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Treatment for a Patient With a Common Condition

Essay Instructions:

Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs.
Case: An elderly widow who just lost her spouse.
Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications:
Metformin 500mg BID
Januvia 100mg daily
Losartan 100mg daily
HCTZ 25mg daily
Sertraline 100mg daily
Current weight: 88 kg
Current height: 64 inches
Temp: 98.6 degrees F
BP: 132/86
By Day 3 of Week 7
Post a response to each of the following:
List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.
Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.
List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.
List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?
Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.
Reading Resourses
Freudenreich, O., Goff, D. C., & Henderson, D. C. (2016). Antipsychotic drugs. In T. A. Stern, M. Favo, T. E. Wilens, & J. F. Rosenbaum. (Eds.), Massachusetts General Hospital psychopharmacology and neurotherapeutics (pp. 72–85). Elsevier.
American Psychiatric Association. (2019). Practice guideline for the treatment of patients with schizophrenia. https://www(dot)psychiatry(dot)org/File%20Library/Psychiatrists/Practice/Clinical%20Practice%20Guidelines/APA-Draft-Schizophrenia-Treatment-Guideline.pdf
Clozapine REMS. (2015). Clozapine REMS: The single shared system for clozapine. https://www(dot)clozapinerems(dot)com/CpmgClozapineUI/rems/pdf/resources/Clozapine_REMS_A_Guide_for_Healthcare_Providers.pdf
Funk, M. C., Beach, S. R., Bostwick, J. R., Celano, C. M., Hasnain, M., Pandurangi, A., Khandai, A., Taylor, A., Levenson, J. L., Riba, M., & Kovacs, R. J. (2018). Resource document on QTc prolongation and psychotropic medications. American Psychiatric Association. https://www(dot)psychiatry(dot)org/File%20Library/Psychiatrists/Directories/Library-and-Archive/resource_documents/Resource-Document-2018-QTc-Prolongation-and-Psychotropic-Med.pdf
Levenson, J. C., Kay, D. B., & Buysse, D. J. (2015). The pathophysiology of insomnia. Chest, 147(4), 1179–1192. https://www(dot)ncbi(dot)nlm(dot)nih(dot)gov/pmc/articles/PMC4388122/
NOTE: If you're using any resources that are outside these, please use the most recent within 5 years.
IBM Corporation. (2020). IBM Micromedex. https://www(dot)micromedexsolutions(dot)com/micromedex2/librarian/deeplinkaccess?source=deepLink&institution=SZMC%5ESZMC%5ET43537
amisulpride
aripiprazole
asenapine
brexpiprazole
cariprazine
chlorpromazine
clozapine
flupenthixol
fluphenazine
haloperidol
iloperidone
loxapine
lumateperone
lurasidone
olanzapine
paliperidone
perphenazine
pimavanserin
quetiapine
risperidone
sulpiride
thioridazine
thiothixene
trifluoperazine
ziprasidone

Essay Sample Content Preview:

Treatment for a Patient with a Common Condition
First Name, Middle Initials, Last Name
Institutional Affiliation
Course Number and Name
Professor's name
Date
Treatment for a patient with a common condition
Introduction
Grief is one of the causes of insomnia, especially with the loss of a close loved one. The patient has suffered significant loss from her husband's death, and it is manifesting through her insomnia. Below I give various steps to be taken throughout the treatment process, including therapy and drugs administered to the patient. The essay also includes a post-treatment section of questions to ensure the patient is on her way to recovery.
Diagnosis questions
* How is your weight management, diet, or eating habits?
* What part of the sleeping process are you having difficulty with (i.e., initiating or maintaining), and how is your sleep quality?
* How many times do you experience sleeping difficulty in a week?
In getting the patient's history, it is essential to identify other risk factors, such as the possible presence of major depressive disorder, that may also affect the patient's sleep quality CITATION Psynd \l 13321 (Psycom, n.d.). The effect is especially true in the patient's case because she suffered from losing a loved one ten months ago; this is the rationale for asking the first question. The last two questions are directed to the DSM-V criteria for an insomnia disorder (Glasheen, 2016; Levenson et al., 2016).
Questions for people close to the patient
The primary caregivers (i.e., children, grandchildren, or any guardian), particularly those who live with her, should be interviewed for a comprehensive patient assessment. The interview questions should be directed to the patient's quality of life and mental and emotional stability (Boelen & Lenferink, 2020). Some of the questions to be used are as follows: 1) Which changes from the patient's everyday activities have been evident since her husband died up to the present?; 2) How does the patient communicate or interact with other household members or friends outside the home?; 3) What are the evident changes with the patient's emotional and mental state (i.e., emotional lability, cognition).
Physical exams and diagnostic tests
General physical examination (PE) with emphasis on neurologic examination should be done on the patient. General PE is vital in understanding the patient's body physiology, especially because she takes many medications that may affect her sleep quality. Consequently, a careful neurologic assessment should be done to identify other risk factors associated with possible insomnia or depression CITATION Cha \l 13321 (Chawla, 2018).
The differential diagnosis for the patient
The following are the differential diagnosis for the patient: bereavement, major depressive disorder, insomnia disorder. The patient most likely has a major depressive disorder, although a thorough history taking is necessary to fulfill the DSM-V criteria. According to the patient, this is most likely because her depression had gotten worse since her husband's death ten months ago. Based on DSM-V, MDD can be diagnosed after two weeks of at least five of its primary symptoms, with one of these as loss of pleasure or...
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