Depression Scenarios

Week 6 Discussion 1: Depression Scenarios

Done: Make forum posts: 1

Value: 100 points

Due: Create your initial post by Day 4, and reply to at least two of your classmates’ posts by Day 7.

Grading Category: Discussion Forums

Initial Post

  1. For this discussion, you will build on your treatment plan from Week 5: Assignment 1: Depression Case Study. You will be seeing your patient at the six-week follow-up.
  2. Describe your treatment plan for your patient in each of these four 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

  1. Patient reports that there is no response to the medication.
  2. Patient reports that there is a partial response to the medication. Mood has lifted, but energy and motivation are still poor.
  3. Patient reports that mood is improved but sexual side effects are interfering with quality of life.
  4. Patient reports that mood has improved, but they now have an extreme increase in energy and can’t slow down, are not sleeping, and feel like they can get four days work completed in only a few hours.

Reply Posts

Compare your response to two of your peers’ posts. What are the pros and cons of their choices? What other suggestions might you offer?

Your response should include evidence of your review of the course material through the inclusion of proper citations using APA format.

Please refer to the Grading Rubric for details on how this activity will be graded.

The described expectations meet the passing level of 80 percent. Students are directed to review the Discussion Grading Rubric for criteria that exceed expectations. 

This is my peer’s post. I am replying to her post 

Re: Week 6 Discussion 1: Depression Scenarios

by Trisha Antoine – Wednesday, 8 February 2023, 1:15 AM

During the six week follow up, if the patient states there is no response to Escitalopram, an important question to ask is about medication compliance. Another question to ask is if the patient has engaged in psychotherapy and aerobic exercises as recommended. Zamani et al. (2022) states that “….aerobic exercise is a non-pharmacological strategy for improving various brain functions, such as cognition and mood” (p. 1460). Other things to consider is that the patient may be known as nonresponders, sometimes called treatment-resistant or treatment-refractory. According to Stahl (2021), “some patients may experience apparent lack of consistent efficacy due to activation of latent or underlying bipolar disorder, and require antidepressant discontinuation and a switch to a mood stabilizer” (p. 251). Some considerations may include switching patient to a different class of antidepressants, other than SSRIs, or adding another SSRI agent.During the six week follow up, if the patient states there is partial response to Escitalopram, mood has improved but energy and motivation has not, then medication compliance is still an important question to ask. Another question to ask is if the patient has engaged in psychotherapy and aerobic exercises as recommended. It’s important to assess her energy and motivation with follow up questions during the visit.It’s also important to assess if the patient had experienced postpartum depression after having her two children, even though they are grown. Fluoxetine can be a good medication to augment with Escitalopram. According to Shafia et al. (2023), “It has been shown that a combination of fluoxetine and exercise, but not fluoxetine alone, increases neurogenesis in postpartum depression” (p. 2).During the six week follow up, if the patient states that her mood has improved while taking Escitalopram but she is experiencing sexual dysfunction, she can be offered one of the these augmenting medications: Bupropion, sildenafil, vardenafil, or tadalafil (Stahl et al., 202, p. 252). I would recommend bupropion due to its positive effects on improving poor concentration and fatigue which was initially reported by the patient. It is important to assess sexual dysfunction and to recommend treatment because it will not only impact a person’s quality of life, relationships, mental health, and recovery but it will also lead to medication noncompliance. Esteves-Sousa et al. (2020) states that “ Sexual dysfunction is frequently cited as a reason for nonadherence or discontinuation of treatment for depression” (p. 1).During the six week follow up, if the patient states that her mood has improved while taking Escitalopram but now experiencing an extreme increase in energy and can’t slow down, are not sleeping, and feel like they can get four days work completed in only a few hours; there should be an in depth evaluation of these symptoms. During the evaluation, one of the differential diagnoses could be bipolar 1 disorder. According to American Psychiatric Association Publishing, 2022, Diagnostic and statistical manual of mental disorders V; criteria of bipolar 1 disorder, manic episode includes the following: “A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary). Bipolar 1 disorder, hypomanic episode refers to “A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day” (p. 124). For treatment plan, psychotherapy would be recommended as well as patient continuing Escitalopram, max dose in addition to adding low doses of lithium or quetiapine if no psychotic features.ReferenceAmerican Psychiatric Association Publishing. (2022). Diagnostic and statistical manual of mental disorders: Dsm-5-Tr.Esteves-Sousa, D., Moura, N., Albuquerque, M., Facucho-Oliveira, J., Espada-Santos, P., Mendonça, L., & Tropa, J. (2020). Managing antidepressant-associated sexual dysfunction. European Psychiatry, 63, S663.Shafia, S., Nikkhah, F., & Akhoundzadeh, K. (2023). Effect of combination fluoxetine and exercise on prefrontal BDNF, anxiety-like behavior and fear extinction in a female rat model of post-traumatic stress disorder (PTSD): a comparison with male animals. Behavioral & Brain Functions, 19(1), 1–12. https://doi.org/10.1186/s12993-023-00204-zStahl, S. M., Grady, M. M., & Muntner, N. (2021). Stahl’s essentialpsychopharmacology: Prescriber’s Guide. Cambridge University Press.Zamani, M., Radahmadi, M., & Reisi, P. (2022). Therapeutic effects ofexercise-accompanied escitalopram on synaptic potency and long-term plasticity in the hippocampal CA1 area in rats under chronic restraint stress. Iranian Journal of Basic Medical Sciences, 25(12), 1460–1467. https://doi.org/10.22038/IJBMS.2022.66718.14629*Hanging indentation not retained for references*

