Depressive Disorder Assignment Essay
Assignment 1- “Captain of the Ship” Project – Depressive Disorder –WK2
As nurse practitioners strive to achieve full-autonomous practice across the country, it should be noted that many states grant this ability to practice independently to psychiatric mental health nurse practitioners. To that end, you will be engaging in projects this semester that assume that you are practicing in a state that allows full-practice authority for NPs, meaning that the PMHNP may be the “captain of the ship” concerning caring for a patient population. The “captain of the ship” is the one who makes referrals to specialists, coordinates care for their patients/clients, and is responsible and accountable for patient/client outcomes overall. This is a decided change from a few decades ago when physicians were the “captain of the ship” and NPs played a peripheral role.
In this Assignment, you will become the “captain of the ship” as you provide treatment recommendations and identify medical management, community support resources, and follow-up plans for a client with a depression disorder.Depressive Disorder Assignment Essay
Learning Objectives
Students will:
• Recommend psychopharmacology treatments based on therapeutic endpoints for clients with depression disorders
• Recommend psychotherapy based on therapeutic endpoints for clients with depression disorders
• Identify medical management needs for clients with depression disorders
• Identify community support resources for clients with depression disorders
• Recommend follow-up plans for clients with depression disorders
To prepare for this Assignment:
• Select an adult or older adult client with a depressive disorder you have seen in your practicum.
In 3–4 pages, write a treatment plan for your client in which you do the following:
• Describe the HPI and clinical impression for the client.
• Recommend psycho pharmacologic treatments and describe specific and therapeutic endpoints for your psycho pharmacologic agent. (This should relate to HPI and clinical impression.)
• Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.
• Identify medical management needs, including primary care needs, specific to this client.Depressive Disorder Assignment Essay
• Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client.
• Recommend a plan for follow-up intensity and frequency and collaboration with other providers.
History of Presenting Illness and Clinical Impression for the Client
A 28-year-old African American SK presented to the clinic with complaints of chronic fatigue and frequent headaches. She also reported disturbed sleep which forced her to wake up very early. SK described her headache as being dull, generalized and aching and had lasted for approximately two weeks before presentation. She also reported lacking interest in daily activities and how she frequently missed work due to inability to concentrate and generalized fatigue. Despite the fact that both her children were in school, she was concerned that she rarely spent quality time with them. Apart from losing appetite, SK noted that she had lost up to 10 pounds in a month. SK acknowledged to take ibuprofen for her headaches but denied using any drugs or alcohol.
The physical exam revealed an alert and a cooperative patient who neither had delusions nor hallucinations. She had logical and goal-oriented thoughts. During the interview, she could burst into tears and acknowledged to feel sad most of the times. She admitted the fact that her thoughts were often full of worries, being worthless and hopeless but denied suicidal ideation. The laboratory values were within the normal ranges. Based on the DSM for diagnosing mental health disorders, a clinical impression that was made for SK was major depressive disorder which is primarily characterized by sleep disturbance, lost interest in activities of daily life, excess worry, fatigue, loss of appetite, feelings of being worthless and hopeless for two weeks and inability to concentrate (Zimmerman et al., 2015).
Psychopharmacologic Treatments with Therapeutic Endpoints
Among patients with depressive disorders, recommendations for treatment are often made if a patient’s symptoms impair their physical and social functioning or lead to significant distress. SK reported that she missed a lot of days at work due to difficulty concentrating and that her relationship with her children was gradually being torn apart. This evidence reveals that her symptoms impaired her social functioning and occupational life. Therefore, she will be prescribed Zoloft, 50mg PO qDay. Zoloft, also known as sertraline is an antidepressant which belongs to the class of selective serotonin reuptake inhibitors. It acts by inhibiting the neuronal uptake of serotonin (Gautam, 2017). She will be informed to expect a number of side effects which are primarily side effects of antidepressants and SSRIs. In this case, the goal of pharmacotherapy will be to ensure that SK’s depressive symptoms which interfere with her social and occupational life are minimized.
