Question

Post a treatment plan for the older adult client in the Week 10: Case Study found in this week’s Learning Resources. Be sure to address the following in your post:

• Which diagnosis should be considered?
• What is the DSM-V Coding for the diagnosis you are considering?
• What is your rationale for the diagnosis? Be sure and link the client’s signs and symptoms to the DSM-V diagnostic criteria to support your diagnosis.
• What tests or tools should be considered to help identify the correct diagnosis?
• What differential diagnosis should be considered?
• What Treatment Strategy would you recommend?
• What treatment would you prescribe and what is the rationale?
• Safety
• Psychopharmacology
• Diagnostic Tests
• Psychotherapy
• Psychoeducation
• What standard guidelines would you use to treat or assess this patient?
• Clinical Note: Is depression a normal part of aging?

Support your approach with evidence-based literature.

NURS 6640: Psychotherapy with Individuals

Week 10: Case Study

IDENTIFICATION: The patient is a 69-year-old, widowed African American male who is the father of one adult child and grandfather of six grandchildren. The patient is self-referred to a psychiatric outpatient clinic.

CHIEF COMPLAINT: “I need help with depression and anxiety.

HISTORY OF CHIEF COMPLAINT: The patient reports that his father is dying, and he has been experiencing worsening of depression and anxiety symptoms over the past few months. He is seeking a psychiatric evaluation at his son’s advice. The patient does not enjoy being with his family.

He has difficulty falling asleep, but then spends the day lying on the couch and reports feeling like he is “moving in slow motion.” He reports feeling tired all the time. He has also stopped going to his volunteer job at the nursing home.

He responded to the practitioner’s question of “why depressed now?” by saying that with the imminent death of his father, he is losing his main support. In addition to his father’s illness, the patient was diagnosed and treated for prostate cancer this year. He received psychotherapy at that time which focused on his anxiety about the diagnosis, his denial of its severity, his wish to “not know what he knew,” and, ultimately, end-of-life issues.

PAST PSYCHIATRIC HISTORY: The patient was never hospitalized for psychiatric reasons. He has no history of suicidal thoughts, gestures, or attempts. The patient described either a partial or negative response from several medications he had been prescribed from his primary care provider (PCP) over the course of a several years, including Effexor, Prozac, Zoloft Lexapro and Duloxetine.

He is currently prescribed Lorazeapm 1 mg BID by his PCP which he has been taking for several years.

MEDICAL HISTORY: GERD, HTN and hyperlipidemia. History of prostate cancer.

HISTORY OF DRUG OR ALCOHOL ABUSE: The patient denies history of drug and alcohol abuse.

FAMILY PSYCHIATRIC HISTORY: Patient reports that his mother had depression. He is an only

Answer 1

#. The diagnosis to be considered is depression

#. The DSM-V Coding for the diagnosis is F 32. Major depressive disorder, single episode.

#. Rational for the diagnosis :-

According to the Fifth Edition of the Diagnostic and Statistical Manual of MentalDisorders (DSM‐5) ,five or more of the symptoms listed below must be present during the same 2‐week time period that represents changes in functioning. At least one symptom is either a depressed mood or loss of interest.

 Depressed mood most of the day nearly every day, as indicated in the subjective report or in observation made by others

 Markedly diminished interest in pleasure in all, or almost all, activities most of the day and nearly every day

 Significant weight loss when not dieting or weight gain, for example, more than 5 percent of body weight in a month or changes in appetite nearly every day

 Insomnia or hypersomnia nearly everyday

 Psychomotor agitation or retardation nearly every day

 Fatigue or loss of energy nearly every day

 Feelings of worthlessness or excessive or inappropriate guilt

 Diminished ability to think or concentrate, or indecisiveness nearly every day

 Recurrent thoughts of death

The patient has five sign and symptoms which comes under the criteria for depression .

#. The tool that should be considered to help identify the correct diagnosis :-