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Depression Scenarios

 

This is a peer’s post, I’am replying to her post

Re: Week 6 Discussion 1: Depression Scenarios

by Cindy Faraguna – Tuesday, 7 February 2023, 9:47 PM

Patient reports that there is no response to the medication.Mrs. Lane comes into the office for her 6-week follow-up visit. She shares she does not feel any better since decreasing her Lexapro. I would switch her to citalopram 10 mg by mouth daily for the first week and then assess for any adverse reactions. If she is tolerating the medication well, I would increase it to 20 mg by mouth daily. Citalopram is a selective serotonin reuptake inhibitor (SSRI) that is FDA-approved for depression in adults (Sharbaf Shoar et al., 2021; Stahl, 2021). I would discuss with Mrs. Lane if she attended any cognitive behavioral therapy (CBT) sessions and how many times has she attended. CBT is an evidence-based intervention to treat depression (Gautam et al., 2020). According to American Psychiatric Association (APA), if a patient experiences no or partial response to treatment, electroconvulsive therapy (ECT) may also be considered for severe depression without psychotic features (APA, 2010). Research has shown the positive effects ECT on depression has on the patient. It has been suggested that ECT should be the first-line therapy to treat depression (Li et al., 2020). This would be discussed with Mrs. Lane and together we will develop the best plan of care for her.

Patient reports that there is a partial response to the medication. Mood has lifted, but energy and motivation are still poor.Mrs. Lane is making progress but feeling unmotivated and experiencing low levels of energy. I would want to know if she is taking the medication in the morning or evening. If this time not the root of her current issue, then I will add an adjunct treatment. Modafinil can be prescribed as an adjunct is generally tolerated well (Ninan et al., 2004). The prescribed dose for modafinil is 200 mg tablet by mouth daily every morning (Stahl, 2021). Studies have shown patient who are prescribed modafinil, respond well and report decreased depression and fatigue with improved cognition (Pary et al., 2015). Modafinil has shown to be a useful adjunct for partial responders to selective serotonin reuptake inhibitors (SSRIs) (Pary et al., 2015)

Patient reports that mood is improved but sexual side effects are interfering with quality of life.Mrs. Lane reports she has responded well to treat for mood; however, has been experiencing low libido. There is a balance when prescribing an effective mediation to treat depression while minimizing the impact on sexuality (Montejo et al., 2019). More than 80% of patients who take an SSRI experience adverse sexual dysfunction (Montejo et al., 2019). Patients who experience sexual side effects may require an antidote to reverse the problem (Regis College, 2023). Cialis, Viagra, bupropion, and buspirone can be prescribed to help with sexual side effects; however, my not be as effective and the patient will need to change medications (Regis College, 2023). Bupropion, after three randomized, double-blind, placebo-controlled studies, to be more effective to improve sexual function (Montejo et al., 2019). Bupropion (Wellbutrin) will be started slowly with 75 mg tablet by mouth twice daily (Yasin et al., 2019). If the treatment does not work, then Mrs. Lane will need to change to a different antidepressant.