Psychotherapy Choices and Therapeutic Endpoints
There is a lot of scientific evidence that supports the use of psychotherapy in the management of depressive disorders together with medications. Clearly, this client has a cognitive disturbance, high levels of social stress, affective disturbance and somatic manifestations whose likelihood is that they are related to her current depressed state (Zimmerman et al., 2015). Therefore, group cognitive behavioral therapy will be the most effective form of psychotherapy for the management of this client.Depressive Disorder Assignment Essay
Since CBT bases on principles which support the idea that changes in negative thinking patterns and a reduction in maladaptive behaviors are of significant benefits in improving the behavior and emotions of an individual, it is expected that the client will be able to develop more effective strategies of dealing with stressful situations (Powers & Smits, 2017). Group therapy will benefit the client further as a result of normalization, cohesion, being able to engage in behavioral experiments and learning from others within the group. The goal of group CBT in this case will be to influence positive change in SK’s behavior and ensure some improvement in the quality of her life. It should also be noted that the group psychotherapy sessions will be started and continuously managed by a therapist (Powers & Smits, 2017).
Medical Management Needs, Community Support Resources and Primary Care Needs
There will need to link with the primary healthcare provider of SK for frequents updates on her progress. In these consultations, there are baseline laboratory investigations that will be conducted such as complete blood count, liver profile, kidney function tests whose results will be discussed. Since SK will be prescribed zoloft, an antidepressant SSRI, it is expected that she will experience some side effects such as nausea, and dry mouth. Therefore, her primary care provider will be informed to frequently check her electrolytes. An EKG will also be done after starting the client on an SSRI since SSRIs can potentially increase the OT interval among healthy individuals (Gautam, 2017). To ensure that she gets the necessary support and resources within her community, she will be linked to her local groups such as the Depression and Bipolar Support Alliance (DBSA) or those sponsored by Mental Health America (Behler et al., 2017).
Follow-Up Plan and Collaboration with Other Providers
Initially, SK will be asked to return for follow-up after one week. The purpose of this follow-up visit will be to assess the efficiency, effectiveness, and tolerance of SK to zoloft. During this follow-up visit, her dosage will be adjusted and compliance to medication will also be assessed. After this visit, subsequent visits will be done after every 4 weeks. Psychotherapy will also be initiated the same week when medications will be started. Every week, the client’s primary care provider will monitor the client for any reports on suicidal ideations (Gautam, 2017).
References
Behler, J., Daniels, A., Scott, J., & Mehl-Madrona, L. (2017). Depression/Bipolar Peer Support Groups: Perceptions of Group Members about Effectiveness and Differences from Other Mental Health Services. The Qualitative Report, 22(1), 213-236.Depressive Disorder Assignment Essay
Gautam, S., Jain, A., Gautam, M., Vahia, V. N., & Grover, S. (2017). Clinical practice guidelines for the management of depression. Indian journal of psychiatry, 59(Suppl 1), S34.
Powers, M. B., & Smits, J. A. J. (2017). Core Mechanisms of Cognitive Behavioral Therapy for Anxiety and Depression: A Review. The Psychiatric clinics of North America, 40(4), 611-623.
Zimmerman, M., Ellison, W., Young, D., Chelminski, I., & Dalrymple, K. (2015). How many different ways do patients meet the diagnostic criteria for major depressive disorder?. Comprehensive Psychiatry, 56, 29-34.
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
- Chapter 8, “Mood Disorders” (pp. 347–386)
Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications.
- Chapter 12, “Psychotherapy of Mood Disorders”
- Chapter 14, “Pharmacological and Somatic Treatments for Major Depressive Disorder”
Note: You will access this textbook from the Walden Library databases.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
- “Depressive Disorders”
- Major Depressive Disorder
- Persistent Depressive Disorder (dysthymia)
- Premenstrual Dysphoric Disorder
- Substance/Medication-Induced Depressive Disorder
- Depressive Disorder Due to Another Medical Condition
- Other Specified Depressive Disorder
- Unspecified Depressive Disorder Depressive Disorder Assignment Essay
Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.
Note: All Stahl resources can be accessed through the Walden Library using the link below. This link will take you to a login page for the Walden Library. Once you log in to the library, the Stahl website will appear. http://ezp.waldenulibrary.org/login?url=http://stahlonline.cambridge.org/
To access information on specific medications, click on The Prescriber’s Guide, 5th Ed. tab on the Stahl Online website and select the appropriate medication.
