Psychotherapy With Older Adults.

NRNP 6640: Psychotherapy With Individuals Week 10: Psychotherapy With Older Adults Case Study IDENTIFICATION: The patient is a 69-year-old, widowed African American male who is the father of one adult child and grandfather of six grandchildren. The patient is self-referred to a psychiatric outpatient clinic. CHIEF COMPLAINT: “I need help with depression and anxiety. HISTORY OF CHIEF COMPLAINT: The patient reports that his father is dying, and he has been experiencing worsening of depression and anxiety symptoms over the past few months. He is seeking a psychiatric evaluation at his son’s advice. The patient does not enjoy being with his family.Psychotherapy With Older Adults.

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He has difficulty falling asleep, but then spends the day lying on the couch and reports feeling like he is “moving in slow motion.” He reports feeling tired all the time. He has also stopped going to his volunteer job at the nursing home. He responded to the practitioner’s question of “why depressed now?” by saying that with the imminent death of his father, he is losing his main support. In addition to his father’s illness, the patient was diagnosed and treated for prostate cancer this year. He received psychotherapy at that time which focused on his anxiety about the diagnosis, his denial of its severity, his wish to “not know what he knew,” and, ultimately, end-of-life issues. PAST PSYCHIATRIC HISTORY: The patient was never hospitalized for psychiatric reasons. He has no history of suicidal thoughts, gestures, or attempts. The patient described either a partial or negative response from several medications he had been prescribed from his primary care provider (PCP) over the course of a several years, including Effexor, Prozac, Zoloft Lexapro and Duloxetine. He is currently prescribed Lorazeapm 1 mg BID by his PCP which he has been taking for several years. MEDICAL HISTORY: GERD, HTN and hyperlipidemia. History of prostate cancer.Psychotherapy With Older Adults. HISTORY OF DRUG OR ALCOHOL ABUSE: The patient denies history of drug and alcohol abuse. FAMILY PSYCHIATRIC HISTORY: Patient reports that his mother had depression. He is an only child and does not recall any emotional difficulties in grandparents or other relatives. Personal History Perinatal: No known perinatal complications. TRAUMA/ABUSE HISTORY: Denies Mental Status Examination Appearance: Well-groomed, appropriately dressed, older Gentleman who is obese Behavior and psychomotor activity: Good eye contact, pleasant, cooperative. Slightly unsteady gait uses walker. Consciousness: Alert and able to answer all questions appropriately. Orientation: Oriented to person, place, time, and situation. Memory: Intact. Good recent and remote memory. Concentration and attention: Appears to have good concentration during the interview but reports that he has recently had trouble concentrating while reading. Visuospatial ability: Not formally assessed. Abstract thought: Within normal limits, appropriate use of metaphors.Psychotherapy With Older Adults. Intellectual functioning: Patient has Masters degree Speech and language: Normal rate and rhythm. Perceptions: No abnormalities present. Thought processes: Goal directed, but evidence of guilt and rumination consistent with depressive symptomatology. Thought content: Patient is highly anxious and expresses thoughts of sadness, frustration. He is preoccupied with thoughts about the anticipated loss of his father. Mood: Depressed and anxious. Affect: Congruent with mood. Impulse control: Good. Judgment/insight/reliability: Good. Post a treatment plan for the older adult client in the Week 10: Case Study found in this week’s Learning Resources. Be sure to address the following in your post: Which diagnosis should be considered? What is the DSM-V Coding for the diagnosis you are considering? What is your rationale for the diagnosis? Be sure and link the client’s signs and symptoms to the DSM-V diagnostic criteria to support your diagnosis. What tests or tools should be considered to help identify the correct diagnosis? What differential diagnosis should be considered? What Treatment Strategy would you recommend? What treatment would you prescribe and what is the rationale? Safety Psychopharmacology Diagnostic Tests Psychotherapy Psychoeducation What standard guidelines would you use to treat or assess this patient? Clinical Note: Is depression a normal part of aging? References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.Psychotherapy With Older Adults.