Patient reports that mood has improved, but they now have an extreme increase in energy and can’t slow down, are not sleeping, and feel like they can get four days work completed in only a few hours.There are a few options for Mr. Lane. I would first re-assess Mrs. Lane for possible bipolar disorder. This is critical because the use of an antidepressant in bipolar depression need to monitored for manic switches, cycle acceleration, and suicidal behavior (Cheniaux & Narid, 2019). I can start lithium and/or discontinue citalopram (Stahl, 2021). I would also want check labs to assure patient is not experiencing any additional medical conditions. Lithium is best used for mania and depression (Chokhawala et al., 2022). Lithium slow release 300 mg by mouth daily can take up to 1 to 3 weeks to take effect (Chokhawala et al., 2022).ReferencesAmerican Psychiatric Association (APA). (2010). Treatment of patients with major depressive disorder [PDF]. Psychiatry Online. https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdfCheniaux, E. and Nardi, A.E. (2019). Evaluating the efficacy and safety of antidepressants in patients with bipolar disorder. Expert Opinion on Drug Safety, 18(10), 893–913. https://doi.org/10.1080/14740338.2019.1651291.Chokhawala K, Lee S, and Saadabadi A. (2022, July 11). Lithium. In StatPearls. StatPearls Publishing. Retrieved February 7, 2023 from https://www.ncbi.nlm.nih.gov/books/NBK519062/Gautam, M., Tripathi, A., Deshmukh, D., and Gaur, M. (2020). Cognitive behavioral therapy for Depression. Indian Journal of Psychiatry, 62(8). https://doi.org/10.4103/psychiatry.indianjpsychiatry_772_19.Li M, Yao X, Sun L, Zhao L, Xu W, Zhao H, Zhao F, Zou X, Cheng Z, Li B, Yang W, Cui R.( 2020). (2020). Effects of electroconvulsive therapy on depression and its potential mechanism. Frontiers in Psychology, 11(1). https://doi.org/10.3389/fpsyg.2020.00080.Montejo, A., Prieto, N., Alarcon, R., Casado-Espada, N., Iglesia, J., and Montejo, L. (2019). Management strategies for antidepressant-related sexual dysfunction: A clinical approach. Journal of Clinical Medicine, 8(10). https://doi.org/10.3390/jcm8101640.Ninan, P.T., Hassman, H., Glass, S., and McManus, F. (2004). Adjunctive modafinil at initiation of treatment with a selective serotonin reuptake inhibitor enhances the degree and onset of therapeutic effects in patients with major depressive disorder and fatigue. The Journal of Clinical Psychiatry, 65(3), 414–420. https://doi.org/10.4088/jcp.v65n0318.Pary, R., Scarff, J., Jijakli, A., Tobias, C., and Lippmann, S. (2015) A review of psychostimulants for adults with depression, Federal practitioner : for the health care professionals of the VA, DoD, and PHS. U.S. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375494/Regis College. (2023). Week 6 lesson: After the first appointment: Treatment decisions making in depression presentation.Sharbaf Shoar N, Fariba KA, and Padhy RK. (2021, Dec 11). Citalopram. In StatPearls. StatPearls Publishing. Retrieved February 4, 2023 from https://www.ncbi.nlm.nih.gov/books/NBK482222/Stahl, S.M., Grady, M.M. and Muntner, N. (2021) Stahl’s essential psychopharmacology: Prescriber’s Guide (7th ed.). Cambridge University Press.Yasin, W., Ahmed, S.I. and Gouthro, R.V. (2019). Does bupropion impact more than mood? A case report and review of the literature. Cureus. https://doi.org/10.7759/cureus.4277.  

 

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Depression Scenarios

NU-643-05-23PCSP Adv.Psychopharmacology

Week 6 Discussion 1: Depression Scenarios

To do: Make forum posts: 1

Value: 100 points

Due: Create your initial post by Day 4, and reply to at least two of your classmates’ posts by Day 7.

Grading Category: Discussion Forums

Initial Post

  1. For this discussion, you will build on your treatment plan from Week 5: Assignment 1: Depression Case Study. You will be seeing your patient at the six-week follow-up.
  2. Describe your treatment plan for your patient in each of these four 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

  1. Patient reports that there is no response to the medication.
  2. Patient reports that there is a partial response to the medication. Mood has lifted, but energy and motivation are still poor.
  3. Patient reports that mood is improved but sexual side effects are interfering with quality of life.
  4. Patient reports that mood has improved, but they now have an extreme increase in energy and can’t slow down, are not sleeping, and feel like they can get four days work completed in only a few hours. 

 

 

Additional information

This is the week 5 work I did. Depression case study, I gave you guys the work , guess couldn’t upload the file , was giving me issues, pls use this to complete the week six, not really the best. use it to create week six

 

 

Depression case study week 5

Student’s Name

 

 

Introduction and Differential Diagnoses

The patient is a 42-year-old Korean American woman known as Mrs. Lane, who presents to the clinic with symptoms of depression. She arrived in the US at age 18 and stated that after every two to three years, she visited Korea. For twenty years, she has been married to her husband, and they have two children, who are both daughters. In her family, she is the youngest of six children. Currently, the patient illustrates that she is working at a retirement home as an LPN, whereas one of his daughters lives in the town with her husband, whereas the other lives in California. Nevertheless, their family typically visit each other as they live a few houses away. Mrs. Lane’s symptoms in the past three months include no interest in cooking or seeing family and worsening moods. Two years ago, she suggested that she was diagnosed with primary depression. In addition, three years ago, the patient was also diagnosed with generalized anxiety disorder and major depressive disorder. Her poor memory issues has exacerbated, and she has difficulty concentrating on tasks. However, her appetite is the same; the patient state that she completely lost interest in cooking, where she typically used to set aside Saturday as the official day of cooking for the family. Due to stress, she experiences difficulty sleeping. However, Mrs. Lane denies hospitalization due to psychiatric disorders.

