Analyze and apply critical thinking skills in the psychopathology of mental health patients and provide treatment and health promotion while applying evidence-based research.Scenario:
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. I 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.
Questions:
Remember to answer these questions from your textbooks and NP guidelines. At all times, explain your answers.
- Describe the presenting problems.
- Generate a primary and differential diagnosis using the DSM5 and ICD 10 codes.
- Formulate and prioritize a treatment plan.
- 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.
Describing the Presenting Problems:
Kel, a 42-year-old CPA, is experiencing a range of emotional, behavioral, and physical symptoms that indicate a potential mental health issue:
- Depressed Mood: Kel describes feeling sad and hopeless. She has lost interest in activities she used to enjoy, such as planning a yearly cruise trip.
- Fatigue and Lack of Energy: Kel struggles with daily tasks due to a lack of energy, which includes getting out of bed, preparing for work, and maintaining her appearance.
- Appetite and Weight Changes: She has experienced a significant weight loss of 15 pounds over the last 2 months due to a lack of appetite and primarily consuming crackers and canned soup.
- Social Withdrawal: Kel is isolating herself both at work and in her personal life. She avoids social interactions, ignores calls and emails from friends, and makes no effort to connect with coworkers and clients.
- Disorganization and Poor Concentration: Kel finds it overwhelming to complete tasks at work that she used to enjoy, such as filing taxes and writing reports. She feels disorganized and lacks concentration.
- Sleep Disturbances: Despite sleeping for many hours, Kel still reports feeling tired all the time. This suggests possible sleep disturbances.
- Neglected Self-Care: Kel’s appearance is unkempt, she wears drab and disheveled clothing, and she neglects personal hygiene.
Primary and Differential Diagnosis:
Based on the presenting problems, Kel may be experiencing a major depressive episode. Here are the primary and differential diagnoses:
Primary Diagnosis:
- Major Depressive Disorder (MDD) as per the DSM-5 criteria.
- DSM-5 Code: 296.22 (for a single major depressive episode)
Differential Diagnoses:
- Dysthymic Disorder (Persistent Depressive Disorder): This could be considered if Kel has experienced chronic low-level depressive symptoms for at least two years.
- Adjustment Disorder with Depressed Mood: If the symptoms are primarily related to a specific life stressor, this diagnosis could be considered.
- Bipolar Disorder: Although this scenario doesn’t mention manic or hypomanic episodes, it’s important to rule out bipolar disorder as mood disorders can sometimes involve manic or hypomanic phases.
Formulating a Treatment Plan:
The treatment plan for Kel should be comprehensive and evidence-based, considering the severity of her symptoms:
- Immediate Crisis Intervention: Given her significant weight loss and suicidal ideation (as discussed in the next question), Kel should be evaluated for hospitalization or intensive outpatient treatment if there is an immediate threat to her safety.
- Psychotherapy: Cognitive-Behavioral Therapy (CBT) or Interpersonal Therapy (IPT) can be effective in treating depression. Regular sessions with a qualified therapist should be initiated.
- Medication: Antidepressant medication, such as SSRIs (Selective Serotonin Reuptake Inhibitors), may be prescribed by a psychiatrist to help alleviate her depressive symptoms.
- Nutritional Assessment and Support: A nutritionist can evaluate Kel’s dietary habits and provide guidance on healthy eating to address her weight loss and lack of appetite.
- Sleep Evaluation: A sleep specialist should assess her sleep patterns and address any potential sleep disorders contributing to her fatigue.
- Social Support: Encourage Kel to reconnect with her sister Sue and other supportive friends and family members. Social support can be crucial in her recovery.
- Work Accommodations: Discuss potential accommodations at work, such as a reduced workload or flexible hours, to support her during treatment.
- Regular Follow-Up: Schedule regular follow-up appointments with her healthcare provider and therapist to monitor progress and adjust the treatment plan as needed.
Screening for Suicidal Ideation:
Given Kel’s statement of feeling “sad and hopeless,” along with her significant changes in appetite, weight loss, and loss of interest in life, it’s essential to assess her for suicidal ideation. Appropriate screening instruments include:
- PHQ-9 (Patient Health Questionnaire-9): This tool includes a question about suicidal ideation, allowing healthcare professionals to gauge the severity and immediacy of suicidal thoughts.
- Columbia-Suicide Severity Rating Scale (C-SSRS): This is a more comprehensive assessment tool specifically designed to assess suicidal ideation and behavior.
- Beck Scale for Suicidal Ideation (SSI): The SSI is a self-report questionnaire that provides insights into the presence and severity of suicidal thoughts.
In Kel’s case, given her expressed hopelessness and potential danger, a thorough assessment of her suicidal ideation is crucial for determining the appropriate level of intervention and care.
In summary, Kel’s presentation indicates a major depressive episode, and a comprehensive treatment plan involving therapy, medication, social support, and addressing physical symptoms is essential for her well-being. Additionally, thorough assessment of suicidal ideation is critical to ensure her safety.