Case Study: Kel

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Purpose:
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Questions:
Case Study: Kel
Analyze and apply critical thinking skills in the psychopathology of mental health patients and provide treatment and health promotion while applying evidence-based research.
Kel is a 42-year-old certified public accountant (CPA) who dreams each year that she will board a cruise ship the day after Tax Day and go somewhere, anywhere,
except Portsmouth, Virginia. Each year the dream, like the ocean, ebbs and flows, but this year she is not even going to think about such a “ridiculous idea. in fact, she does not
even have the energy to dream: getting out of bed and preparing to go to work is simply too labor intensive.
Each evening Kel retires to bed with a lack of energy to complete her normal tasks such as readying her clothes for work and making a lunch. She lacks the energy to shop in the
evening: consequently, she eats mostly crackers and canned soup. She is not hungry, and her scale reflects this. She has lost 15 pounds over the last 2 months. She does not
attend to her makeup or clothes; she finds both too taxing. The clothes she selects are drab and not ironed. At work she makes no effort to talk with her co-workers and does not
initiate new contacts with clients. The normal work of filing taxes and writing reports, which she used to enjoy, are overwhelming, and she feels too disorganized to complete
them. Telephone calls and e-mail messages from friends are ignored. Attendance at work is spotty,
Sue, her sister, becomes alarmed with Kel’s unanswered telephone calls and e-mails. Worried. she decides to visit her sister at home. She finds the apartment unclean and in
disarray. Kel is unkempt, disheveled, and looks sad. Her voice is monotone and flat. Kel tells Sue that she feels “sad and hopeless. Nothing is ever going to change. l am a bad
person and I can’t even do my work right. Although I sleep for many hours, I am still tired all the time. Sue is alarmed at the changes in her sister and arranges for Kel to visit a
health care worker at the medical clinic.
Remember to answer these questions from your textbooks and NP guidelines, At all times, explain your answers.
1 Describe the presenting problems.
2 Generate a primary and differential diagnosis using the DSM5 and ICD 10 codes.
3. Formulate and prioritize a treatment plan.
4 identify and discuss appropriate screening instruments for a patient who has suicidal ideation.
Submission Instructions.
•Your initial post should be at least 500 words. formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.

Case Study: Kel

Case Study: Kel

Presenting Problems

Kel, a 42-year-old certified public accountant, presents with several concerning symptoms indicative of a significant decline in her mental health. Over the past two months, Kel has experienced:

  • Marked anhedonia: She no longer dreams about taking a cruise after Tax Day, which used to be a source of joy and anticipation for her.
  • Severe fatigue: Simple tasks such as getting out of bed, preparing for work, and engaging in social interactions feel labor-intensive.
  • Drastic changes in daily routines: She does not prepare her clothes or meals, relying on crackers and canned soup, and has lost 15 pounds.
  • Neglect of personal hygiene and appearance: She does not wear makeup, chooses drab and unironed clothes, and appears unkempt and disheveled.
  • Social withdrawal: She avoids interaction with co-workers and friends, ignores emails and calls, and shows no interest in forming new contacts.
  • Work impairment: She feels disorganized, overwhelmed, and unable to complete her usual work tasks.
  • Depressive symptoms: Kel expresses feelings of sadness, hopelessness, and self-deprecation. Her voice is monotone and flat, and she reports feeling perpetually tired despite sleeping for many hours.

Primary and Differential Diagnosis

Primary Diagnosis

Based on the DSM-5 criteria, the primary diagnosis for Kel is Major Depressive Disorder (MDD), Severe, without psychotic features. The ICD-10 code for this diagnosis is F32.2.

  • DSM-5 Criteria for Major Depressive Disorder:
    • Depressed mood most of the day, nearly every day.
    • Markedly diminished interest or pleasure in all, or almost all, activities most of the day.
    • Significant weight loss or decrease in appetite.
    • Insomnia or hypersomnia nearly every day.
    • Fatigue or loss of energy nearly every day.
    • Feelings of worthlessness or excessive guilt.
    • Diminished ability to think or concentrate.
    • Recurrent thoughts of death or suicidal ideation.

Kel exhibits most of these symptoms, warranting the diagnosis of MDD.

Differential Diagnoses

  1. Persistent Depressive Disorder (Dysthymia) (ICD-10: F34.1)
    • Although Kel’s symptoms are severe and recent, Persistent Depressive Disorder typically involves a longer duration of milder symptoms. This is less likely but could be considered if her symptoms persist beyond two years.
  2. Bipolar II Disorder (ICD-10: F31.81)
    • Bipolar II Disorder includes periods of hypomania and major depressive episodes. If Kel has a history of hypomanic episodes, this diagnosis might be considered.
  3. Generalized Anxiety Disorder (ICD-10: F41.1)
    • Kel’s symptoms of fatigue, sleep disturbance, and concentration difficulties might overlap with anxiety disorders, although her predominant mood is depressed.

Treatment Plan

  1. Pharmacotherapy:
    • Initiate an antidepressant such as an SSRI (e.g., Sertraline) or an SNRI (e.g., Venlafaxine). These are first-line treatments for Major Depressive Disorder.
    • Consider augmentation with atypical antipsychotics (e.g., Aripiprazole) if no response is observed.
  2. Psychotherapy:
    • Cognitive Behavioral Therapy (CBT) to address negative thought patterns and improve coping mechanisms.
    • Interpersonal Therapy (IPT) to focus on improving Kel’s interpersonal functioning and relationships.
  3. Lifestyle Modifications:
    • Encourage regular physical activity and a healthy diet.
    • Establish a consistent sleep routine to improve sleep hygiene.
  4. Social Support:
    • Facilitate connection with support groups or community resources.
    • Engage family members in Kel’s treatment plan for additional support and monitoring.

Screening Instruments for Suicidal Ideation

For a patient with suicidal ideation, appropriate screening instruments include:

  1. Columbia-Suicide Severity Rating Scale (C-SSRS):
    • This tool helps to identify the severity and immediacy of suicidal ideation and behavior, aiding in the assessment of suicide risk.
  2. Patient Health Questionnaire-9 (PHQ-9):
    • Item 9 of the PHQ-9 specifically inquires about suicidal thoughts, making it a useful screening tool for identifying patients at risk of suicide.
  3. Beck Scale for Suicide Ideation (BSS):
    • This tool assesses the presence and intensity of suicidal ideation.

Using these instruments, healthcare providers can systematically assess and address Kel’s risk of suicide, ensuring timely and appropriate interventions.

Conclusion

Kel’s symptoms are consistent with Major Depressive Disorder, Severe, without psychotic features. A comprehensive treatment plan including pharmacotherapy, psychotherapy, lifestyle modifications, and social support is crucial for her recovery. Screening instruments like the C-SSRS, PHQ-9, and BSS will be instrumental in monitoring and addressing any suicidal ideation.

References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
  • Sadock, B. J., Sadock, V. A., & Ruiz, P. (2017). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (12th ed.). Wolters Kluwer.
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