Differential Diagnosis List 

1. Alzheimer’s, Parkinson’s

2. Bipolar disorder

3. Depression

Rationale

Mrs. Lane could have Alzheimer’s or Parkinson’s disease. This is because she experiences poor memory, difficulty concentrating, changes in mood and behavior, and forgetting recently learned information. To indicate the change in attitude and behavior, the patient illustrates that she no longer cooks for the family on Saturdays as she used to due to the lack of interest.

On the other hand, the patient could also be ailing from bipolar disorder. This is due to the symptoms that she showcases, such as a reduced need for sleep, loss of touch with reality, loss of interest in daily activities, low motivation, sadness, and lack of concentration. Mrs. Lane claims that several times, she has been depressed and anxious but did not seek treatment, which could be linked to her current episodes of sadness.

Lastly, Mrs. Lane could be diagnosed with depression. Her disease’s adverse symptoms include lack of concentration, changes in sleep, loss of interest, sadness, and depressed mood. It has not been indicated whether she has headache, vomiting, diarrhea, or chest pain, thus making depression a critical diagnosis.

Narrative Mental Status Exam

During the interview, the patient illustrated that after the birth of her second child and when she stopped breastfeeding, she felt depressed and anxious. Two years ago, she was diagnosed with depression and started taking the medication immediately. However, after 12 sessions of therapy, she ceased the therapeutic approach. The symptoms she has recently showcased, such as poor memory, sadness, and loss of interest, have drastically changed her life. However, Mrs. Lane suggests that talking to family and reading in bed play a significant role in reducing her symptoms of anxiety. Sometimes, she feels sad and considers everything to be in green shades.

Variations from Normal and Monitoring Needs

Offering the patient Lexapro 10 mg I tablet PO qd could trigger adverse side effects such as insomnia, sexual side effect, and nausea. Therefore, since the patient already has difficulty sleeping, the medication could exacerbate her situation rather than improve it. 

Assessment

Primary Diagnosis and Coding 

The DSM 5 code for Alzheimer’s Parkinson’s disease is 332.0(G20), whereas its ICD 10 code is G31.83.On the other hand, the ICD-10 code for bipolar disorder is F31.2, and its DSM 5 code is F31.3.Lastly, the DSM-5 code for depression is DSM-5 296.20 is F33.0 (Sheu et al., 2022).

Plan of Treatment and Rx

Alzheimer’s, Parkinson’s

The appropriate drug class for Alzheimer’s and Parkinson’s disease is cholinesterase inhibitors (Bickley, 2021). The commonly prescribed medication is donepezil to support the communication between the nerve cell. The affected neurotransmitters are Acetylcholinesterase. Indeed the drug has been approved for treatment by the FDA.

Nonpharmacological Interventions

Physical exercises will be appropriate for the patient.

Patient Education: 

The most common adverse effects of cholinesterase inhibitors encompass dizziness, fatigue, muscle cramps, dyspepsia, decreased appetite, and diarrhea (Foley & Steel, 2019).

Safety Plan: 

Due to respiratory failure, severe cholinesterase inhibition can cause death to the patient or convulsion.

Follow-up and Outcomes: 

The outcome of treatment for Alzheimer’s disease is to decrease the breakdown of acetylcholine.

Billing Code for visit

The family members and caregivers need to assist the patients ailing from Alzheimer’s disease in their daily activities as they frequently forget information.

Approach to Care and Clinical Guidelines

The best treatment plan for early to mid-stages of Alzheimer’s Parkinson’s disease is medications like rivastigmine, galantamine, donepezil, and acetylcholinesterase inhibitors.

Bipolar disorder

Pharmacologic Interventions

The drug class for the bipolar disease includes antipsychotics and mood stabilizers‌ (Dains, Scheibel, & Baumann, 2020). The antipsychotics such as olanzapine have several strengths, including 20mg, 15 mg, 10 mg, 5 mg, and 2.5 mg. Antipsychotic medications play a significant role in clearing confusion and calming the patient within hours after administration. However, patients must check their vital signs before and after the medication to circumvent drug overdose cases, which can be fatal.

Nonpharmacological Interventions

Cognitive mindfulness therapy, along with meditation practice

Patient Education: 

The patients are not supposed to rapidly stop taking the medications once they have started using them but instead should cease slowly through the help of a physician. The common side effects of antipsychotic drugs are vomiting, nausea, constipation, blurred vision, dizziness, and drowsiness. Nonetheless, the patients can reduce depression and concentrate after using the medication as they increase the norepinephrine levels. The SNRI with the least side effects encompasses fluvoxamine, paroxetine, sertraline, fluoxetine, and citalopram.

Safety Plan

The medications need to be taken as prescribed to avoid overdose

Follow-up and Outcomes

The patients are required to cope with their negative feelings after taking the medication

Billing Code for visit

The patients are to be assisted by colleagues, friends, and family members to cope with their feelings

Approach to Care and Clinical Guidelines

The most widely prescribed mood stabilizer medication is lithium

Depression

Pharmacologic Interventions

The effective drug to treat the condition is tricyclic, SNRI, and SSRI.

