Summary of the Clinical Case
Helen is a 45-year-old patient of African American origin who, two months ago, separated from her husband of25 years. The husband’s extramarital relationship was the cause of the divorce. She resides with her fraternal twins, who are 18 years old, taking care of them and performing house chores. Helen has a part-time job at a neighborhood dry cleaner. She began to have anxiety, difficulty falling asleep, sad thoughts, and loss of appetite, which started three months ago. Nobody in her family has any mental health issues. She did, however, begin to experience unidentified lower extremity neuropathy.
Helen is dealing with a challenging time in her life when factors including divorce, financial support, and raising her children alone are precipitating factors to depression episodes. Over the past four weeks, she has been experiencing worsening symptoms that include sadness, low energy, a sense of worthlessness (she is beginning to believe that “life is not worth living”), and poor appetite, thus pointing at the major depressive disorder. The symptoms have been accompanied by insomnia, daytime fatigue, and anxiety over the past three months. The next issue Helen needs to address is an unknown cause of lower extremity neuropathy. The medical history revealed occasional, but not excessive, alcohol use once or twice a month. Chronic illnesses have not existed in the past.
What Is The DSM5 Diagnosis?
Major depressive disorder
Identify The Rationale For Your Diagnosis Using The Dsm5 Diagnostic Criteria.
A major depressive episode must last for at least two weeks, and typically, someone who has been diagnosed with one exhibits at least four of the symptoms listed below: altered appetite and weight, altered sleep and activity patterns, fatigue, feelings of guilt, difficulty thinking clearly and making decisions, and recurrent thoughts of suicide or death (Bains & Abdijadid, 2022). In this case, Helen started experiencing insomnia, increased anxiety levels, and daytime fatigue for the past three months. However, the symptoms have progressed for the last four weeks to increased sadness, guilt feelings, poor appetite, lack of energy, lack of interest in usual activities, and hopelessness.
Appropriate Pharmacological Treatment to Prescribe. Include The Medication Name, Dose, Frequency, And Rationale For This Treatment.
Selective serotonin re-uptake inhibitors, i.e., fluoxetine 20mg PO once daily for four weeks. SSRIs prevent serotonin re-uptake by inhibiting serotonin transporters (Bains & Abdijadid, 2022). Also, it is indicated for both depression and anxiety.
Appropriate Non-Pharmacological Treatment Would You Prescribe? (Exclude Psychotherapy Modalities) Include The Risk And Benefits Of The Chosen Rationale For This Treatment.
Acupuncture- Acupuncture is a form of ancient Chinese medicine whereby tiny needles are put into the skin at specific bodily locations (Armour et al., 2019). This is aimed at balancing the body’s energy flow and alleviating symptoms of various ailments, such as pain, insomnia, and episodes of depression.
Assessment of medication\’s appropriateness, cost, effectiveness, safety, and potential for patient adherence.
Describe any potential side effects, drug interactions, recommended dosages, and the optimum situations for taking the medication, such as fasting or meals to prevent any interactions or stomach irritations. It is crucial to ensure that the patient comprehends the explanation to reduce risks, prevent complications, and ultimately encourage adherence to the recommended course of action. Some of the ADRs of fluoxetine include nausea, agitation, drowsiness, headaches, and sexual dysfunction. Fluoxetine 20mg PO 30 capsules retail at 24$ in Wal-Mart, which is the cheapest (GoodRx, 2022). In most cases, medication cost is covered by insurance.
Armour, M., Smith, C. A., Wang, L.-Q., Naidoo, D., Yang, G.-Y., MacPherson, H., Lee, M. S., & Hay, P. (2019). Acupuncture for Depression: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine, 8(8), 1140. https://doi.org/10.3390/jcm8081140
Bains, N., & Abdijadid, S. (2022, June 1). Major Depressive Disorder. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559078/
GoodRx. (2022). Fluoxetine Prices, Coupons & Savings Tips. GoodRx. https://www.goodrx.com/fluoxetine
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