Describe the HPI and clinical impression for the client. Chose any depressed client scenario
Recommend psychopharmacologic treatments and describe specific and therapeutic endpoints for your psychopharmacologic agent. (This should relate to HPI and clinical impression.)
Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.
Identify medical management needs, including primary care needs, specific to this client.
Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client.
Recommend a plan for follow-up intensity and frequency and collaboration with other providers Nursing Depression Sample Research Paper.
Each question should be a paragraph
Depression is a mood disorder that is common but serious. It can be either a clinical depression or a major depressive disorder. The disease has severe symptoms that interfere with how a person think, feel and handle daily activities like working, eating or sleeping (Sherbourne et al, 2017). For a diagnosis of depression to be made, the symptoms must have persisted for at least two weeks. The paper will provide a depressed client scenario and a pharmacological therapy of choice. Additionally, it will offer psychotherapy choices, medical management needs, community support resources and a follow-up plan Nursing Depression Sample Research Paper.
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The scenario in place comprises a 21 years old patient who was diagnosed with depression in the year 2016. He was using Citalopram but he felt “flat” and stopped taking it. In the same year, he saw a therapist who treated anxiety and gave weekly counselling without medication. To take a break, the patient moved away from the counselling centre to live with his aunt where he stopped seeing a counsellor and taking medication. Currently, the patient is experiencing loss of enjoyment and interest in daily activities. At the same time, he has persistent sadness, hopeless moods, anxiety, irritability and nervousness. He sleeps well although he has experienced decreased energy and overtiredness in the past. In the past, he has experienced significant weight loss and over the past year, he has lost almost 20 pounds. The patient, however, denies difficulty in making decisions, remembering or concentrating. He also denies suicidal thoughts currently though he states the thoughts has crossed his mind in the past. He denies taking any medicine currently but insists that his homework cause anxiety sometimes.
To manage depressed clients, one can use selective serotonin reuptake inhibitors, atypical antidepressants, tricyclic antidepressants, serotonin/norepinephrine reuptake inhibitors, serotonin-dopamine activity modulators, St. John’s wort and monoamine oxidase inhibitors (Combs et al, 2014). For the scenario above, the best one to use is the SSRIs. These drugs happen to be lipophilic and by reducing the gastric motility they are able to control gastric emptying. The mode of action is through correction and modulation of neurotransmitters responsible for the change in thoughts, behaviour and mood. The general rules of using the drugs are beginning with half of the smallest dose in relation to size and age of the patient (Combs et al, 2014). For the case provided, the patient can be started with 25mg of Zoloft daily orally. The low dose is essential to test if the patient can withstand the side effects and at the same time maintain the drug therapeutic goals. Second decision entails an increase of the dosage to 50mg daily. The reason for the increase is to meet therapeutic expectations not met by the low dosage initially and still withstand the side effects. Lastly, the dosage should be maintained since the side effects are not visible and depression symptoms can be controlled, however, if the patient can withstand side effects of high dosage drugs, an increase is applicable for maximum efficiency (Combs et al, 2014).
The above treatment can be combined with a psychotherapy approach. Some of the efficacious and specific therapies include interpersonal psychotherapy, cognitive behaviour therapy, behavioural activation and problem-solving therapy (Cuijpers et al, 2014). The psychotherapy applicable for the scenario above is the cognitive behavioural therapy. Cognitive behavioural therapy focuses on teaching adolescents and young adults on various coping techniques to facilitate improvements in mood disorders and efficiently manage complicated situations. The method improves mood by moderating emotions, characters, behaviours and thoughts (Cuijpers et al, 2014). This is done through the process of problem identification, becoming aware of the thoughts and emotions, identifying negative and inaccurate thinking and reshaping the negative and inaccurate thoughts.
Looking at the scenario above, it’s a history of relapse and cessation of drug and counselling therapy. The medical management needs would follow the process outlined below. The patient should undergo comprehensive assessments by giving questionnaires, medical evaluation and drugs assessments (Arroll et al, 2016). An ongoing safety evaluation should also be in place to determine suicidal risk. The evaluation helps in identifying protective and risk factors. He should then be taken through a treatment goals setting. Since the basic need for the scenario above is getting rid of the symptoms, medications should be the best option. After establishing medication to use the patient should learn how to meet the goals. The patient should have good support network from family and friends or join national support groups. Additionally, he should have regular follow-up which should be spaced as the patient improve. He should also be given mood charts to help in making the decision on whether to change treatment or retain it (Arroll et al, 2016). The appointments given should be meaningful and referrals to a psychiatrist should be made if there is no response to the treatment Nursing Depression Sample Research Paper.
In terms of community resources and support, the patient should talk openly with family members and friends so that they can understand his treatment and support him in following given recommendations (Sherbourne et al, 2017). Religious organizations can also help especially from small groups’ pastors or rabbi. The client can also join online support groups like Mental Health America and American Psychiatric Association to get effective support and care.
For follow-up purposes, the patient should have two weeks continuous visits until a clear progress can be established. The short intervals are included because young adults who use antidepressants have a high likelihood of increased agitation. The agitation is linked to increased suicide risk (Roca et al, 2015). The visit should be 30 minutes long a common psychiatric practice. Collaboration should be made through referrals when treatment fails.
Arroll, B., Chin, W. Y., Martis, W., Goodyear-Smith, F., Mount, V., Kingsford, D., & MacGillivray, S. (2016). Antidepressants for treatment of depression in primary care: a systematic review and meta-analysis. Journal of Primary Health Care, 8(4), 325-334.
Combs, K., Smith, P. J., Sherwood, A., Hoffman, B., Carney, R. M., Freedland, K., & Blumenthal, J. A. (2014). Impact of sleep complaints and depression outcomes among participants in the standard medical intervention and long-term exercise study of exercise and pharmacotherapy for depression. The Journal of nervous and mental disease, 202(2), 167-171.
Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., Beekman, A. T., & Reynolds, C. F. (2014). Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta‐analysis. World Psychiatry, 13(1), 56-67.
Roca, M., Monzón, S., Vives, M., López-Navarro, E., Garcia-Toro, M., Vicens, C., & Gili, M. (2015). Cognitive function after clinical remission in patients with melancholic and non- melancholic depression: a 6 month follow-up study. Journal of affective disorders, 171, 85-92.
Sherbourne, C. D., Aoki, W., Belin, T. R., Bromley, E., Chung, B., Dixon, E., & Khodyakov, D. (2017). Comparative effectiveness of two models of depression services quality improvement in health and community sectors. Psychiatric services, 68(12), 1315-1320 Nursing Depression Sample Research Paper.
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