Posted: August 14th, 2023

Understanding and Addressing Major Depressive Disorder

Subjective Objective
The client is a 25-year-old, Latino male referred by his primary care provider for a psychiatric Assessment at an outpatient clinic.
Client’s Chief Complaints:
“I think I might be depressed.”

History of Present Illness
The client reports increasing depressive symptoms with onset three months ago. He is experiencing stress related to unemployment, financial strain, and needing to sell his home quickly because he cannot afford the mortgage. He reports depressed mood, low energy, low motivation, anhedonia, poor concentration, loneliness, low self-esteem, hopelessness, and decreased appetite with 12 lb. weight loss over the past month. He reports difficulty falling and staying asleep due to anxiety and restlessness, difficulty making decisions, and self-isolation. He endorses stress related to the abovementioned stressors, as manifested by restlessness, worry, and muscle tension. He reports that his current mental state is impeding his ability to apply for new employment and prepare his home for the impending sale.
Past psychiatric history: no previous history; this is the client’s first contact with a mental health provider.
Past Medical History: none
Family History
• Father is alive and well.
• Mother is alive, has had depression “all her life”
• One brother, age 18, alive and well
Social History
• Lives alone
• single
• does not have any friends
• alcohol use 1-2 times/week.
• no marijuana or illicit drug use
• attended one year of college.
Trauma history: Client reports was bullied in middle school due to his poor grasp of the English language at that time. No reports of nightmares or flashbacks.
Review of Systems
• appetite diminished, weight loss 15 lbs
• sleeps 5-6 hours at night, difficulty falling asleep with frequent night waking.
• No headache
• No palpitations, tremors
Allergies: NKDA, allergic to grass, perennial trees, dust mites, and cockroaches. Physical Examination:
Height: 65″, weight: 205 lb.
General: Well-nourished male appears stated age
Mental status exam:
Appearance: appropriate dress for age and situation, well nourished, eye contact poor, slumped posture
Alertness and Orientation: alert, fully oriented to person‚ place‚ time‚ and situation,
Behavior: cooperative
Speech: soft, flat
Mood: depressed
Affect: constricted, congruent with stated mood
Thought Process: logical‚ linear
Thought content: Self-defeating thoughts endorses thoughts suggestive of low self-worth. No thoughts of suicide‚ self-harm‚ or passive death wish
Perceptions: No evidence of psychosis, not responding to internal stimuli.
Memory: Recent and remote WNL
Judgement/Insight: Insight is fair, Judgement is fair
Attention and observed intellectual functioning: Attention intact for the purpose of assessment. Able to follow questioning.
Fund of knowledge: Good general fund of knowledge and vocabulary
Musculoskeletal: normal gait

Primary diagnosis: Major Depressive Disorder, single episode, moderate with anxious distress (F32.1)

NR546 Wk5 case study. General Directions

Must be in APA format with at least 3 scholarly articles within the past 5 years.

Review the provided case study to complete this week’s discussion.

Include the following sections:

Application of Course Knowledge: Answer all questions/criteria with explanations and detail.
Select one drug to treat the diagnosis(es) or symptoms.
List medication class and mechanism of action for the chosen medication.
Write the prescription in prescription format.
Provide an evidence-based rationale for the selected medication using at least one scholarly reference. Textbooks may be used for additional references but are not the primary reference.
List any side effects or adverse effects associated with the medication.
Include any required diagnostic testing. State the time frame for this testing (testing is before medication initiation or q 3 months, etc.). Includes normal results range for any listed laboratory tests.
Provide a minimum of three appropriate medication-related teaching points for the client and/or family.
Integration of Evidence: Integrate relevant scholarly sources as defined by program expectations:
Cite a scholarly source in the initial post.
Cite a scholarly source in one faculty response post.
Cite a scholarly source in one peer post.
Accurately analyze, synthesize, and/or apply principles from evidence with no more than one short quote (15 words or less) for the week.
Include a minimum of two different scholarly sources per week. Cite all references and provide references for all citations.
Engagement in Meaningful Dialogue: Engage peers and faculty by asking questions, and offering new insights, applications, perspectives, information, or implications for practice.
Peer Response: Respond to at least one peer on a topic other than the initially assigned topic.
Faculty Response: Respond to at least one faculty post.
Communicate using respectful, collegial language and terminology appropriate to advanced nursing practice.
Professionalism in Communication: Communicate with minimal errors in English grammar, spelling, syntax, and punctuation.
Reference Citation: Use current APA format to format citations and references and is free of errors.
Wednesday Participation Requirement: Provide a substantive response to the graded discussion topic (not a response to a peer or faculty), by Wednesday, 11:59 p.m. MT of each week.
Total Participation Requirement: Provide at least three substantive posts (one to the initial question or topic, one to a student peer, and one to a faculty question) on two different days during the week.