Patient Education:

The patients must immediately visit the health care facilities if they experience severe sweating, confusion, agitation, and anxiety. The side effects associated with the medication are changes in sexual desire, inability to maintain an erection, insomnia, constipation, constipation, and tiredness.

Safety Plan

Drugs could raise the blood pressure as levomilnacipran, desvenlafaxine, and venlafaxine.

Follow-up and Outcomes

The physicians must monitor the patient’s liver functions and blood pressure after administering the medication.

Billing Code for visit

The doctors are required to provide guidelines to patients to slow quit SSRI drugs.

Approach to Care and Clinical Guidelines

The best therapeutic approach of care to depression is CBT, which teaches patients to cope with their mood and anxiety.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

Bickley, L. (2021). Bate’s guide to physical examination and history taking (13th Ed.). Wolters Kluwer.

‌Dains, J. E., Scheibel, P., & Baumann, L. C. (2020). Advanced health assessment and clinical diagnosis in primary care (6th Ed.). Elsevier.

Foley, H. M., & Steel, A. E. (2019). Adverse events associated with oral administration of melatonin: A critical systematic review of clinical evidence. Complementary therapies in medicine42, 65-81.

Sheu, Y. H., Magdamo, C., Miller, M., Smoller, J. W., & Blacker, D. (2022). Initial antidepressant choice by non-psychiatrists: Learning from large-scale electronic health records. General Hospital Psychiatry.

 

 

 

 

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Depression Scenarios

NU-643-05-23PCSP Adv.Psychopharmacology

Week 6 Discussion 1: Depression Scenarios

To do: Make forum posts: 1

Value: 100 points

Due: Create your initial post by Day 4, and reply to at least two of your classmates’ posts by Day 7.

Grading Category: Discussion Forums

Initial Post

  1. For this discussion, you will build on your treatment plan from Week 5: Assignment 1: Depression Case Study. You will be seeing your patient at the six-week follow-up.
  2. Describe your treatment plan for your patient in each of these four 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

  1. Patient reports that there is no response to the medication.
  2. Patient reports that there is a partial response to the medication. Mood has lifted, but energy and motivation are still poor.
  3. Patient reports that mood is improved but sexual side effects are interfering with quality of life.
  4. Patient reports that mood has improved, but they now have an extreme increase in energy and can’t slow down, are not sleeping, and feel like they can get four days work completed in only a few hours. 

 

 

Additional information

This is the week 5 work I did. Depression case study, I gave you guys the work , guess couldn’t upload the file , was giving me issues, pls use this to complete the week six, not really the best. use it to create week six

 

 

Depression case study week 5

Student’s Name

 

 

Introduction and Differential Diagnoses

The patient is a 42-year-old Korean American woman known as Mrs. Lane, who presents to the clinic with symptoms of depression. She arrived in the US at age 18 and stated that after every two to three years, she visited Korea. For twenty years, she has been married to her husband, and they have two children, who are both daughters. In her family, she is the youngest of six children. Currently, the patient illustrates that she is working at a retirement home as an LPN, whereas one of his daughters lives in the town with her husband, whereas the other lives in California. Nevertheless, their family typically visit each other as they live a few houses away. Mrs. Lane’s symptoms in the past three months include no interest in cooking or seeing family and worsening moods. Two years ago, she suggested that she was diagnosed with primary depression. In addition, three years ago, the patient was also diagnosed with generalized anxiety disorder and major depressive disorder. Her poor memory issues has exacerbated, and she has difficulty concentrating on tasks. However, her appetite is the same; the patient state that she completely lost interest in cooking, where she typically used to set aside Saturday as the official day of cooking for the family. Due to stress, she experiences difficulty sleeping. However, Mrs. Lane denies hospitalization due to psychiatric disorders.

Differential Diagnosis List 

1. Alzheimer’s, Parkinson’s

2. Bipolar disorder

3. Depression

Rationale

Mrs. Lane could have Alzheimer’s or Parkinson’s disease. This is because she experiences poor memory, difficulty concentrating, changes in mood and behavior, and forgetting recently learned information. To indicate the change in attitude and behavior, the patient illustrates that she no longer cooks for the family on Saturdays as she used to due to the lack of interest.

On the other hand, the patient could also be ailing from bipolar disorder. This is due to the symptoms that she showcases, such as a reduced need for sleep, loss of touch with reality, loss of interest in daily activities, low motivation, sadness, and lack of concentration. Mrs. Lane claims that several times, she has been depressed and anxious but did not seek treatment, which could be linked to her current episodes of sadness.

Lastly, Mrs. Lane could be diagnosed with depression. Her disease’s adverse symptoms include lack of concentration, changes in sleep, loss of interest, sadness, and depressed mood. It has not been indicated whether she has headache, vomiting, diarrhea, or chest pain, thus making depression a critical diagnosis.

