Case: An elderly widow who just lost her spouse
Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications:
- Metformin 500mg BID
- Januvia 100mg daily
- Losartan 100mg daily
- HCTZ 25mg daily
- Sertraline 100mg daily
Current weight: 88 kg
Current height: 64 inches
Temp: 98.6 degrees F
BP: 132/86
By Day 3 of Week 7
Post a response to each of the following:
- List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.
- Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
- Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.
- List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.
- List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
- For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on ethical prescribing or decision-making. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals based on ethical prescribing guidelines or decision-making?
- Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.
Treatment for a Patient with a Common Condition
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Treatment for a Patient with a Common Condition
Introduction
Depression can be detrimental to the health of people if not properly addressed. Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. It is also called major depressive disorder and affects how one thinks, feels, and behaves (LeMoult & Gotlib, 2019). The case study is about a patient experiencing depressive symptoms. This paper answers all the questions to complete the assignment.
Some of the questions include that the patient would be asked include what is your name? do you take alcohol, smoke, or abuse any hard drug? do you take your medications in time?. Asking the patient about her name is important as an introductory part of the conversation (McIntyre et al., 2020). Knowing the patient’s name will help when addressing her. Asking about alcohol and drug abuse is important to help figure out the exact problem and also to understand the extent of her depression. Asking about whether she takes her medicine in time will help understand her medication compliance or adherence.
Some of the people to ask questions about the patient include her children (daughters or sons), personal assistant (if she has any), and any other family member close to the patient. These people may help identify important information to help the patient ((McIntyre et al., 2020). Some of the questions include: how often is the patient been hospitalized in the past 12 months? does the patient perform daily duties normally? Does she believe in medical interventions, doe she takes her medications easily?.
Physical examination may include asking questions about the patients’ health. It may include past illness or depressing situations, sleep habits, lifestyle, and medical history. The doctor may assess the patient’s mood, concentration, and fatigue, or loss of energy (LeMoult & Gotlib, 2019). Lab tests (complete blood count test) may be done to check for any sign of underlying illness. Also, a thyroid test can be performed to ensure it is functioning well. DSM-5 may be used to perform diagnosis of suspected mental disorders.
The most likely differential diagnosis for the patient is major depressive disorder (depression). The patient medical history makes her more vulnerable to depression. The patient stated that since the death of her husband, her depression has grown worse. She also complains of insomnia, which is one of the symptoms of depression. She also experiences hypertension, which is often associated with depression.
The two pharmacologic agents for this patient include imipramine (Tofranil) and sertraline (Zoloft). The most preferred agent is sertraline (Zoloft) because it is a selective serotonin reuptake inhibitor (SSRI) (Malhi & Mann, 2018). The medications are considered safer and lead to fewer bothersome side effects than other antidepressants. Imipramine (Tofranil) is one of the tricyclic antidepressants. They are known to cause more severe side effects.
Zoloft is contraindicated in patients taking pimozide or those treated with methylene blue injection. Also, patients who are using or have used MAO in the past 14 days should not use Zoloft (Malhi & Mann, 2018). People allergic to medication should avoid using it. These are contraindications for Zoloft.
An effective follow-up plan for the patient is necessary to enhance recovery. The patient will return to the clinic for checkups on week 4, week 8, and week 12 (McIntyre et al., 2020). The therapist will assess any drug side effects as well as symptoms and overall wellbeing.
Concussion
Depression can lead to serious negative impacts on the patient’s health. Depression is one of the common and devastating mental illnesses. The case study is about a patient experiencing depressive symptoms. More appropriate medical interventions are identified. All the questions were answered regarding the assignment.
References
LeMoult, J., & Gotlib, I. H. (2019). Depression: A cognitive perspective. Clinical Psychology Review, 69, 51-66. https://doi.org/10.1016/j.cpr.2018.06.008
Malhi, G. S., & Mann, J. J. (2018). Depression. The Lancet, 392(10161), 2299-2312. https://doi.org/10.1016/S0140-6736(18)31948-2
McIntyre, R. S., In Rong, C., In Subramaniapillai, M., & In Lee, Y. (2020). Major depressive disorder. Elsevier.