82 THE SEVERE AND PERSI STENT MENTAL ILLNESS PROGRESS NOTES PLAN NER C. The client was monitored for the effectiveness and side effects of his/her prescribed medications. D. Concerns about the client's medication effectiveness and side effects were communicated to the physician. E. Although the client was monitored for medication side effects, he/she reported no concerns in this area. 17. Monitor Symptom Increase Due to an Antidepressant (17) A. The client's pattern of severe and persistent mental illness symp toms was monitored due to the possibility of these being exacerbated by the introduction of an antidepressant medication. B. The client's severe and persistent mental illness symptoms appear to have increased subsequent to the introduction of an antidepre ssant, and this information was reflected to the prescribing physician. C. Medication adjustments have been implemented in order to decrease the negative effects of the antidepressant medication on the client's severe and persistent mental illness symptom s. D. No exacerbation of severe and persistent mental illness symptoms has been identified subsequent to the introduction of antidepressants. 18. Discuss Depression Development, Maintenance, and Changes (18) A. Factors that were related to the developmen t and maintenance of the client's depression were discussed. B. The focus was placed on how treatment will target specific factors that develop and maintain the client's depression. C. The client has been able to disclose factors that develop and maintai n his/her depression and is accepting of the ways in which treatment will target these factors for change. D. The client has been uncertain about the factors that develop and maintain his/her depression and was provided with remedial feedback in this area. 19. Identify Depressogenic Schemata (19) A. The client was assisted in developing an awareness of his/her automatic thoughts that reflect depressogenic schemata. B. The client was assisted in developing an awareness of his/her distorted cognitive mess ages that reinforce hopelessness and helplessness. C. The client was helped to identify several cognitive messages that occur on a regular basis and feed feelings of depression. D. The client recalled several instances of engaging in negative self-talk t hat precipitated feelings of helplessness, hopelessness, and depression; these were processed. 20. Assign Dysfunctional-Thinking Journal (20) A. The client was requested to keep a daily journal that lists each situation associated with depressed feelings and the dysfunctional thinking that triggered the depression. B. The client was assigned to use the “Daily Record of Dysfunctional Thoughts,” as described in Cognitive Therapy of Depression (Beck, Rush, Shaw, and Emery). C. The client was directed to co mplete the “Negative Thoughts Trigger Negative Feelings” assignment from the Adult Psychotherapy Homework Planner, 2nd ed. (Jongsma). 