Narrative Mental Status Exam

During the interview, the patient illustrated that after the birth of her second child and when she stopped breastfeeding, she felt depressed and anxious. Two years ago, she was diagnosed with depression and started taking the medication immediately. However, after 12 sessions of therapy, she ceased the therapeutic approach. The symptoms she has recently showcased, such as poor memory, sadness, and loss of interest, have drastically changed her life. However, Mrs. Lane suggests that talking to family and reading in bed play a significant role in reducing her symptoms of anxiety. Sometimes, she feels sad and considers everything to be in green shades.

Variations from Normal and Monitoring Needs

Offering the patient Lexapro 10 mg I tablet PO qd could trigger adverse side effects such as insomnia, sexual side effect, and nausea. Therefore, since the patient already has difficulty sleeping, the medication could exacerbate her situation rather than improve it. 

Assessment

Primary Diagnosis and Coding 

The DSM 5 code for Alzheimer’s Parkinson’s disease is 332.0(G20), whereas its ICD 10 code is G31.83.On the other hand, the ICD-10 code for bipolar disorder is F31.2, and its DSM 5 code is F31.3.Lastly, the DSM-5 code for depression is DSM-5 296.20 is F33.0 (Sheu et al., 2022).

Plan of Treatment and Rx

Alzheimer’s, Parkinson’s

The appropriate drug class for Alzheimer’s and Parkinson’s disease is cholinesterase inhibitors (Bickley, 2021). The commonly prescribed medication is donepezil to support the communication between the nerve cell. The affected neurotransmitters are Acetylcholinesterase. Indeed the drug has been approved for treatment by the FDA.

Nonpharmacological Interventions

Physical exercises will be appropriate for the patient.

Patient Education: 

The most common adverse effects of cholinesterase inhibitors encompass dizziness, fatigue, muscle cramps, dyspepsia, decreased appetite, and diarrhea (Foley & Steel, 2019).

Safety Plan: 

Due to respiratory failure, severe cholinesterase inhibition can cause death to the patient or convulsion.

Follow-up and Outcomes: 

The outcome of treatment for Alzheimer’s disease is to decrease the breakdown of acetylcholine.

Billing Code for visit

The family members and caregivers need to assist the patients ailing from Alzheimer’s disease in their daily activities as they frequently forget information.

Approach to Care and Clinical Guidelines

The best treatment plan for early to mid-stages of Alzheimer’s Parkinson’s disease is medications like rivastigmine, galantamine, donepezil, and acetylcholinesterase inhibitors.

Bipolar disorder

Pharmacologic Interventions

The drug class for the bipolar disease includes antipsychotics and mood stabilizers‌ (Dains, Scheibel, & Baumann, 2020). The antipsychotics such as olanzapine have several strengths, including 20mg, 15 mg, 10 mg, 5 mg, and 2.5 mg. Antipsychotic medications play a significant role in clearing confusion and calming the patient within hours after administration. However, patients must check their vital signs before and after the medication to circumvent drug overdose cases, which can be fatal.

Nonpharmacological Interventions

Cognitive mindfulness therapy, along with meditation practice

Patient Education: 

The patients are not supposed to rapidly stop taking the medications once they have started using them but instead should cease slowly through the help of a physician. The common side effects of antipsychotic drugs are vomiting, nausea, constipation, blurred vision, dizziness, and drowsiness. Nonetheless, the patients can reduce depression and concentrate after using the medication as they increase the norepinephrine levels. The SNRI with the least side effects encompasses fluvoxamine, paroxetine, sertraline, fluoxetine, and citalopram.

Safety Plan

The medications need to be taken as prescribed to avoid overdose

Follow-up and Outcomes

The patients are required to cope with their negative feelings after taking the medication

Billing Code for visit

The patients are to be assisted by colleagues, friends, and family members to cope with their feelings

Approach to Care and Clinical Guidelines

The most widely prescribed mood stabilizer medication is lithium

Depression

Pharmacologic Interventions

The effective drug to treat the condition is tricyclic, SNRI, and SSRI.

Patient Education:

The patients must immediately visit the health care facilities if they experience severe sweating, confusion, agitation, and anxiety. The side effects associated with the medication are changes in sexual desire, inability to maintain an erection, insomnia, constipation, constipation, and tiredness.

Safety Plan

Drugs could raise the blood pressure as levomilnacipran, desvenlafaxine, and venlafaxine.

Follow-up and Outcomes

The physicians must monitor the patient’s liver functions and blood pressure after administering the medication.

Billing Code for visit

The doctors are required to provide guidelines to patients to slow quit SSRI drugs.

Approach to Care and Clinical Guidelines

The best therapeutic approach of care to depression is CBT, which teaches patients to cope with their mood and anxiety.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

Bickley, L. (2021). Bate’s guide to physical examination and history taking (13th Ed.). Wolters Kluwer.

‌Dains, J. E., Scheibel, P., & Baumann, L. C. (2020). Advanced health assessment and clinical diagnosis in primary care (6th Ed.). Elsevier.

