Depression Case Study

Description

  1. For this discussion you will build on your treatment plan from Week 5 Discussion1: Depression Case Study. You will be seeing your patient at the six week followup.
  2. Describe your treatment plan for your patient in each of these three scenarios. This means that you will have a treatment plan for each separate scenario.
  3. Your initial post should be in APA format with evidence-based references to support your statements.
    Scenarios
    • There is no response to the medication.
    • There is a partial response to the medication. Mood has lifted but energy and motivation are still poor.
    • Mood is improved but the patient has sexual side effects that interfere with quality of life.

Week 5 Discussion
Depression Case Study

Case Study Questions
Identification of target symptoms/problems

  1. What information, if any, would you like to know that was not included in the case?
    When obtaining a thorough history from a patient suspected to have a psychiatric disorder, a family history of mental illness is necessitated. A positive family history of depression could be a higher predictor of disease as well as other psychiatric conditions. Moreover, I would have loved to inquire about the patient’s social history including aspects like how she previously spent her free time, her previous hobbies and whether her routine has changed. A drug history is also required when carrying out any routine history taking. Drugs here include both pharmacologic and non-pharmacologic that she may be prescribed or self-medicating respectively. Alcohol consumption, cigarette smoking and other narcotic use should be inquired about in depth asking about the frequency of use, time of day and the feelings she gets when using the intoxicants (Ramirez, Nedley & Seidel, 2019).
  2. Which psychiatric symptoms are a treatment priority for thiscase?
    The patient presents with numerous psychiatric symptoms of concern including hopelessness, sleep disturbances, suicidal ideations, a previous suicidal attempt, altered concentration span, decreased pleasure in activities that would otherwise give her pleasure, disturbances at work and overall decreased social interaction. These symptoms match the DSM-V criteria of Depression. However, the priority psychiatric symptoms are the suicidal ideations, sleep disturbances and overall hopelessness (Guay, 2018).
  3. What are the non-pharmacologic issues in this case (problems/complaints that cannot be addressed bymedication)?
    Appetite loss
    Decreased concentration span
    Hopelessness/ helplessness
    Suicidal ideations
    Decreased pleasure in daily routine.

Medication Choice 1

  1. List one medication that would be appropriate for this case. Include the name and starting dose.
    Escitalopram 10mg OD PO
  2. Describe your clinical decision making. What is your rationale for choosing this medication? Also, include the mechanism of action for this medication choice, and the neurotransmitters and areas of the brain in which the medication is proposed to acton.
    Escitalopram is a commonly used antidepressant in the class of selective serotonin reuptake inhibitor (SSRIs) which prevent the reuptake of the neurotransmitter serotonin in the brain with little or no effect on norepinephrine and dopamine reuptake (Giribaldi, 2018). It is highly recommended in the management of depressive and anxiety disorders with a proven better therapeutic index in comparison to its predecessor citalopram.
  3. What laboratory testing/monitoring is needed for safely prescribing this medication?
    Renal function tests (RFTs) and liver function tests (LFTs) should be carried out before the administration of this medication. This is because escitalopram is metabolized hepatically and partially excreted by the kidneys. A failure in either of these organs would be highly contraindicated in drug administration hence the need for LFTs and RFTs.
  4. Are there any contraindications or safety issues associated with this medication?
    Escitalopram is greatly contraindicated in individuals with hypomagnesemia, hyponatremia, hypokalemia and those with coagulopathies (Cüppers, 2015). Moreover, the drug should be avoided in renal or hepatic disease as well as in individuals with syndrome of inappropriate antidiuretic hormone release. Commonly occurring adverse effects that the patient should be warned about is dizziness, drowsiness, general body malaise, nausea, xerostomia and appetite changes.
    Non pharmacologic Interventions
  5. What non-pharmacologic interventions do you recommend?
    Do you recommend including but not limited to psychotherapy, complimentary and holistic therapies? Psychotherapy or “talk-therapy” is the mainstay non-pharmacologic management modality in psychiatric conditions including depression (Rosmarin, Bocanegra, Hoffnung & Appel, 2019). Cognitive behavioral therapy (CBT) and Supportive Therapy are highly implemented in individual psychotherapy. Complementary techniques such as breathing exercises and recreational exercises like yoga have been proven to have a good outcome in depressed patients. The patient should be well educated on the crucial laws governing social interactions and encouraged to reach out to their social support system such as the client’s sister and boyfriend in this situation. A strong social support system is key in the management of psychiatric conditions.

Safety Risk Assessment

  1. What are the safety concerns, if any, associated with this case?
    How will you address safety?
    My primary concern is the patient’s suicidal ideations and previous suicidal attempts which weigh greatly on the patient’s daily activities especially during her sleepless nights when she just thinks about random things. Psychotherapy engages the patient in conversation allowing them to talk about their thought process leading up to the ordeal. Psychotherapy then utilizes CBT to replace the mal-adaptive behaviors mechanisms with appropriate coping responses to daily stressors.
  2. When would you follow up with this patient?
    I would follow up on this patient 4 weeks from now following education about her diagnosis, initiation of medication and psychotherapy management. This is to allow the antidepressant medication to reach its optimal peak concentration and assess the need or lack thereof dosage adjustment.

References

Cüppers, R. (2015). Psychological Contraindications. DeutschesAerzteblatt Online. doi: 10.3238/arztebl.2015.0614a
Giribaldi, B. (2018). Psilocybin vs escitalopram for depression. Http://Isrctn.com/. doi: 10.1186/isrctn10584863
Guay, M. O. D. (2018). Management of Psychological Symptoms Including Anxiety and Depression. Oxford Medicine Online. doi: 10.1093/med/9780190633066.003.0008
Ramirez, F., Nedley, N., & Seidel, V. (2019). F214. Alcoholics in the Family Increases Risk of Depression. Biological Psychiatry, 85(10). doi: 10.1016/j.biopsych.2019.03.751
Rosmarin, D. H., Bocanegra, E. S., Hoffnung, G., & Appel, M. (2019). Effectiveness of Cognitive Behavioral Therapy for Anxiety and Depression Among Orthodox Jews. Cognitive and Behavioral Practice, 26(4), 676–687. doi: 10.1016/j.cbpra.2019.07.005

Sample Solution

The post Depression Case Study appeared first on homework handlers.

 
"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"
Looking for a Similar Assignment? Our Experts can help. Use the coupon code SAVE30 to get your first order at 30% off!

Hi there! Click one of our representatives below and we will get back to you as soon as possible.

Chat with us on WhatsApp