Week 3 Psychiatric Disorders and Screening Assignment

Week 3 Psychiatric Disorders and Screening Assignment

Psychiatric Disorders and Screening Sample

The most appropriate screening tools to use in assessing Patient K.F. are the PHQ-9 assessment, a self-reporting questionnaire used to assess depression symptoms, and the Generalized Anxiety Disorder Scale-7 (GAD-7), a self-rated scale that assesses the severity of excessive anxiety or worrying. My decision to select the PHQ-9 tool draws from the fact that it is the Gold Standard tool in assessing depression and can easily be used within a primary care setting (Levis, Benedetti, & Thombs, 2018 Week 3 Psychiatric Disorders and Screening Assignment). On the other hand, I have selected the GAD-7 tool primarily because it is easy to score and can equally be used within a primary care setting.

Week 3 Psychiatric Disorders and Screening Assignment

Based on the information provided, K.F. scores on the PHQ-9 scale are as follows: Little interest in pleasure – 3, feeling down and hopeless – 3, trouble falling asleep or staying asleep – 1, feeling tired and with little energy – 3, Poor or diminished appetite or overeating – 3, Feeling bad about oneself – unknown, trouble concentrating – 3, Slow speech, feeling fidgety or restless – unknown, thought of being better dead or of hurting self – unknown. Total PHQ-9 score for K.F. = 16, which translates to moderately severe depression. Note that the scale ranges from 0 = not at all to 3 = nearly every day, as experienced by the patient over the past 14 days.Week 3 Psychiatric Disorders and Screening Assignment

K.F. scores on the GAD-7 scale are as follows: feeling nervous or anxious – 0 (patient reports feeling the same 10 years ago), unable to stop or control worrying – 0, trouble relaxing – 0, restlessness to an extent one cannot stay still – 0, easily annoyed or irritable – 0, feeling afraid as if one might encounter an awful event – 0. Total GAD-7 score for K.F. = 0, which reflects zero of extremely mild anxiety. Note that the scoring ranges from 0-5 (Mild Anxiety), 6-10 (moderate anxiety), 11-15 (moderately severe anxiety) and 15-21 (severe anxiety) as experienced over the last 14 days. Week 3 Psychiatric Disorders and Screening Assignment

My next step when evaluating K.F. would be prescribing an antidepressant, specifically a selective serotonin reuptake inhibitor (SSRI) such as Lexapro. Lexapro achieves mental balance by increasing serotonin in the brain. Administer Lexapro (Escitalopram) 10mg, 1 tablet daily, taken orally, for 30 days. A patient on Lexapro may take 1-2 weeks, sometimes up to 4 or more weeks, before the full benefits begin to show.

However, one should consider changing prescription or resorting to higher dosage within the first 2 weeks of treatment for better efficacy (Johnson et al., 2017 Week 3: Psychiatric Disorders and Screening Assignment). The patient should continue taking the drug even when they begin to feel good before completing the dosage. Any missed dosage must be taken as soon as the patient remembers.

Week 3: Psychiatric Disorders and Screening Assignment References

Johnson, C. F., Williams, B., MacGillivray, S. A., Dougall, N. J., & Maxwell, M. (2017). ‘Doing the right thing’: factors influencing GP prescribing of antidepressants and prescribed doses. BMC Family Practice, 18(72), 6458. https://doi.org/10.1186/s12875-017-0643-z

Levis, B., Benedetti, A., & Thombs, B. D. (2019). Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ, (), l1476–. doi:10.1136/bmj.l1476. Week 3 Psychiatric Disorders and Screening Assignment

Week 3 Psychiatric Disorders and Screening Assignment Instructions and Case Study

The purpose of student discussions is to provide the opportunity for the application of depression and anxiety screening tools to a selected case-patient. Week 3 Psychiatric Disorders and Screening Assignment

Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:

Explain the purpose of two selected screening tools (CO7)
Interpret the scoring criteria of two selected screening tools (CO7)
Discuss the mechanism of action, side effects and expected onset of action for a selected medication (CO4)
Due Date:

The initial posting to the graded collaborative discussions is due by Wednesday, 11:59 p.m. MT.

Peer responses and responses to faculty must be posted prior to the week deadline of Sunday 11:59 MT.

A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0). Week 3 Psychiatric Disorders and Screening Assignment

Total Points Possible: 70
Requirements:
Anxiety and depression are the most common psychiatric problems you will encounter in your primary care practice.

Review this case study

HPI: KF, 56-year-old Caucasian female presents to office with complaints of “no energy and not wanting to go out.” These symptoms have been present for about 3 months and seem worse in the morning and improve slightly through the day. It is hard to get out of bed and get the day started because does not feel rested when she wakes up in the morning.  Week 3 Psychiatric Disorders and Screening Assignment

KF reports a \”loss of joy\”. States\” I really don\’t feel like going anywhere or doing anything\”.  She tries to do at least one social activity a week, but it can be really exhausting. Reports she also has difficulty completing projects for work, she cannot stay focused anymore. She reports not feeling hungry, so she is not eating regularly and has lost some weight.  KF has been a widow for 2 years. Her husband died unexpectedly, he had a MI.

