Captain of Ship Depression Case study.
In 3–4 pages, write a treatment plan for your client in which you do the following:
• 1. Describe the HPI and clinical impression for the client.
• 2. Recommend psychopharmacologic treatments and describe specific and therapeutic endpoints for your psychopharmacologic agent. (This should relate to HPI and clinical impression.)Captain of Ship Depression Case study.
• 3. Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.
• 4. Identify medical management needs, including primary care needs, specific to this client.Captain of Ship Depression Case study.
• 5. Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client.
• 6. Recommend a plan for follow-up intensity and frequency and collaboration with other providers.Captain of Ship Depression Case study.
As nurse practitioners strive to achieve full-autonomous practice across the country, it should be noted that many states grant this ability to practice independently to psychiatric mental health nurse practitioners. To that end, you will be engaging in projects this semester that assume that you are practicing in a state that allows full-practice authority for NPs, meaning that the PMHNP may be the “captain of the ship” concerning caring for a patient population. The “captain of the ship” is the one who makes referrals to specialists, coordinates care for their patients/clients, and is responsible and accountable for patient/client outcomes overall. This is a decided change from a few decades ago when physicians were the “captain of the ship” and NPs played a peripheral role.
In this Assignment, you will become the “captain of the ship” as you provide treatment recommendations and identify medical management, community support resources, and follow-up plans for a client with a depression disorder.Captain of Ship Depression Case study.
Recommend psychopharmacologic treatments based on therapeutic endpoints for clients with depression disorders
Recommend psychotherapy based on therapeutic endpoints for clients with depression disorders
Identify medical management needs for clients with depression disorders
Identify community support resources for clients with depression disorders
Recommend follow-up plans for clients with depression disorders
To prepare for this Assignment:
Select an adult or older adult client with a depressive disorder you have seen in your practicum.Captain of Ship Depression Case study.
In 3–4 pages, write a treatment plan for your client in which you do the following:
APA 7 FORMAT
3 REFERENCES; NO OLDER THAN 2015
68 yoAfghanistanian retired female presented for initial patient evaluation as a transfer pt. Patient was last seen Dec. 2019 and left once the practice underwent a total transition of Telehealth appts only. She asserts her diagnosis was unspec. Depressive disorder and previously prescribed Risperdal 2mg BID and Lithium 300mg daily; last taken today.She was not exactly sure but thinks she was initially diagnosed ~4yrs ago. Patient states she fell into depression 3 years ago after a divorce and close of her business as a Daycare owner. Recently she was found trespassing outside her brother’s home and depression resurfaced. The brother was her only source of support. The has two adult sons who reside in California. She denies family Psychx and other medical hx includes Thyroid disease and NIDDM for which is prescribed Levothyroxine 100mcg daily and Metformin 1000mg BID. She denies any previous inpthx; no surgeries.Captain of Ship Depression Case study.
Patient does not smoke, nor use any other illicit substances. She sleeps
~8hrs/night. Denies any fluctuations in appetite and weight.
Depression is a major cause of disability that contributes to the global disease burden. Over the years, this prevalence has been increasing gradually, and currently, its lifetime prevalence in women ranges between 20-25% and 7-12% in men (Wang et al., 2017). As a fundamental determinant of the QoL that accounts for close to 50% of psychiatric visits and 10% of admissions to hospital. For both inpatients and outpatients, depression is associated with significant direct and indirect healthcare-related costs as it results in unemployment and loss of productivity (Wang et al., 2017). Knowledge of the clinical presentation, pathophysiology, and management of depression helps to inform efforts on prevention and management of depression among patients.Captain of Ship Depression Case study.
HPI and Clinical Impression
The patient is a 68-year-old Afghan retired female who was referred for an initial evaluation. Her last visit was in December 2019 after which she left immediately the practice transitioned to the use of Telehealth apps only. From her previous visit, she asserts that her diagnosis was unspecified depressive disorder. The doctor prescribed Risperdal 2mg BID and Lithium 300mg daily; last taken today. Although she was uncertain, her initial diagnosis was reportedly four years ago after a divorce and closure of her business as the owner of a daycare. Recently, she went into depression after she was found trespassing outside her brother’s home. Her brother was her only support system. She has two adult sons residing in California. She denied having a family psychiatric history. She has NIDDM, and thyroid disease for which she takes metformin 1000mg BID and levothyroxine 100mcg daily. She denies any previous histories of surgeries. She does not smoke or use any illicit drugs. She sleeps 8 hours every night and denies having any fluctuations in weight and appetite.Captain of Ship Depression Case study.
