Question

Case A: A 25 year old male patient came to the clinic with chief complain of depression and anger problem. Patient was reported to have mood swings with angry outburst. He has history of irritable temperament, substance abuse and anxiety. Reported occasional agitation, restlessness, poor concentration, passive suicide thoughts, zero sense of guilt with amotivation. He has difficulty delaying gratification, poor frustration tolerance.

Clinical Impressions: (Rationale for diagnosis and recommendations for services)

DSM-5 Diagnosis with list of diagnostic creterials:                                   

Recommendations:

Labs:

Psychiatric Medications:                                                                                                                                                                                          

Drug:                                            Dose/Schedule:                            Number/Refill:                                           Fact Sheet Given     Other

Rationale for each recommendation

Teaching

What would you include in a biopsychosocial treatment plan for the patient in addition to pharmacotherapy?

Answer 1

1 A typical depressive episode is characterized by the following features,which should last for atleast two weeks inorder to make a diagnosis.Depressed mood which is characterised by sadness of mood ,loss of pleasure in all activities.Depressive cognitions which is characterized by no hope in the future,suicidal thoughts characterised by ideas of hopelessness,helplessness,unreasonable guilt and self-blame over trivial matters in the past.Psychomotor activity in which psychomotor retardation is frequent and is evidenced by slowing of thought.Psychotic features are patients have delusions and hallucinations and are often mood congruent.

2 DSM 5 criteria for a major depressive episode are as follows.Five out of 9 symptoms in the same two week period.Each of these symptoms represents a change from previous functioning and needs to be present nearly everyday.such as depressed mood,loss of interest,change in weight,insomnia,psychomotor retardation,change in weight,insomnia,loss of energy,impaired concentration and suicidal ideation.

b.symptoms cause significant distress or impairement.

c Episodes is not attributable to a substance or medical condition/

d Episode is not better explained by a psychotic disorder

e there has never been a manic or hypomanic episode.

3 Pharmacotherapy

Antidepressants are the treatment of choice for a vast majority of depressive episodes.Antidepressants are highly lipophilic and protein-bound.it is primarily metabolized in liver Tab.Imipramine oral dosage is 75-300

4teaching plan are

• patients on MAOI should be warned against the danger of ingesting tyramine -rich foods which can result in hypertensive crisis.Some of these foods are beef,liver,chicken liver,fermented saucages and dried fish.
• Report promptly if occipital headache,nauseas,vomiting,or other unusual symptoms occur.
• Instruct the patient not to take any medication without prescription.
• Caution the patient to chage his position slowly to minimise orthostatic hypotension.
• Strict monitoring of vitals

4 Other than pharmacotherapy psychosocial treatment which include cognitive therapy,supportive psychotherapy,Group therapy,Family therapy and Behaviour therapy.

Electroconvulsive ECT is given in severe depression with suicidal risk and is one of the most common indication for ECT/

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