Question

Case B: 27 year old Caucasian female came to the clinic with the chief complain “I have problem taking instructions from my supervisor.” She was first hospitalized at the age of 15 for ADHD, She is unable to keep friend because of intrusive behavior. Patient had presented in the past with alternative agitation and depression, has had two hospitalization for depression and is currently depressed with no interest in activity, have problem falling asleep, unable to think and has loss of energy. Patient denied suicidal ideation. She has thought blocking, easily distractible and disorganized. No history of drug abuse

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

Clinical Impressions: Unipolar depression

DSM-5 Diagnosis with list of diagnostic creterials: MAJOR DEPRESSIVE DISORDER

• Depressed with no interest in activity
• Problem falling asleep
• Unable to think
• Distractable
• Loss of energy
• Disorganised

Recommendations:

• Psychotherapy
• Selective serotonin reuptake inhibitors (SSRIs)
• Relaxation techniques
• Antipsychotics
• Vitamin supplements
• Acupuncture
• Yoga
• Stress reduction techniques

LABS:

• Complete blood count
• Throid function tests
• Electrolytes
• Blood urea nitrogen

RATIONALE FOR RECOMMENDATIONS;

Psychotherapy

1. To relieve symptoms,
2. Identify negative beliefs and behaviors and replace them with healthy, positive ones
3. Explore relationships and experiences, and develop positive interactions with others
4. Find better ways to cope and solve problems
5. Identify issues that contribute to your depression and change behaviors that make it worse

• Selective serotonin reuptake inhibitors (SSRIs)-Safer and generally cause fewer bothersome side effects than other types of antidepressants. SSRIs include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft) and vilazodone (Viibryd).
• Tricyclic antidepressants
• Relaxation techniques- For decreasing aggressiveness
• Antipsychotics
• Vitamin supplements-To provide energy
• Acupuncture-To relieve from tension
• Yoga-To relax
• Stress reduction techniques

Always treatment should be taken regularly.