Psychopharmacologic Treatments with Therapeutic Endpoints
Based on the recommendations provided by the American Psychiatric Association on the management of depression, a PMHNP should initiate treatment if a patient’s symptoms cause distress or impair social and physical functioning. It further recommends that, for patients diagnosed with depression and initiated on treatment, PMHNPs should alter treatment if a patient does not respond adequately to pharmacotherapy within six to eight weeks. After obtaining the required therapeutic response, a PMHNP should continue with treatment for four to nine months for patients reporting with the first episode of major depression not linked with catastrophic outcomes or suicidality. However, for patients who have reportedly had two or more depressive episodes, a PMHNP should maintain a longer maintenance course of treatment.Captain of Ship Depression Case study.
Since the patient has an underlying history of NIDDM and thyroid disease, yet she exhibits good progress, she will continue therapy with Risperdal 2mg BID and Lithium 300mg daily that have a lower potential for precipitating diabetes. Risperdal is a typical antipsychotic that acts by reducing the serotonergic and dopaminergic pathways in the brain. In this case, Risperdal is an adjunct inhibits the reuptake of norepinephrine and serotonin to produce antidepressant effects. On the other hand, lithium, a mood stabilizer, is used to manage depression in patients who do not show improvement after using antidepressants. Its antidepressant effects are linked to its effect on glutamate receptors to increase the level of activity between cells at a healthy level and it helps to prevent suicide and suicidal thoughts in patients with depression (Abou-Saleh, Müller-Oerlinghausen & Coppen, 2017). She will however be educated on the side effects that she should watch for such as dizziness, drowsiness, and weight gain for Risperdal and increased urination, thirst, hand tremors, and vomiting for lithium.Captain of Ship Depression Case study.
Psychotherapy Choices with Therapeutic Endpoints
To achieve the best outcomes when managing patients with depression, Gautam et al (2020) recommend CBT as one of the most effective psychological interventions for managing depressive disorders. The researchers further highlight that, when used in combination with medications, there is a low relapse rate when compared to patients managed with drugs alone.Captain of Ship Depression Case study.
It will be appropriate to initiate individual CBT for this patient to enable her to establish a strong familial or social support system based on her advanced age. As highlighted by Gautam et al. (2020), CBT will help to modify any underlying beliefs or schemas that maintain the depression, address any psychosocial problems that may be contributing to her depressive symptoms (previous divorce and possible loneliness), it will also help to decrease the likelihood of recurrence and increase compliance to the prescribed medications. CBT will include regular planned outpatient sessions, each session lasting one hour based on her suitability.Captain of Ship Depression Case study.
Medical Management Needs Including Primary Care Needs.
The patient has an underlying diagnosis of NIDDM and thyroid disease for which she takes metformin 1000mg BID and levothyroxine 100mcg daily. Lithium increases the risk of goiter, hyper, and hypothyroidism. Besides, it also causes increased urination, thirst, and urination, which are symptoms of type, 2 DM. Both lithium and Risperdal tend to cause weight gain and this can increase the risk of resistance to insulin. One can easily mistake the symptoms of worsening thyroid disease or NIDDM for the side effects of lithium and Risperdal (Vancampfort et al. 2015). Therefore, it will be important to consult with the patient’s PCP for any concerns that might emerge about her management. This is the best strategy since her PCP can provide more insights on potential issues that might hinder the attainment of therapeutic goals. The PCP will have to order for thyroid function tests, monitor blood glucose, weight, and severity of the medication side effects. The PCP will also take steps to promote physical activity and prevent weight gain. As recommended by Vancampfort et al. (2015), this will also require collaboration between the diabetic and psychiatric teams to reduce the risk of treatment failure and resultant complications. The PCP will conduct regular assessments for cardiovascular risks such as hypertension and dyslipidemia and intervene appropriately.Captain of Ship Depression Case study.
Community Support Resources and Community Agencies
The patient is a retired Afghan aged 68 years old. She has two adult sons who reside in California and currently, she went into depression after she was found trespassing outside her brother’s home, who is presenting her only close support system. Based on her advanced age, she needs financial, social, and emotional support. With the help of a social worker, it will be beneficial to link her to a local community support group for elderly people. A community health worker will also help her to obtain financial support from her brother, sons, and social security services.Captain of Ship Depression Case study.
Plan for Follow-Up
In this follow-up visit, the patient will return to the clinic after two weeks. During this visit, the PMHNP will assess her psychiatric progress, compliance, and tolerance to the prescribed medications and suicidal risk. The initial visit will also help to determine the need for medication alterations, dose adjustments, and if the recommended therapy addresses the patient’s medical management and psychiatric needs. The patient will return for other subsequent visits in 4-week intervals.Captain of Ship Depression Case study.