Adult/Geriatric Depression

Adult/Geriatric Depression

The client is a 70 year-old Hispanic American male who came to the United States when he was in high school with his father. His mother died back in Mexico when he was in school. He presents today to your office for an initial appointment for complaints of depression. The client was referred by his PCP after “routine” medical work-up to rule out an organic basis for his depression. He has no other health issues with the exception of some occasional back pain and “stiff” shoulders which he attributes to his current work as a laborer in a warehouse. Adult/Geriatric Depression

SUBJECTIVE

During today’s clinical interview, client reports that he always felt like an outsider as he was “teased” a lot for being “black” in high school. States that he had few friends, and basically kept to himself. He describes his home life as “good.” Stating “Dad did what he could for us, there were 8 of us.” He also reports a remarkably diminished interest in engaging in usual activities, states that he has gained 15 pounds in the last 2 months. He is also troubled with insomnia which began about 6 months ago, but have been progressively getting worse. He does report poor concentration which he reports is getting in “trouble” at work.

MENTAL STATUS EXAM

The client is alert, oriented to person, place, time, and event. He is casually dressed. Speech is clear, but soft. He does not readily make eye contact, but when he does, it is only for a few moments. He is endorsing feelings of depression. Affect is somewhat constricted, but improves as the clinical interview progresses. He denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment and insight appear grossly intact. He is currently denying suicidal or homicidal ideation. You administer the “Montgomery- Asberg Depression Rating Scale (MADRS)” and obtained a score of 51 (indicating severe depression). Adult/Geriatric Depression

RESOURCES

§ Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389

Decision Point One Begin zoloft 25 mg orally daily

RESULTS OF DECISION POINT ONE

 Client returns to clinic in four weeks

 Reports a 25% decrease in symptoms

 Client is concerned over the new onset of erectile dysfunction

Decision Point Two

Select what you should do next:

RESULTS OF DECISION POINT TWO

 Client returns to clinic in four weeks

 Client stated that depressive symptoms have decreased even more and his erectile dysfunction has abated

 Client reports that he has been feeling “jittery” and sometimes “nervous”

Decision Point Three

CHANGE WELLBUTRIN TO XL 150 MG ORALY DAILY IN AM

Guidance to Student You should be aware that Zoloft or Wellbutrin could be responsible for the client complaints of Jitteriness. This feeling is usually temporary with SSRIs, however. The cause of the client’s complaint of “jitteriness” is most likely related to the Wellbutrin immediate release. As a result, the most appropriate answer would be to change the Wellbutrin to an extended release formulation. It would not be appropriate to add Ativan as you should never add an additional medication to treat the side effect of another medication without first attempting to modify/change the medication causing the side effect.

The client is a 70 year-old Hispanic American male who came to the United States when he was in high school with his father. His mother died back in Mexico when he was in school. He presents today to your office for an initial appointment for complaints of depression. The client was referred by his PCP after “routine” medical work-up to rule out an organic basis for his depression. He has no other health issues with the exception of some occasional back pain and “stiff” shoulders which he attributes to his current work as a laborer in a warehouse. Adult/Geriatric Depression

SUBJECTIVE

During today’s clinical interview, client reports that he always felt like an outsider as he was “teased” a lot for being “black” in high school. States that he had few friends, and basically kept to himself. He describes his home life as “good.” Stating “Dad did what he could for us, there were 8 of us.” He also reports a remarkably diminished interest in engaging in usual activities, states that he has gained 15 pounds in the last 2 months. He is also troubled with insomnia which began about 6 months ago, but have been progressively getting worse. He does report poor concentration which he reports is getting in “trouble” at work.

ORDER A PLAGIARISM FREE PAPER NOW

MENTAL STATUS EXAM

The client is alert, oriented to person, place, time, and event. He is casually dressed. Speech is clear, but soft. He does not readily make eye contact, but when he does, it is only for a few moments. He is endorsing feelings of depression. Affect is somewhat constricted, but improves as the clinical interview progresses. He denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment and insight appear grossly intact. He is currently denying suicidal or homicidal ideation. You administer the “Montgomery- Asberg Depression Rating Scale (MADRS)” and obtained a score of 51 (indicating severe depression). Adult/Geriatric Depression

RESOURCES

§ Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389

Decision Point One Begin zoloft 25 mg orally daily

RESULTS OF DECISION POINT ONE

 Client returns to clinic in four weeks

 Reports a 25% decrease in symptoms

 Client is concerned over the new onset of erectile dysfunction

Decision Point Two

Select what you should do next:

RESULTS OF DECISION POINT TWO

 Client returns to clinic in four weeks

 Client stated that depressive symptoms have decreased even more and his erectile dysfunction has abated

 Client reports that he has been feeling “jittery” and sometimes “nervous”

Decision Point Three

CHANGE WELLBUTRIN TO XL 150 MG ORALY DAILY IN AM

Guidance to Student You should be aware that Zoloft or Wellbutrin could be responsible for the client complaints of Jitteriness. This feeling is usually temporary with SSRIs, however. The cause of the client’s complaint of “jitteriness” is most likely related to the Wellbutrin immediate release. As a result, the most appropriate answer would be to change the Wellbutrin to an extended release formulation. It would not be appropriate to add Ativan as you should never add an additional medication to treat the side effect of another medication without first attempting to modify/change the medication causing the side effect Adult/Geriatric Depression

Also check: Transforming Nursing And Healthcare Through Technology