Foley, H. M., & Steel, A. E. (2019). Adverse events associated with oral administration of melatonin: A critical systematic review of clinical evidence. Complementary therapies in medicine42, 65-81.

Sheu, Y. H., Magdamo, C., Miller, M., Smoller, J. W., & Blacker, D. (2022). Initial antidepressant choice by non-psychiatrists: Learning from large-scale electronic health records. General Hospital Psychiatry.

 

 

 

 

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Depression Scenarios

NU-643-05-23PCSP Adv.Psychopharmacology

Week 6 Discussion 1: Depression Scenarios

To do: Make forum posts: 1

Value: 100 points

Due: Create your initial post by Day 4, and reply to at least two of your classmates’ posts by Day 7.

Grading Category: Discussion Forums

Initial Post

  1. For this discussion, you will build on your treatment plan from Week 5: Assignment 1: Depression Case Study. You will be seeing your patient at the six-week follow-up.
  2. Describe your treatment plan for your patient in each of these four 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

  1. Patient reports that there is no response to the medication.
  2. Patient reports that there is a partial response to the medication. Mood has lifted, but energy and motivation are still poor.
  3. Patient reports that mood is improved but sexual side effects are interfering with quality of life.
  4. Patient reports that mood has improved, but they now have an extreme increase in energy and can’t slow down, are not sleeping, and feel like they can get four days work completed in only a few hours. 

 

 

Additional information

This is the week 5 work I did. Depression case study, I gave you guys the work , guess couldn’t upload the file , was giving me issues, pls use this to complete the week six, not really the best. use it to create week six

 

 

Depression case study week 5

Student’s Name

 

 

Introduction and Differential Diagnoses

The patient is a 42-year-old Korean American woman known as Mrs. Lane, who presents to the clinic with symptoms of depression. She arrived in the US at age 18 and stated that after every two to three years, she visited Korea. For twenty years, she has been married to her husband, and they have two children, who are both daughters. In her family, she is the youngest of six children. Currently, the patient illustrates that she is working at a retirement home as an LPN, whereas one of his daughters lives in the town with her husband, whereas the other lives in California. Nevertheless, their family typically visit each other as they live a few houses away. Mrs. Lane’s symptoms in the past three months include no interest in cooking or seeing family and worsening moods. Two years ago, she suggested that she was diagnosed with primary depression. In addition, three years ago, the patient was also diagnosed with generalized anxiety disorder and major depressive disorder. Her poor memory issues has exacerbated, and she has difficulty concentrating on tasks. However, her appetite is the same; the patient state that she completely lost interest in cooking, where she typically used to set aside Saturday as the official day of cooking for the family. Due to stress, she experiences difficulty sleeping. However, Mrs. Lane denies hospitalization due to psychiatric disorders.

Differential Diagnosis List 

1. Alzheimer’s, Parkinson’s

2. Bipolar disorder

3. Depression

Rationale

Mrs. Lane could have Alzheimer’s or Parkinson’s disease. This is because she experiences poor memory, difficulty concentrating, changes in mood and behavior, and forgetting recently learned information. To indicate the change in attitude and behavior, the patient illustrates that she no longer cooks for the family on Saturdays as she used to due to the lack of interest.

On the other hand, the patient could also be ailing from bipolar disorder. This is due to the symptoms that she showcases, such as a reduced need for sleep, loss of touch with reality, loss of interest in daily activities, low motivation, sadness, and lack of concentration. Mrs. Lane claims that several times, she has been depressed and anxious but did not seek treatment, which could be linked to her current episodes of sadness.

Lastly, Mrs. Lane could be diagnosed with depression. Her disease’s adverse symptoms include lack of concentration, changes in sleep, loss of interest, sadness, and depressed mood. It has not been indicated whether she has headache, vomiting, diarrhea, or chest pain, thus making depression a critical diagnosis.

Narrative Mental Status Exam

During the interview, the patient illustrated that after the birth of her second child and when she stopped breastfeeding, she felt depressed and anxious. Two years ago, she was diagnosed with depression and started taking the medication immediately. However, after 12 sessions of therapy, she ceased the therapeutic approach. The symptoms she has recently showcased, such as poor memory, sadness, and loss of interest, have drastically changed her life. However, Mrs. Lane suggests that talking to family and reading in bed play a significant role in reducing her symptoms of anxiety. Sometimes, she feels sad and considers everything to be in green shades.

Variations from Normal and Monitoring Needs

Offering the patient Lexapro 10 mg I tablet PO qd could trigger adverse side effects such as insomnia, sexual side effect, and nausea. Therefore, since the patient already has difficulty sleeping, the medication could exacerbate her situation rather than improve it. 

Assessment

Primary Diagnosis and Coding 

The DSM 5 code for Alzheimer’s Parkinson’s disease is 332.0(G20), whereas its ICD 10 code is G31.83.On the other hand, the ICD-10 code for bipolar disorder is F31.2, and its DSM 5 code is F31.3.Lastly, the DSM-5 code for depression is DSM-5 296.20 is F33.0 (Sheu et al., 2022).

