Question

Mr. Prichep, 67, and his wife have come to the clinic for a consultation. "It's her idea, not mine," he says. He glares at you like it's your fault too, this meeting. As Mrs. Prichep begins to talk, you learn that Mr. Prichep recently suffered a myocardial infarction one day in his antiques shop and missed work for about 2 weeks. He was eager to get back to work, but his wife, who runs the shop with him, and their two employees have both seen some changes that concern them since he's come back. "It's true, he likes his cocktails," his wife says. She smiles at him and takes his hand. He stares at her but stays quiet. "He usually insists that we have a little 'happy hour' in the shop after closing, just the two of us, after everyone else has gone. But that's all. He really doesn't drink much more than that, but now sometimes he acts like he's drunk. Our employees see it too. Something's different." When pressed for more details, Mr. Prichep gets angry and defensive, arguing with his wife's perceptions. She shares that Mr. Prichep has trouble sleeping at night. At work he has lapses in judgment, which has caused a few breakages, and forgets things he's just been told. Used to doing his own bookkeeping, Mr. Prichep now seems to lose his concentration. "I walked in while he was supposedly doing the books one afternoon, to find he was just staring. I said, 'Honey, what are you doing?' And he looked at me, bewildered, and said, 'What am I supposed to do now? I just can't think.' He becomes discouraged easily and seems sad," she says. "And his sadness is the hardest part for me. I wouldn't mind the rest."

1. Identify at least three possible causes, besides aging, that may be contributing to Mr. Prichep's symptoms.

2. Mr. Prichep is diagnosed with depression, but with new signs of cognitive impairment. Mr. Prichep asks, "I'm depressed because of the heart attack and how vulnerable it's made me feel. Plus I feel old and fumbling. If my depression is cured, do you think I can get rid of my 'mind problems'?" How will you answer Mr. Prichep?

3. It is believed, at this point, that Mr. Prichep's dementia is related more to depression, brought on by altered physical condition as a result of the myocardial infarction, rather than being caused by any physical damage to the brain from the infarction itself. Nor is it caused by alcohol abuse. As you begin collaborating with Mr. Prichep's doctor on a treatment plan, what will you include in an education plan for Mrs. Prichep, who is his primary caretaker.

Answer 1

1) Three possible causes, besides aging, that may be contributing to Mr. Prichep's symptoms are :-

- not able to work as before

- feeling vulnerable

- episode of Myocardial infarction

2) Yes , ofcourse you can get rid of mind problems if your depression is cured . It's just you are feeling afraid of about the future, what will happen if I get bed ridden and all due to heart attack . The continuous thinking about the episode of Myocardial infarction has lead to the mind problems . Once this is resolved you will be out of depression and hence the mind problems .

3) As we got to know that dementia is present as a part of his depression so I included the following in the care plan to avoid complications associated with Dementia :-

- don't leave the patient alone

- don't give any high risk tasks to him

- one person should be always with him

- place all articles needed by him nearby him

- use of methods to sharpen memory

- let him be independent but be there to assist him in need to maut his self esteem