Understanding and Addressing Major Depressive Disorder: A Case Study Analysis

Introduction:
In this article, we delve into the case study of a 25-year-old Latino male who has been referred for a psychiatric Assessment due to his self-identified concern of being depressed. The client’s chief complaints, history of present illness, family history, social history, and physical examination findings have been outlined. Furthermore, we will apply course knowledge to address this case study by discussing a suitable medication, its mechanism of action, prescription format, evidence-based rationale, potential side effects, required diagnostic testing, and medication-related teaching points.

Client’s Presentation:
The client’s chief complaints indicate a significant burden of depressive symptoms that emerged three months ago. The stressors in his life, including unemployment, financial difficulties, and the need to sell his home, are driving factors for his distress. The client’s self-reported symptoms encompass a spectrum of indicators including low mood, energy, motivation, anhedonia, concentration issues, loneliness, low self-esteem, hopelessness, and weight loss. Sleep disturbances, anxiety, and self-isolation compound his distress.

Diagnostic Consideration:
Based on the presented case study, the client meets the criteria for a diagnosis of Major Depressive Disorder (MDD), single episode, moderate with anxious distress (F32.1) according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).

Medication Selection and Rationale:
Considering the client’s diagnosis, a suitable medication option is a Selective Serotonin Reuptake Inhibitor (SSRI) such as Escitalopram. Escitalopram functions by inhibiting the reuptake of serotonin in the brain, thereby increasing serotonin levels and improving mood. This medication is a first-line treatment for MDD due to its efficacy and relatively favorable side effect profile.

Prescription Format:

Medication: Escitalopram
Dosage: 10 mg
Route: Oral
Frequency: Once daily
Duration: As directed by the healthcare provider
Evidence-Based Rationale:
A study by Cipriani et al. (2018) compared the efficacy of different antidepressants and found that Escitalopram had one of the highest response rates and was well-tolerated by patients. Its relatively fast onset of action and minimal drug interactions make it a suitable choice for the client’s condition.

Side Effects and Adverse Effects:
Common side effects of Escitalopram include nausea, insomnia, drowsiness, and sexual dysfunction. Adverse effects such as serotonin syndrome and hyponatremia are rare but should be monitored for.

Diagnostic Testing and Monitoring:
Before initiating Escitalopram, it’s advisable to conduct baseline liver function tests and an electrocardiogram (ECG) to assess the client’s cardiovascular health. Periodic follow-up visits are recommended to monitor symptom improvement, adverse effects, and overall treatment response.

Medication-Related Teaching Points:

Adherence: Emphasize the importance of taking the medication as prescribed and not discontinuing abruptly.
Side Effects: Educate the client about potential side effects and encourage open communication if they experience any discomfort.
Time Frame: Explain that it may take a few weeks for the medication to take full effect and encourage patience.
Avoid Alcohol: Advise against alcohol use due to potential interactions with the medication.
Conclusion:
This case study underscores the significance of a comprehensive assessment in understanding and treating Major Depressive Disorder. The selection of Escitalopram as a therapeutic intervention is well-supported by evidence and offers the potential to alleviate the client’s depressive symptoms and improve his overall quality of life.

References:

Cipriani, A., Furukawa, T. A., Salanti, G., Chaimani, A., Atkinson, L. Z., Ogawa, Y., … & Geddes, J. R. (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. The Lancet, 391(10128), 1357-1366.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). American Psychiatric Pub.
National Institute for Health and Care Excellence (NICE). (2019). Depression in adults: recognition and management. Clinical Guideline [CG90].
Gelenberg, A. J. (2019). Practice Guideline for the Treatment of Patients with Major Depressive Disorder. American Psychiatric Association Practice Guidelines.

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