Plan of Treatment and Rx

Alzheimer’s, Parkinson’s

The appropriate drug class for Alzheimer’s and Parkinson’s disease is cholinesterase inhibitors (Bickley, 2021). The commonly prescribed medication is donepezil to support the communication between the nerve cell. The affected neurotransmitters are Acetylcholinesterase. Indeed the drug has been approved for treatment by the FDA.

Nonpharmacological Interventions

Physical exercises will be appropriate for the patient.

Patient Education: 

The most common adverse effects of cholinesterase inhibitors encompass dizziness, fatigue, muscle cramps, dyspepsia, decreased appetite, and diarrhea (Foley & Steel, 2019).

Safety Plan: 

Due to respiratory failure, severe cholinesterase inhibition can cause death to the patient or convulsion.

Follow-up and Outcomes: 

The outcome of treatment for Alzheimer’s disease is to decrease the breakdown of acetylcholine.

Billing Code for visit

The family members and caregivers need to assist the patients ailing from Alzheimer’s disease in their daily activities as they frequently forget information.

Approach to Care and Clinical Guidelines

The best treatment plan for early to mid-stages of Alzheimer’s Parkinson’s disease is medications like rivastigmine, galantamine, donepezil, and acetylcholinesterase inhibitors.

Bipolar disorder

Pharmacologic Interventions

The drug class for the bipolar disease includes antipsychotics and mood stabilizers‌ (Dains, Scheibel, & Baumann, 2020). The antipsychotics such as olanzapine have several strengths, including 20mg, 15 mg, 10 mg, 5 mg, and 2.5 mg. Antipsychotic medications play a significant role in clearing confusion and calming the patient within hours after administration. However, patients must check their vital signs before and after the medication to circumvent drug overdose cases, which can be fatal.

Nonpharmacological Interventions

Cognitive mindfulness therapy, along with meditation practice

Patient Education: 

The patients are not supposed to rapidly stop taking the medications once they have started using them but instead should cease slowly through the help of a physician. The common side effects of antipsychotic drugs are vomiting, nausea, constipation, blurred vision, dizziness, and drowsiness. Nonetheless, the patients can reduce depression and concentrate after using the medication as they increase the norepinephrine levels. The SNRI with the least side effects encompasses fluvoxamine, paroxetine, sertraline, fluoxetine, and citalopram.

Safety Plan

The medications need to be taken as prescribed to avoid overdose

Follow-up and Outcomes

The patients are required to cope with their negative feelings after taking the medication

Billing Code for visit

The patients are to be assisted by colleagues, friends, and family members to cope with their feelings

Approach to Care and Clinical Guidelines

The most widely prescribed mood stabilizer medication is lithium

Depression

Pharmacologic Interventions

The effective drug to treat the condition is tricyclic, SNRI, and SSRI.

Patient Education:

The patients must immediately visit the health care facilities if they experience severe sweating, confusion, agitation, and anxiety. The side effects associated with the medication are changes in sexual desire, inability to maintain an erection, insomnia, constipation, constipation, and tiredness.

Safety Plan

Drugs could raise the blood pressure as levomilnacipran, desvenlafaxine, and venlafaxine.

Follow-up and Outcomes

The physicians must monitor the patient’s liver functions and blood pressure after administering the medication.

Billing Code for visit

The doctors are required to provide guidelines to patients to slow quit SSRI drugs.

Approach to Care and Clinical Guidelines

The best therapeutic approach of care to depression is CBT, which teaches patients to cope with their mood and anxiety.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

Bickley, L. (2021). Bate’s guide to physical examination and history taking (13th Ed.). Wolters Kluwer.

‌Dains, J. E., Scheibel, P., & Baumann, L. C. (2020). Advanced health assessment and clinical diagnosis in primary care (6th Ed.). Elsevier.

Foley, H. M., & Steel, A. E. (2019). Adverse events associated with oral administration of melatonin: A critical systematic review of clinical evidence. Complementary therapies in medicine42, 65-81.

Sheu, Y. H., Magdamo, C., Miller, M., Smoller, J. W., & Blacker, D. (2022). Initial antidepressant choice by non-psychiatrists: Learning from large-scale electronic health records. General Hospital Psychiatry.

 

 

 

 

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Use the following coupon
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Depression Scenarios

This a Depression Scenarios paper.  The instruction is as follows: 

  1. For this discussion you will build on your treatment plan from Week 5 Assignment 1: Depression Case Study You will be seeing your patient at the six-week follow-up.
  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

  1. There is no response to the medication.
  2. There is a partial response to the medication. Mood has lifted but energy and motivation are still poor.
  3. Mood is improved but the patient has sexual side effects that interfere with quality of life.

Get 15% discount on your first order with us
Use the following coupon
FIRST15

Order Now