Assignment 1: “Captain of the Ship” Project – Depressive Disorder
Depressive disorder is typified by affect changes, as well as changes in cognition and neuro-vegetative functions. This paper will focus on a client with a major depressive disorder. This is because the client presents with symptoms such as sleep disturbance, sadness, impaired social functioning, fatigue, anhedonia etc (Sadock et al, 2014). Accordingly, this paper will present the client’s HPI and the clinical impression, the psychopharmacologic and psychotherapy treatments for the client. Finally, the medical management needs, community support resources and follow-up plan for the client will be discussed. Depressive Disorder Assignment Essay
HPI and Clinical Impression for the Client
MM a 42-year old woman had a history of a recurring major depressive disorder. Her first episode of depression started when she was aged 18 while in college. Five years ago, her depressive symptoms started to manifest gradually, typified by sad mood, irritability, reduced interest in her normal activities, sleep difficulties, psychomotor retardation, fatigue, loss of weight, reduced appetite, as well as recurring suicidal ideation. MM reported that these symptoms had impaired her work and also affected her social functioning. She had become withdrawn because she no longer wanted to socialize with anyone. She also did not attend her work which was a business because she always felt fatigued and did not have any energy. Consequently, MM is currently jobless and has become very isolated. When her depressive symptoms started, she was treated with Lithium and Nefazadone but the two medications did not achieve sustained benefits for MM because her depressive symptoms persisted. Her other medical history includes obesity and high blood pressure. Her current depressive symptoms include sad mood, irritability, reduced interest in her normal activities, sleep difficulties, psychomotor retardation, fatigue, loss of weight, reduced appetite, as well as recurring suicidal ideation. Her depressive symptoms and sad mood has persisted for more than 2 years and hence MM manifests symptoms of major depressive disorder (American Psychiatric Association, 2013). Depressive Disorder Assignment Essay
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Fluoxetine: The client’s prescription is 20/die mg fluoxetine. Fluoxetine is an SSRI that is recommended by the current guidelines as the primary pharmacologic treatment of major depressive disorder (Jia et al, 2016). Additionally, evidence shows that fluoxetine is effective in treating and managing symptoms of major depressive disorder. The client also has suicidal ideations and fluoxetine has demonstrated significant improvement in suicidal actions in individuals with depression (Jia et al, 2016).
Mirtazapine: This is another medication that is a suitable prescription for the client. This is because Mirtazapine has been used as an add-on treatment for better efficacy. Mirtazapine is an atypical antidepressant that has both noradrenergic and serotonergic antidepressant effects (Stahl, 2014). Mirtazapine also has potent antagonistic effects on various postsynaptic serotonin receptors and is a potent antagonist for histamine receptor. These characteristics of Mirtazapine make it an effective antidepressant. The medication also has sedating effects and hence it is appropriate for this client due to the sleep disturbance she has (Kenji et al, 2016).
Interpersonal therapy (IPT): This type of psychotherapy will focus on the client’s relationships with others. The basis of this therapy is that personal relationships are the main cause of psychological problems (Health Quality Ontario, 2017). Therefore, the focus of IPT is how relationships cause depression and hence the blame is shifted from the client to the disease and to some level, to the client’s personal situation. The cause of the symptoms will be identified and then consequent treatment started. The IPT will also encompass psycho-educational element where the patient will be educated regarding the root cause of depression, as well as different treatment options (Hees et al, 2014).
Cognitive Behavioral Therapy (CBT): CBT will be used to help the client identify negative thoughts that contribute to depression and replace these thoughts with healthy and realistic thoughts. The patient will be taught new and adaptive skills that can improve her mood and her ability to cope with everyday stressors. Accordingly, after changing her thoughts and behavior, the client will have a positive mood change (Huguet et al, 2016).
Medical Management Needs
Medical symptoms associated with depression such as pain, fatigue, and poor health outcomes need to be managed effectively. Additionally, factors that trigger the client’s depressive symptoms need to be monitored and managed (Gabbard, 2014). The client’s adherence to the treatment regiment needs to be monitored too. Finally, the client admitted to suicidal ideation and thus there is a need to have close monitoring for the client (Petrosyan et al, 2017).
Community Support Resources
The client is currently jobless and therefore it is essential to ensure she is provided financial help to manage the treatment cost and medication. The client will be referred to Partnership for Prescription Assistance organization to access free therapy. The client will also be referred to various websites that offer educational information on how to manage depression, as well as a local support group. Depressive Disorder Assignment Essay
Follow-up and Collaboration
The patient will attend the review clinic after two weeks. Mental health practitioners including a psychologist, social worker and a psychiatrist will collaborate to improve the client’s access to mental health services (Unutzer & Park, 2014). All these will collaborate in the patient’s treatment. The social worker will further offer visitation services to the client to monitor her progress and adherence to treatment while at home. There will also be a care manager who will facilitate referrals to any other necessary service for the client. Finally, a psychiatric consultation will be essential for consultation about the client from the care manager and primary care provider.
The client is a 42-year old woman with recurring major depressive disorder. Symptoms manifesting the depressive disorder in the client include; ahedonia, sleep difficulties, psychomotor retardation, fatigue, loss of weight etc. The recommended psychopharmacologic treatments for the client include fluoxetine and mirtazapine while the psychotherapy choices are interpersonal therapy and cognitive behavioral therapy. The medical management needs for the client such as pain, suicide ideation, fatigue etc need effective management. Finally, the client should be referred to an organization and community support to support her financially and provide psychological support as well. A competent follow-up plan involving different healthcare providers will be implemented for effective management of the client’s condition.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.
Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications
Health Quality Ontario. (2017). Psychotherapy for Major Depressive Disorder and Generalized Anxiety Disorder: A Health Technology Assessment. Ont Health Technol Assess Ser. 17(15), 1–167.
Hees M, Rotter T, Tim E &Evers S. (2014).The effectiveness of individual interpersonal psychotherapy as a treatment for major depressive disorder in adult outpatients: a systematic review. BMC Psychiatry. 13(22).
Huguet A, Rao S, McGrath PJ, Wozney L, Wheaton M, Conrod J, et al. (2016) A Systematic Review of Cognitive Behavioral Therapy and Behavioral Activation Apps for Depression. PLoS ONE. 11(5).
Jia Y, Zhu H & Leugn S. (2016). Comparative efficacy of selective serotonin reuptake inhibitors (SSRI) in treating major depressive disorder: a protocol for network meta-analysis of randomised controlled trials. BMJ Open. 6(6): e010142.
Kenji M, Oka M, Kaname O, Osada K. (2016). Efficacy of mirtazapine for the treatment of fibromyalgia without concomitant depression: a randomized, double-blind, placebo-controlled phase IIa study in Japan. PAIN. 157(9), 2089-2096.
Petrosyan Y, Sahakyan Y, Jan B, Kerry K, Liu B & Wodchis W. (2017). Quality indicators for care of depression in primary care settings: a systematic review. Syst Rev. 6(126).
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer
Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.
Unutzer J & Park M. (2014). Strategies to Improve the Management of Depression in Primary Care. Prim Care. 39(2), 415–431.
Depressive Disorder Assignment Essay
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