NURS 6670 Week 2 Assignment Paper

NURS 6670 Week 2 Assignment Paper

NURS 6670 Week 2 Assignment Paper

Major Depressive Disorder Case Management Sample Paper

Ms. Christie was hospitalized last week due to chief complaints of hearing and seeing a staff who was asked to jump out of her window. She reports lacking enough night sleep and usually fears about the security of her household stuff and as result hoard them in the fridge to keep them secure. At work, she doesn’t talk frequently with colleagues appears withdrawn. She works as a clerk in the bank and is reported that she lost her previous job due to her inability to maintain proper personal hygiene. However, she is eating well. She was diagnosed with a major depressive disorder and was prescribed Zoloft 50mg daily and Wellbutrin 50mg PO BID. She sees a psychotherapist twice weekly and attends group therapy once a month. She is married with four children who are all grownups, alive, and well. NURS 6670 Week 2 Assignment Paper

Clinical impression

The presentation of Ms. Christie is consistent with a major depressive disorder. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides criteria for the diagnosis of a major depressive disorder. Disturbed sleep, diminished interest in daily activities, and inappropriate guilt are some of the symptoms that were used to diagnose her with a major depressive episode, F32.3 (American Psychiatric Association, 2013 NURS 6670 Week 2 Assignment Paper). She had psychotic features including active hallucinations. No anxiety symptoms were noted

Psychopharmacologic Treatments

Wellbutrin and Zoloft medications suit her well for now. However, a third medication to manage psychotic features such as visual and auditory hallucinations is needed. She would, therefore, be prescribed Abilify 2.5 mg daily as adjunctive treatment to her anti-depression regimen. However, she would need close monitoring as the drug combination of Abilify (Aripiprazole) and Wellbutrin (bupropion) due to the risk of seizures. The endpoints of this pharmacotherapy would be the elevation of mood, reduction in hallucinations, improved workplace concentration & agility, and reduction in the occurrence of inappropriate guilt. Reduction in hallucinations would reduce the severity of her major depression. Achievement of these endpoints would require adjunctive social support and psychotherapy. NURS 6670 Week 2 Assignment Paper

Recommended Psychotherapy

Cognitive-based therapy (CBT) and interpersonal therapy would be the best psychotherapy modalities for Ms. Christie. The two types of psychotherapy have been proven through evidence-based practice to be highly efficacious in the nonpharmacological management of depression in a major depressive disorder (Health Quality Ontario, 2017). Ms. Christie is already attending a group therapy session monthly and visits a psychotherapist twice a week. The best option for her psychotherapy would include structured group psychotherapy.

There is no other family member with a similar symptom but the inclusion of the family members in her care would be recommended. Group therapy offers more advantages to her psychotherapy because it would ensure improvement in communication skills at work and with family members (American Psychological Association, 2019 NURS 6670 Week 2 Assignment Paper). There would be improvements in self-acceptance and awareness that would increase the overall outcome of her psychotherapy. The endpoints of her psychotherapy would be to improve her social and personal interaction skills and ensure her participation in the care. Self-participation in care would provide more benefits to the overall therapy.

Medical Management Needs

The World Health Organization associates depression with several medical comorbidities such as cardiovascular diseases and the causal relationship can be vice versa (World Health Organization, 2020 NURS 6670 Week 2 Assignment Paper). Ms. Christie is at risk of the development of such comorbidities if not managed properly and in time. Currently, there are no medical management needs in Ms. Christie. Her physical health is gross normal with good eating habits but poor sleep. Management of her depression would possibly manage her sleep patterns and improve her general medical health.

Community Support Resources and Agencies

Ms. Christie has limited access to community support resources due to the current pandemic protocols. However, there exists a variety of online community support agencies that can aid Ms. Christie in supporting her care. Examples of such agencies include the National Alliance on Mental Illness (NAMI) and the Mental Health America (MHA) that are dedicated to supporting people with any degree and type of mental illness. These groups would provide her with the emotional support that she may require in conjunction with group therapy.

Follow-Up Plan

Ms. Christie would need a close follow-up for improvement every two weeks. Daily monitoring of adverse drug reactions and interactions would be highly indicated. The patient may not show improvement with the pharmacological regimen and would require dose readjustments or change or medications. The collaboration between her psychologist and her psychiatrist would be instrumental in the assessment of the efficacy of the treatment. The family involvement would be critical because they provide social support for the improvement of Ms. Christie’s condition

Conclusion

Ms. Christie has a severe major depressive disorder with psychiatric features which has impacted her work and social life. She is on antidepressants only would need an additional antipsychotic to manage her hallucinations. Therefore, close monitoring would be required alongside sustainable social and community support resources. The endpoints of her management would majorly include an improvement in social and work life, improvement of her depressed mood, and treatment of psychiatric symptoms. These would require a functional collaboration between the family members, her psychologist, and her psychiatrist.  NURS 6670 Week 2 Assignment Paper

NURS 6670 Week 2 Assignment Paper References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5 (R)) (5th ed.). American Psychiatric Association Publishing.

American Psychological Association. (2019). Psychotherapy: Understanding group therapy. Apa.Org. https://www.apa.org/topics/psychotherapy/group-therapy

Health Quality Ontario. (2017). Psychotherapy for major depressive disorder and generalized anxiety disorder: A health technology assessment. Ontario Health Technology Assessment Series, 17(15), 1–167. https://www.ncbi.nlm.nih.gov/pubmed/29213344

World Health Organization. (2020). Depression. Who.Int. https://www.who.int/news-room/fact-sheets/detail/depression

NURS 6670 Week 2 Assignment Paper Instructions