Which diagnosis should be considered?

The diagnosis to be considered is major depressive disorder. This is because the patient presents several symptoms including depression and anxiety experiences for a few months’ insomnia, and fatigue.

What is the DSM-V Coding for the diagnosis you are considering?

Major Depressive Disorder is a diagnosis of DSM-5 assigned to people who lose interest or feel down in activities they initially used to enjoy(American Psychiatric Association., 2013). For a diagnosis to be made, this depressed feeling should happen every day for almost two weeks. An individual may experience decreased energy, loss of enthusiasm, weight fluctuations, sleep changes, suicidal thinking, and lack of concentration and avoid things beyond low or negative emotions.Psychotherapy With Older Adults.

What is your rationale for the diagnosis? Be sure and link the client’s signs and symptoms to the DSM-V diagnostic criteria to support your diagnosis.

For a diagnosis to be made for this disorder, the symptoms should be present in a period of two weeks. The symptoms include everyday depressed moods, diminished interest in activities, insomnia, fatigue and insomnia(American Psychiatric Association., 2013). The client in this case presents all this symptoms including difficulty in sleeping, losing interest in going to work and worsening depression and anxiety moods.The signs cause severe psychological suffering or disability in the emotional, educational or other essential functional regions. The episode is not ascribable to any substance’s physiological impacts or to another medical problem. Schizoaffective disorder, bipolar, schizophreniform condition, dissociative disorders, or other defined yet undefined continuum with schizophrenia and other psychotic conditions do not describe the frequency of the major depressive disorder further.Psychotherapy With Older Adults.

What tests or tools should be considered to help identify the correct diagnosis?

The tools to be used in identifying major depressive order include clinician-rated measure and self- report record (Kupfer et al., 2016). The Hospital Anxiety and Depression scale is greatly validated and investigated scale to be used for screening. tests or tools.Psychotherapy With Older Adults.

What differential diagnosis should be considered?

The differential diagnoses for major depressive disorder include bipolar disorder, hyperactivity disorder and adjustment disorder.

What Treatment Strategy would you recommend?

The treatment strategies for major depressive disorder involve administering pharmacological treatments, sequential treatments, combination treatments, and psychotherapy, switching and augmentation strategies (Wheeler, 2014).

What treatment would you prescribe and what is the rationale?

The treatments I will prescribe for the client is psychotherapy and antidepressants. A careful evaluation of risks is essential for individuals with major depressive disorder. The evaluation includes detailed inquiryon the intent, means, plans, suicidal thoughts and behaviors. It is also crucial to assess the clients’ level of nutrition, hydration and self-care. The Psychopharmacology of major depressive disorder involve administering glutamate modulating agents, immunomodulators and anti-inflammatories, Neurosteroids,and  anticholinergic muscarinic drugs.Psychotherapy With Older Adults.

The diagnostic tests for the major depressive disorder include physical examination which involves the doctor asking the client questions about his health including the pre-existing medical conditions (Craighead et al., 2015). Laboratory test should also be done for example conducting a blood test to test the functionality of the thyroid.Attachment-based psychotherapy promotes the value and acceptance of client-therapist partnerships. Researchers suggests that in combination with psychotherapeutic methods, the interaction between client and the therapist will create new mechanisms in the brain of clients that improve cognitive connectivity and healthy functioning. Psychoeducation is accepted as an integral aspect of effective care for people with a psychiatric illness, along with conventional medicine and counseling. It has been shown that psychoeducation decreases the risk of hospitalization and relapse of individuals with depression and reduces the stress on their caregivers.Psychotherapy With Older Adults.

What standard guidelines would you use to treat or assess this patient?

Pharmacotherapy, combined therapeutic interventions and psychotherapy, can be utilized in people with major depressive disorder without psychotic features; nevertheless, psychotherapy should not be used independently (Pan et al., 2017). Antidepressant and antipsychotic medications can be used in people with extreme disorder or psychotic characteristics.Psychotherapy With Older Adults.