She recently got a puppy, which she thought would help with the loneliness, but the care of the puppy seems overwhelming at times. Rest and exercise, specifically yoga and meditation seem to help her feel better. At this time, she does not want to do either, it seems like too much effort to get up and go. She has not tried any medications, prescribed or otherwise. She reports drinking a lot of coffee, but that does not seem to help with her energy levels.  Week 3: Psychiatric Disorders and Screening Assignment

Current medications: Excedrin PM about once a week when she can\’t sleep, seems to help a bit. NKDA.

PMH: no major illnesses. Immunizations up to date.

SH: widowed, employed full time as a consultant. Drinks 1 glass of wine almost every night. No tobacco use, no illicit drug use. Previously married 20 years ago while living in France, reports an abusive relationship. The French government gave custody of her son to the ex-husband. She returned to US without her son 10 years ago. She sees her son two times a year, they skype and text \”all the time\” but she misses him. Her son is now an adult and is considering moving to the US. Week 3 Psychiatric Disorders and Screening Assignment

FH: Parents are alive and well. Has one son, age 21, he is healthy but lives in France with his father.

ROS

CONSTITUTIONAL: reports weight loss of 4-5 pounds, no fever, chills, or weakness reported. Daily fatigue.

HEENT: Eyes: No visual loss, blurred vision, double vision or yellow sclera. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose or sore throat. Week 3 Psychiatric Disorders and Screening Assignment

CARDIOVASCULAR: No chest pain, chest pressure or chest discomfort. No palpitations or edema.

RESPIRATORY: No shortness of breath, cough or sputum.

GASTROINTESTINAL: Reports decreased appetite for about 3 months. No nausea, vomiting or diarrhea. No abdominal pain or blood.

NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control. Week 3 Psychiatric Disorders and Screening Assignment

GENITOURINARY: no burning on urination. Last menstrual period 4 years ago.

PSYCHIATRIC: No history of diagnosed depression or anxiety. Reports history of great anxiety due to verbal and concern for physical abuse, reports feeling very sad and anxious when divorcing and leaving her son in France. Did not seek treatment. She started to feel better after about 4 months. Week 3 Psychiatric Disorders and Screening Assignment

ENDOCRINOLOGIC: No reports of sweating, cold or heat intolerance. No polyuria or polydipsia

ALLERGIES: No history of asthma, hives, eczema or rhinitis.

Discussion Questions:

Research screening tools for depression and anxiety. Choose one screening tool for depression and one screening tool for anxiety that you feel are appropriate to screen KF.

Explain in detail why each screening tool was chosen. Include the purpose and time frame of each chosen tool.

Score KF using both of your chosen screening tools based on the information provided (not all data may be provided, those areas can be scored as not present). Pay close attention to the listed symptom time frame for your chosen assessment tool.  In your response include what questions could be scored, and your chosen score.  Interpret the score according to the screening tool scoring instructions. Assume that any question topics not mentioned are not a concern at this time. Week 3 Psychiatric Disorders and Screening Assignment

Identify your next step for evaluation and treatment for KF. Remember to consider both physical and mental health differential diagnoses when answering this question.   (2-3 sentences).

What medication or treatment is appropriate for KF based on her screening score today? Provide the rationale. Any medications should include the medication class, mechanism of action of the medication and why this medication is appropriate for KF. Include initial prescribing information. Week 3 Psychiatric Disorders and Screening Assignment

If the medication works as expected, when should KF expect to start feeling better?

DISCUSSION CONTENT

Category

Points

%

Description

Application of Course Knowledge

21

30

Initial discussion post includes the following:

1) two screening tools chosen- 1 for depression, one for anxiety

2) Student explains the rationale for both screening tool choices (2-3 sentences)

3) both screening tools are scored using provided case study information only AND scores are interpreted using tool scoring guidelines. Week 3 Psychiatric Disorders and Screening Assignment

4) Next steps for treatment includes physical health diagnoses and suggested necessary diagnostics

5) Medication choice is listed. Rationale includes medication class, mechanism of action and initial prescribing information and education to include side effects and when KF should notice efficacy.

Support from Evidence-Based Practice (EBP)

14

20

1. Discussion post is supported with appropriate, scholarly sources; AND

2. Sources are published within the last 5 years ; AND

3. Reference list is provided and in-text citations match; AND

4. Includes a minimum of one scholarly reference, textbook is not used

56

80%

Total CONTENT Points= 56 points

DISCUSSION FORMAT

Category

Points

%

Description

Organization

7

10

1) Discussion is presented in a logical format, AND

2) Responses are in sequence with the listed bullet points AND

3) The discussion response is understandable and easy to follow AND

4) All responses are relevant to the discussion  topic. Week 3: Psychiatric Disorders and Screening Assignment

Comments / Note