| Depression | Premenstrual dysphoric disorder | Seasonal affective disorder (MDD with Seasonal Variation) | ||
| agomelatine amisulpride amitriptyline amoxapine amphetamine (d) amphetamine (d,l) aripiprazole (adjunct) asenapine atomoxetine bupropion buspirone (adjunct) citalopram clomipramine cyamemazine desipramine desvenlafaxine dothiepin paroxetine phenelzine protriptyline |
quetiapine (adjunct) reboxetine selegiline sertindole sertraline sulpiride tianeptine tranylcypromine triiodothyronine trazodone trimipramine venlafaxine vilazodone vortioxetine doxepin duloxetine escitalopram fluoxetine flupenthixol fluvoxamine |
iloperidone imipramine isocarboxazid ketamine lisdexamfetamine lithium (adjunct) l-methylfolate (adjunct) lofepramine lurasidone maprotiline methylphenidate (d) methylphenidate (d,l) mianserin milnacipran mirtazapine moclobemide modafinil (adjunct) nefazodone nortriptyline olanzapine |
citalopram desvenlafaxine escitalopram fluoxetine paroxetine sertraline venlafaxine |
bupropion |
Grieve, S. M., Korgaonkar, M. S., Koslow, S. H., Gordon, E., Williams, L. M. (2013). Widespread reductions in gray matter volume in depression. NeuroImage: Clinical, 3, 332-339. doi:10.1016/j.nicl.2013.08.016
Note: You will access this article from the Walden Library databases.
Lach, H. W., Chang, Y-P., & Edwards, D. (2010). Can older adults with dementia accurately report depression using brief forms? Reliability and validity of the Geriatric Depression Scale. Journal of Gerontological Nursing, 36(5), 30–37. doi:10.3928/00989134-20100303-01
Note: You will access this article from the Walden Library databases.
Steffens, D. C., McQuoid, D. R., & Potter, G. G. (2014). Amnestic mild cognitive impairment and incident dementia and Alzheimer’s disease in geriatric depression. International Psychogeriatrics, 26(12), 2029–2036. doi:10.1017/S1041610214001446 Depressive Disorder Assignment Essay
Note: You will access this article from the Walden Library databases.
Drug Enforcement Administration. (n.d.). Drug schedules. Retrieved June 14, 2016, from https://www.dea.gov/druginfo/ds.shtml
Required Media
Hagen, B. (Producer). (n.d.-b). Managing depression [Video file]. Mill Valley, CA: Psychotherapy.net.
Note: The approximate length of this media piece is 24 minutes. You will access this video through the Walden Library databases.
Optional Resources
Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications.
- Chapter 15, “Brain Stimulation Treatments for Mood Disorders”
Note: You will access this article from the Walden Library databases.
Ahern, E., & Semkovska, M. (2017). Cognitive functioning in the first-episode of major depressive disorder: A systematic review and meta-analysis. Neuropsychology, 31(1), 52–72. doi:10.1037/neu0000319
Note: You will access this article from the Walden Library databases.
Anderson, N. D., Damianakis, T., Kröger, E., Wagner, L. M., Dawson, D. R., Binns, M. A., . . . Cook, S. L. (2014). The benefits associated with volunteering among seniors: A critical review and recommendations for future research. Psychological Bulletin, 140(6), 1505–1533. doi:10.1037/a0037610
Note: You will access this article from the Walden Library databases.
Inoue, J., Hoshino, R., Nojima, H., Ishida, W., & Okamoto, N. (2016). Additional donepezil treatment for patients with geriatric depression who exhibit cognitive deficit during treatment for depression. Psychogeriatrics, 16(1), 54–61. doi:10.1111/psyg.12121
Note: You will access this article from the Walden Library databases.Depressive Disorder Assignment Essay
Sachs-Ericsson, N., Corsentino, E., Moxley, J., Hames, J. L., Rushing, N. C., Sawyer, K., . . . Steffens, D. C. (2013). A longitudinal study of differences in late- and early-onset geriatric depression: Depressive symptoms and psychosocial, cognitive, and neurological functioning. Aging & Mental Health, 17(1), 1–11. doi:10.1080/13607863.2012.717253
Note: You will access this article from the Walden Library databases.
Shallcross, A. J., Gross, J. J., Visvanathan, P. D., Kumar, N., Palfrey, A., Ford, B. Q., . . . Mauss, I. B. (2015). Relapse prevention in major depressive disorder: Mindfulness-based cognitive therapy versus an active control condition. Journal of Consulting and Clinical Psychology, 83(5), 964–975. doi:10.1037/ccp0000050
Note: You will access this article from the Walden Library databases.
Wanklyn, S. G., Pukay-Martin, N. D., Belus, J. M., St. Cyr, K., Girard, T. A., & Monson, C. M. (2016). Trauma types as differential predictors of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and their comorbidity. Canadian Journal of Behavioural Science / Revue Canadienne Des Sciences Du Comportement, 48(4), 296–305. doi:10.1037/cbs0000056
Note: You will access this article from the Walden Library databases.Depressive Disorder Assignment Essay