BACKGROUND INFORMATION
The client is a 70 year-old Hispanic American male who came to the United States when he was in high school with his father. His mother died back in Mexico when he was in school. He presents today to your office for an initial appointment for complaints of depression. The client was referred by his PCP after “routine” medical work-up to rule out an organic basis for his depression. He has no other health issues with the exception of some occasional back pain and “stiff” shoulders which he attributes to his current work as a laborer in a warehouse.
SUBJECTIVE
During today’s clinical interview, client reports that he always felt like an outsider as he was “teased” a lot for being “black” in high school. States that he had few friends, and basically kept to himself. He describes his home life as “good.” Stating “Dad did what he could for us, there were 8 of us.” He also reports a remarkably diminished interest in engaging in usual activities, states that he has gained 15 pounds in the last 2 months. He is also troubled with insomnia which began about 6 months ago, but have been progressively getting worse. He does report poor concentration which he reports is getting in “trouble” at work.
MENTAL STATUS EXAM
The client is alert, oriented to person, place, time, and event. He is casually dressed. Speech is clear, but soft. He does not readily make eye contact, but when he does, it is only for a few moments. He is endorsing feelings of depression. Affect is somewhat constricted, but improves as the clinical interview progresses. He denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment and insight appear grossly intact. He is currently denying suicidal or homicidal ideation. You administer the “Montgomery- Asberg Depression Rating Scale (MADRS)” and obtained a score of 51 (indicating severe depression).
RESOURCES
§ Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389.
For this Discussion, you will select an interactive media piece to practice decision making when treating patients with psychological disorders ( Selected above) You will recommend the most effective pharmacotherapeutic to treat the psychological disorder presented and examine potential impacts of pharmacotherapeutics on a patient’s pathophysiology.
To Prepare
· Review this week’s interactive media pieces and select one to focus on for this Discussion.
· Reflect on the decision steps in the interactive media pieces, and consider the potential impacts from the administration of the associated pharmacotherapeutics on the patient’s pathophysiology.
·
Post a brief explanation of the psychological disorder presented( depression) and the decision steps you applied in completing the interactive media piece for the psychological disorder you selected ( as below) Then, explain how the administration of the associated pharmacotherapeutics you recommended may impact the patient’s pathophysiology. How might these potential impacts inform how you would suggest treatment plans for this patient? Be specific and provide examples.
Decision steps taken:
Decision point 1
Begin Zoloft 25mg orally daily. ( pt came back in not feeling better and c/o erectile dysfunction)
Decision point 2
Decrease dose of Zoloft ( pt still feels better but still same complain)
Decision point 3
d/c zoloft and start on paxil ( SSRIs should be first line of treatment while MOAIs last line of treatment for depression( from research, say why this decision will be best for this patient with three references)
__________________
The psychological disorder presented in this case is depression. In completing the interactive media piece, the following decision steps were taken:
Decision point 1: Begin Zoloft 25mg orally daily. (pt came back in not feeling better and c/o erectile dysfunction)
Decision point 2: Decrease dose of Zoloft (pt still feels better but still same complain)
Decision point 3: Discontinue Zoloft and start on Paxil.
The administration of the associated pharmacotherapeutics, in this case, Paxil, may impact the patient’s pathophysiology by increasing the levels of serotonin in the brain. This increase in serotonin levels can help to regulate mood, reduce symptoms of depression, and improve overall well-being. However, Paxil may also have side effects such as nausea, dizziness, and sexual dysfunction, which may need to be monitored closely.
Based on research, SSRIs are considered the first line of treatment for depression, while MAOIs are the last line of treatment due to their potential for serious side effects and interactions with other medications. In this case, Paxil, an SSRI, may be the best option for this patient as it has been shown to be effective in treating depression and has a lower risk of side effects compared to other antidepressants.
References:
American Psychiatric Association. (2010). Practice guideline for the treatment of patients with major depressive disorder. Retrieved from https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf
National Institute of Mental Health. (2016). Depression. Retrieved from https://www.nimh.nih.gov/health/topics/depression/index.shtml
Rush, A. J., Trivedi, M. H., Wisniewski, S. R., Nierenberg, A. A., Stewart, J. W., Warden, D., … & Fava, M. (2006). Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. American Journal of Psychiatry, 163(11), 1905-1917.
