Case Study For Patient Experiencing Severe Depression Mood

Using your learning experience from your clinical experience, preceptor input and evidence-based literature, develop a pharmacology treatment Algorithm of a patient with a DSM diagnosis. You can use your readings to change and add to your work, but it must be an original and not a copy of an algorithm from someone else. This is an algorithm developed specifically for this client to demonstrate your critical thinking throughout the treatment planning. The following areas must be covered in the assignment Case Study For Patient Experiencing Severe Depression Mood.

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Overview of your initial patient clinical assessment including: Chief compliant, medical history, psychiatric history, psychosocial, mental status examination.
Using the information from the assessment, reading materials and textbook, develop an evidence-based algorithm for four treatment stages, tailored to this individual. The information must include interview questions needed to guide decision-making at the different stages, length of treatment in trial/initiation period, dosage titration schedule and duration of time the client should stay on the medication, factors that might influence the effectiveness of the medications, necessary labs and test, and patient education. Include pertinent side effects profiles that would warrant a change in the medication being prescribed and a brief reasoning for your decisions.
Stage 1: initial visit
Stage 2: non-responder to stage 1
Stage 3: non-responder to stage 2
Stage 4: non-responder to stage 3
It must be in an AP

Initial Patient Clinical Assessment

Chief complaint: “I have been experiencing severe depressed mood.”

Medical history: The client reports mild persistent childhood asthma.

Psychiatric history: He reports past depressive episodes and a major depressive disorder (MDD) diagnosis. The client is currently disinterested in performing work-related duties. He is also experiencing severe depressed mood, lack of concentration, reduced need for sleep, and loss of appetite.

Psychosocial: The client’s depressed mood is mainly triggered by stressors. He reported that his first depressive episodes were caused by the loss of his mother four years ago. Major life transitions or occurrences exposed him to depression since that time. He associated the current episode with an email from his employer a month ago, requiring him to work in another town from early next year. The client denies suicidal thoughts or intentions to harm others.

Mental status examination: The client’s PHQ-9 score was 15, indicating moderately severe depression (Urtasun, 2019)Case Study For Patient Experiencing Severe Depression Mood.

Current Diagnosis: Moderately severe Persistent depressive disorder (PDD). This diagnosis was supported by his PHQ-9 score of 15, which portrays moderately severe depression (Urtasun, 2019). Additionally, the client’s psychiatric evaluation today indicates a depressed mood, being disinterested in going to work, insomnia, lack of concentration, and loss of appetite. These depressive symptoms keep recurring for the last four years. Consequently, the client meets the DSM-V diagnostic criteria for PDD that require a person to depict more than five symptoms of depression that have persisted over the last two weeks and these depressive episodes keep recurring for at least two years (Park & Kim, 2018)Case Study For Patient Experiencing Severe Depression Mood.

Treatment Stages

Stage 1:  The client was diagnosed with moderately severe PDD during the initial visit. The client was prescribed Sertraline (Zoloft) 50mg orally once daily. This medication therapy was preferred since it is a selective serotonin reuptake inhibitor (SSRI). The FDA has approved SSRIs as the first-line pharmacological therapy for adults with depressive disorders, including PDD (Potter, 2019)Case Study For Patient Experiencing Severe Depression Mood. Thus, it was expected that Sertraline 50mg would improve the client’s mood due to its efficacy in reducing the severity of depressive symptoms.

Stage 2: The client returned to the psychiatrist’s office after four weeks. The PMHNP asked the client about changes in his mood. He denied improvement in initially reported depressive symptoms, including severely depressed mood, indicating non-response to the initial medication therapy, Zoloft 50mg. Consequently, the client’s dosage was increased to Sertraline 100mg orally once daily. This decision was justified by the effectiveness of higher SSRI doses in improving mood symptoms in adults with depressive disorders (Fagiolini et al., 2021)Case Study For Patient Experiencing Severe Depression Mood.

Stage 3: The client reported significant improvement in his mood during the next visit. He had also gained interest in his duties at work. However, the client seems concerned with undesired drug-related adverse effects, including feeling weak, nausea, dry mouth, diarrhea, and severe headache. These side effects are associated with the high dose of SSRI, Sertraline 100mg once daily. Studies show that high SSRIs dosages expose patients with depressive disorders to adverse drug-related side effects (Oliva et al., 2021). As a result, the client’s dosage was lowered to Sertraline 50mg once daily to prevent undesired side effects. Additionally, the client was enrolled in a group cognitive-behavioral therapy (CBT). Combined therapy of psychotherapies and antidepressants effectively improves mood in adults with depressive disorders (Guidi & Fava, 2021). Thus, combining the current medication therapy with CBT would be more effective in improving his mood symptoms without drug-related safety or tolerability issues.

Stage 4: The client returned to the clinic four weeks later. He reported significant improvement in previously reported depressive symptoms. The client denied undesired experience in response to the provider’s question regarding drug-related effects. His response indicated that the combined therapy was effective in improving his mood and other depressive symptoms and was well tolerated. As a result, the client was advised to continue with the combined therapy for the next four weeks to achieve complete remittance of his mood symptoms. Case Study For Patient Experiencing Severe Depression Mood

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References

Fagiolini, A., Florea, I., Loft, H., & Christensen, M. C. (2021). Effectiveness of vortioxetine on emotional blunting in patients with major depressive disorder with inadequate response to SSRI/SNRI treatment. Journal of Affective Disorders, 283, 472-479.

Guidi, J., & Fava, G. A. (2021). Sequential combination of pharmacotherapy and psychotherapy in major depressive disorder: a systematic review and meta-analysis. JAMA psychiatry, 78(3), 261-269.

Oliva, V., Lippi, M., Paci, R., Del Fabro, L., Delvecchio, G., Brambilla, P., … & Serretti, A. (2021). Gastrointestinal side effects associated with antidepressant treatments in patients with major depressive disorder: a systematic review and meta-analysis. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 109, 110266.

Park, S. C., & Kim, Y. K. (2018). Depression in DSM-5: Changes, controversies, and future directions. Understanding Depression: Volume 2. Clinical Manifestations, Diagnosis and Treatment, 3-14.

Potter, D. R. (2019). Major depression disorder in adults: a review of antidepressants. Int. J. Caring Sci, 12, 1936.

Urtasun, M., Daray, F. M., Teti, G. L., Coppolillo, F., Herlax, G., Saba, G., … & Irazola, V. (2019). Validation and calibration of the patient health questionnaire (PHQ-9) in Argentina. BMC Psychiatry, 19(1), 1-10 Case Study For Patient Experiencing Severe Depression Mood