Objectives For Your Audience

• To diagnose mental health conditions and various ways of managing them across various ages.
• To ensure the audience understands the pharmacological and non-pharmacological approach for the treatment of psychiatric conditions.
• To differentiate between mental and physical health problems and their methods of assessment.
• What are the common mental conditions that affects individuals mostly?
• Which age group is affected most by mental health conditions?
• How many approaches are used in treating cognitive disorders?

Possible Discussion Questions/Prompts for Your Classmates to Respond To

Subjective:

CC (chief complaint): The client 51-year-old male states that, “Hopeless and depressed, I don’t know why I do live anymore”

HPI: Patient started giving away things from yesterday. Has a high risk for self-harm hence suicidal ideation?

Substance Current Use: Not known

Medical History:

• Current Medications:
• Allergies: Not known

• Furosemide 20mg Daily
• NP Thyroid 90mg Tablet Daily (On empty stomach)
• Omeprazole 40mg Daily
• Trazodone HCl 100mg Tablet Daily (at bedtime)
• Carvedilol 12.5mg Tablet BID (with food)
• Glipizide 5mg Tablet Daily (before breakfast)

• Reproductive Hx: Not known

• Pertinent past psychiatric: Not known
• Substance use: Not known
• Medical: Not known
• Social: Not known
• Family history: Mr. Render’s father committed suicide 20 year ago. He attempted to jump from his mother’s car to freeway in traffic

Objective:

• GENERAL: Patient is alert and oriented × 3. He reports weight loss.
• NEUROLOGIC: Patient indicates intactness in CNII-XII. He is well oriented to person, place and time. Confirms functioning of both upper and lower limbs. Bilateral UE/LE strength 5/5.
• HEENT: HEAD: Denies traumas or any abnormalities. Eye: Patient denies eye complications or discharge. Ear: Denies undergoing surgery or having ear discharge. Nose: Denies blockage or tenderness. THROAT: Denies swelling or hoarse throat.
• RESPIRATORY: No airway obstruction, coughing sputum or shortness of breath.
• CARDIOVASCULAR: No murmurs or gallop. Capillary refill <1.5 sec. SIS2, shifts in heart rates and rhythm.
• GASTROINTESTINAL: No enlargement of the bowel or bowel sounds present in all four quadrants upon auscultation.
• MUSCULOSKELETAL: No swelling on joints or movement challenges.
• SKIN: No jaundice, rashes or lesions.

Diagnostic results:

Assessment:

The patient is assessed based on his symptoms to identify the mental condition he is suffering from. The assessment is done through the help of mental health assessment and diagnostic tests.

Mental Status Examination:

Based on the DSM-V diagnostic criteria, the patient suffers from major depressive disorder since he presents with symptoms like suicidal ideations and feelings of hopelessness and tiredness. The patient was well-groomed during the interview session and looked older than his age. The patient seemed troubled and restless during the session. His voice is shaky, his speech is slurred, and he has difficulty maintaining eye contact. He complains of feeling life has no value and regrets because he was born. He complains that he has been losing weight since there has been poor dietary intake resulting from sadness.

Diagnostic Impression:

The main diagnosis is Major Depressive Disorder ICD 10 CM [F32. 9]. The client’s symptoms suggest MDD since he indicates suicidal ideations, feelings of sadness and hopelessness, having low energy, and experiencing weight loss. Based on the DSM-V diagnostic criteria, the client presents various symptoms that confirm MDD as the major diagnosis.

Differential Diagnosis

Bipolar disorder ICD-10 CM [F31.9]

Based on DSM-V diagnostic criteria, the mental disorder is characterized by extreme mood swings that include emotional highs and lows such as depression and manias. Individuals undergoing depression are often saddened and hopeless and may lose interest or pleasure in most activities (Hasin et 2018). They feel empty and worthless, and pessimistic about everything. The condition is ruled out since the individuals may experience episodes of mania despite having feelings of worthlessness or sadness (Fekadu, Shibeshi, and Engidawork, 2017).

Adjustment depressive Disorder ICD-10-CM [F43. 21]

Stressful events and feelings of hopelessness mark the mental condition. Based on the DSM –V diagnostic criteria, the clients with ADD manifest symptoms like sadness, loss of self-esteem, worry, low mood, and stress-related conditions that make individuals overwhelmed (Strain, 2018). The events may affect the normal activity or daily events of an individual. The disorder is different from MDD since it is associated with stressful life events and does not last for long. The ADD is ruled out since the individuals do not manifest with suicidal ideation.

Persistent Depressive Disorder ICD-10 [F33. 9]

The disorder is a continuous form of chronic depression which makes an individual lose interest in daily activities, feel hopeless, feel inadequate and have low self-esteem. The feelings last for years and may significantly interfere with an individual’s relationship, school, work, and daily activities. The condition is ruled out since the individuals do not present with suicidal ideation.

Case Formulation and Treatment Plan

Lab test

A test should be done to confirm the presence of any infection in the body that may lead to having caused the symptoms associated with the mental condition. The laboratory values were found normal hence the patient does not have any infection. However, he had a low urine output which is associated with the stressful situation he was going through.

Treatment Plan

The client is referred to a psychiatrist for counseling, a nurse for medication prescription, and a nutritionist to help with the dietary aspect. The providers have to consider the client's culture during the intervention process. The intervention will be on cognitive behavioral therapy, which will help shape his way of thinking. CBT has been effective for most clients with cognitive conditions, including those with depression symptoms (Cooney et al., 2018). The client also requires Zoloft 50mg daily to prevent the complications or progression of the symptoms (Wang et al., 2021). The drug is taken orally once daily, and the client has to hydrate himself adequately. Nutrition therapy is significant, especially intake of a high caloric diet to improve his weight and body mass index and facilitate the proper functioning of the body organs. The client has to avoid stress triggers like exposure to harmful things or events and avoid any negative self-destructing thoughts associated with suicide or self-harm. Therefore, the combination of the therapies is significant in normalizing brain changes associated with depression and improving the client's thoughts, thus resuming the normal life activities and having some hope in life.

Reflections:

In case of reassessing the patient, I would have conducted a further assessment on the allergy, medical history, family history, and substance and drug use history. Follow-up is significant, especially weekly through telehealth and physical visits to confirm his progress. The interventions were successful since the patient adhered to the therapy and medications given, which improved his condition. The client is followed up until he regains back to normal life with positive thoughts.