The most probable differential diagnosis in this case is a Major Depressive disorder.
Reason for this Decision
As stated by Remick (2012), the DSM-5 criteria for diagnosing a major depressive disorder should include: a patient presenting with 5 or more symptoms that meet the diagnostic criterion. They include: a depressed mood for most part of the day daily, displeasure on nearly all activities of the day, weight loss or weight gain, a slowdown of thoughts, loss of energy/fatigue, feelings of worthlessness, indecisiveness and a diminished ability to concentrate (Remick, 2012). Similarly, Stefanie presented with symptoms that match criterion 1, 5, 6 and 8, although they do not amount to five or more than 5 as expected. A young woman with Depression Essay
It is expected that Stefanie will be diagnosed with a major depressive disorder.
Difference between the Expected Outcome and the Actual Outcome
Stefanie presented with symptoms of both depression and hypomanic disorder. Stefanie presented with the following symptoms of depression. Criteria #1 where she had a depressed mood during most times of the day daily as indicated in the subjective data where she reportedly had feelings of sadness, hopelessness and emptiness. She also demonstrated criteria 6 of fatigue and loss of energy and criteria 8 of diminished ability to concentrate, think and to remain decisive.
At the same time, Stefanie had symptoms of increased goal-directed distractibility and activity but her levels of increased energy only lasted for 3 consecutive days rather than 4 days which do not meet the criteria for a hypomanic disorder. Therefore, basing on the fact that Stefanie presented with symptoms of both depression and hypomania but does not meet the DSM-5 criterion for either a hypomanic or major depressive disorder, and that the occurrence of these behaviors were neither influenced by an underlying illness or drug abuse (Perugia, Hantouchec & Vannucchia, (2017). She will therefore be diagnosed with a cyclothymic disorder whose criteria she fits best.
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Decision 2: Treatment Plan for Psychotherapy
The client will be scheduled for follow-up and psychotherapy every twelve weeks. More specifically, Stefanie will be started on Cognitive Behavioral therapy.
Reason for this decision
Psychotherapy will help to establish Stefanie’s symptoms on an ongoing basis progressively to determine whether they follow the same patterns as before when she initially presented to the clinic or they are gradually subsiding (Tomba, et al., 2016). Cognitive Behavioral therapy has proven to be the most efficient form of therapy sin the management of cyclothymic disorders as they help to decrease the frequency of depressive moods which result to descent behaviors such as social withdrawal.
With CBT, Stefanie can learn how to manage, change and challenge negative thoughts and to rectify behavioral patterns that are troublesome (Tomba, et al., 2016).
Difference between Expected Outcome and Actual Outcome
While assessing the general impact of the symptoms experienced by Stefanie to her overall physical and physiological and their impact on the life of Stefanie, CBT alone was not able to realize effective health outcomes. This called for the decision to include pharmacologic agents to the plan of treatment. A young woman with Depression Essay
Decision 3: Treatment Plan for Psychopharmacology
Therefore, I would start Stefanie on Depakote250mg orally thrice daily and Abilify 10mg orally daily for the first four weeks. Most mental health practitioners manage cyclothymic disorders with drugs used in the management of bipolar disorders since most clients who present with cyclothymic disorders are at very high risk of progressing to bipolar disorders (Perugia, Hantouchec & Vannucchia, 2017).
It is expected that the client will return to the clinic after four weeks for follow-up. With the combination of an antipsychotic and a mood stabilizer, it is also expected that she will have a mood that is more stable as compared to before (Perugia, Hantouchec & Vannucchia, 2017). She will be happier than before and with a significant reduction in the hypomanic episodes.
Difference between Expected Outcome and Actual Outcome
Stefanie returned to the psychiatric clinic with information that she stopped taking the medications after one week due to general fatigue and weight gain. Besides, she also complained about feelings of lightheadedness when moving from a sitting to a standing position which has actually subsided. The symptoms of lightheadedness that Stefanie might have experienced are similar to that of orthostatic hypotension which is common during the initiation of Abilify (Perugia, Hantouchec & Vannucchia, 2017). However, she will need encouragement with continuous monitoring where the current dose of 10mg orally daily will be maintained rather than increasing or discontinuing it.
Besides, it is necessary that Stefanie is educated that sedation and weight gain are transient side effects that are associated with Depakote which are likely to continue for the entire duration when she will be on treatment (Perugia, Hantouchec & Vannucchia, 2017). By decreasing the dosage, the side effects will be reduced and this is the best choice for this case. On the other hand, doubling the dosage will likely increase the side effects of weight gain and sedation. Therefore, the dosage of Depakote will be decreased to 125mg orally twice daily. A young woman with Depression Essay
How Ethical Decisions Might Impact the Treatment Plan and Communication with Clients and Their Family
The ethics of confidentiality and privacy requires that a mental health nurse protects a patient’s right to privacy by ensuring that, client medical information is not shared with other family members or friends without an informed consent. In cases where family support is necessary for decisions in treatment and follow-up, patient onset before disclosure of information must always prevail. Observing this ethical concern tends to encourage respect, communication and a therapeutic relation (Perugia, Hantouchec & Vannucchia, 2017). Besides, based on the ethics of autonomy, mental health nurses need to ensure that decisions on treatment meet the needs and will of a patient. There are instances where a patient may be mentally challenged to make informed choices which may require the intervention of a family member or healthcare provider (Perugia, Hantouchec & Vannucchia, 2017). However, mental health nurses are required to fully educate a patient when mentally stable and let them make their own decisions.
Perugia, G., Hantouchec, E., & Vannucchia, G. (2017). Diagnosis and treatment of cyclothymia: the “primacy” of temperament. Current neuropharmacology, 15(3), 372-379.
Remick A. R., (2012). Diagnosis and management of depression in primary care: a clinical update and review. Canadian Medical Association Journal, 167(11). 1253-1260.
Tomba, E., Tecuta, L., Guidi, J., Grandi, S., & Rafanelli, C. (2016). Demoralization and response to psychotherapy: A pilot study comparing the sequential combination of cognitive-behavioral therapy and well-being therapy with clinical management in cyclothymic disorder. Psychotherapy and psychosomatics, 85(1), 56-57. A young woman with Depression Essay
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