, providing focused physical
examinations, and avoiding unnecessary diagnostic procedures,
invasive treatments, and hospitalizations” (Boland, et al, 2021).
However, the most recent evidence-based success comes from
using CBT which focuses on stress management, activity
regulation, emotional awareness, cognitive restructuring, and
interpersonal communication.
2. How would you evaluate the success of your interventions
for a patient living with somatization?
Successful interventions are based on achieving the goals
developed between the patient and the provider. For example,
if the goal was to adhere to cognitive behavioral therapy
sessions, diary keeping, and a limited number of office visits
per month, these interventions would be successful, and the goal
achieved.
1. After watching the short video, discuss what you’ve learned
about depression and has it changed your thoughts on what it is
like to live with depression?
Depression can overtake every aspect of a person’s life and it

12. can cause a person to take their own life by suicide. Depression
is insidious, it can creep up on a person and take hold little by
little until a person loses the ability to reach out for help.
Several factors can play a role in depression: Biochemistry
(how the brain is wired), genetics (depression can run in
families), personality (low self-esteem can play a role), and
environmental factors (poverty, abuse, neglect). Because a
patient’s socioeconomic status can be a factor with depression,
a thorough biopsychosocial assessment is critical to the plan of
treatment. Research findings have indicated that lifestyle
behaviors and socioeconomic status were significantly
associated with psychological health, such as psychological
distress, depression, anxiety, and well-being” (Wang & Geng,
2019).
2. What interventions and resources would you use for this
patient? How would you evaluate success of treatment?
There are different types of therapy and interventions used to
treat depression. Cognitive behavioral therapy (CBT) works on
identifying negative thoughts and behaviors and replacing these
with more positive ones. Dialectic behavioral therapy (DBT)
helps to identify a person’s strengths, thoughts, and
assumptions. Successful treatment is defined on goals set by
the patient and therapist and is different for every individual
receiving help for their depression.
3. What are a few ways to educate and reduce the stigma around
depression, so that individuals living with depression receive
the help when symptoms first present?
Research has shown a direct link between social media and
depression and suicidality in adolescents (Vidal et al., 2020).
However, the same media that increases depression and anxiety
in adolescents can be the same one that reaches out and offers
hope and healing. “Stigma attached to mental illness appears to
be universal, it plays out indifferent ways according to local
contexts” (Stuart, 2016). Here are some websites that provide
help in different
ways: webmd.com, pickthebrain.com, Imalive.org,

13. and 7cups.com
1. What additional non-pharmacological interventions would
you recommend for the adolescent patient with depression?
“Cognitive behavioral therapy, naturopathic therapy, biological
interventions, and physical activity interventions reduced
depression severity. A shared decision-making approach is
needed to choose between non-pharmacological therapies based
on values, preferences, clinical and social context” (Farah,
2016).
2. Which medication would be the appropriate choice for this
patient? What important patient education would you provide?
“Selective serotonin reuptake inhibitors (SSRIs) would be a
place to start due to the mild side effects and the following
education would be provided” (Moreland & Bonin, 2016).
• The expected benefits and possible risks and side
effects
• The instructions for the dose and timing
• The expected length of time to response
• Potential interactions with other prescription or non-
prescription medications
• When prescribing to this population, education
regarding risk for triggering suicidal ideation must be provided
as there is an FDA black box warning to all antidepressants that
it may increase the risk for suicidal ideation in children,
adolescents, and young adults (Mullen, 2018).
Hanging indent not maintained
References
Allen, L. A., Woolfolk, R. L., Escobar, J. I., Gara, M. A., &
Hamer, R. M. (2006). Cognitive-behavioral therapy for
somatization disorder: a randomized controlled trial. Archives
of Internal Medicine,166(14), 1512–
1518. https://doi.org/10.1001/archinte.166.14.1512
Boland, R., Verduin, M., & Ruiz, P. (2021). Kaplan & Sadock’s
Synopsis of Psychiatry, 12th ed. Wolters Kluwer.
Farah, W. H., Alsawas, M., Mainou, M., Alahdab, F., Farah, M.
H., Ahmed, A. T., Mohamed, E.A., Almasri, J., Gionfriddo, M.

14. R., Castaneda-Guarderas, A., Mohammed, K., Wang, Z., Asi,
N., Sawchuk, C. N., Williams, M. D., Prokop, L. J., Murad, M.
H., & LeBlanc, A. (2016). Non-pharmacological treatment of
depression: a systematic review and evidence map. Evidence-
Based Medicine, 21(6), 214–
221. https://doi.org/10.1136/ebmed-2016-110522
Moreland, C. S., & Bonin, L. (2021). Patient education:
Depression treatment options for children and adolescents
(Beyond the
Basics). UpToDate. https://www.uptodate.com/contents/depres
sion-treatment-options-for-children-and- adolescents-
beyond-the-
basics?search=depression%20treatment%20adolescent&source=
search_result&selectedT
itle=10~150&usage_type=default&display_rank=10
Mullen, S. (2018). Major depressive disorder in children and
adolescents. The mental health clinician, 8(6), 275–
283. https://doi.org/10.9740/mhc.2018.11.275
Smith, G. R., Jr, Monson, R. A., & Ray, D. C. (1986).
Psychiatric consultation in somatization disorder. A randomized
controlled study. The New England Journal of Medicine,
314(22), 1407–1413.
https://doi.org/10.1056/NEJM198605293142203
Stuart, H. (2016). Reducing the stigma of mental illness. Global
mental health,3, e17.
https://doi.org/10.1017/gmh.2016.11
Vidal, C., Lhaksampa, T., Miller, L., & Platt, R. (2020). Social
media use and depression in adolescents: a scoping review.
International review of psychiatry, 32(3), 235–253.
Wang, J., & Geng, L. (2019). Effects of socioeconomic status
on physical and psychological health: Lifestyle as a mediator.
International journal of environmental research and public
health, 16(2),
281.https://doi.org/10.3390/ijerph16020281
Zakhari, R. (2021). The psychiatric-mental health nurse
practitioner certification review manual. Springer Publishing

15. Company, LLC.
Team assignment
Here is our team assignment for this week!
As a team, consider the following scenario:
On Dec. 7, 2000, the Cincinnati Occupational Safety and Health
Administration (OSHA) office heard through media and police
reports that there were two deaths at a nursing home in Ohio.
OSHA determined that the Food and Drug Administration
(FDA) should take a lead role in performing an investigation.
Because the nursing home had many residents who had
unhealthy respiratory systems, the nursing home routinely
ordered and received tanks that contained pure oxygen. During
one delivery, the supplier mistakenly delivered one tank of pure
nitrogen in addition to the three tanks of pure oxygen that had
been ordered. The nitrogen tank had both an oxygen and
nitrogen label. An employee at the nursing home connected the
nitrogen tank to the nursing home's oxygen delivery system.
This event caused two nursing home residents to die, and three
additional nursing home residents were admitted to hospitals in
critical condition. Within the following month, two of these
three additional residents also died, bringing the total death toll
to four. (Based on accident #837914 www.osha.gov)
Team compares the Normal Accident Theory to the Culture of
Safety model. Include the following in your paper:
MY PART
Write 300 word paper
· Explain actions that could have been taken to manage risk by
applying each of the five general principles used in the Culture

16. of Safety model to this scenario.