A 38-year-old woman presents to the office with complaints of weight
loss, fatigue, and insomnia of 3-month duration. She reports that she has
been feeling gradually more tired and staying up late at night because
she cant sleep. She does not feel that she is doing as well in her occupation
as a secretary and states that she has trouble remembering things.
She does not go outdoors as much as she used to and cannot recall the
last time she went out with friends or enjoyed a social gathering. She
feels tired most of the week and states she feels that she wants to go to
sleep and frequently does not want to get out of bed. She denies any
recent medication, illicit drug, or alcohol use. She feels intense guilt
regarding past failed relationships because she perceives them as faults.
She states she has never thought of suicide, but has begun to feel increasingly
worthless.
Her vital signs and general physical examination are normal, although
she becomes tearful while talking. Her mental status examination is significant
for depressed mood, psychomotor retardation, and difficulty attending
to questions. Laboratory studies reveal a normal metabolic panel, normal
complete blood count, and normal thyroid functions.
What is the most likely diagnosis?
What is your next step?
What are important considerations and potential complications of
management?
Here i am going to attached 2 examples.
First example.
Mental illness is a health issue that has been on the rise in various countries and has called for the attention of different organizations to act promptly to provide long-lasting solutions to the issue. Mental disorders are of different types including anxiety, bipolar disorder, dementia, depression among others. The conditions affect peoples thinking capabilities, emotions and mood thus affecting their daily activities and relationships with their families and friends.
According to the case study provided, it is clear that the woman is suffering from mental illness by the name Major depressive disorder. This is because of the symptoms she has been showing including fatigue, insomnia, and weight loss. As well, the woman has been feeling tired all the time, performing poorly in her occupation and experiencing difficulties while trying to remember things. Also, she feels guilty, worthless and loves to stay alone at home instead of going out to socialize with her friends. Finally, she is very tearful while talking and experiences difficulties answering attending to various questions. All these symptoms are common signs of major depressive disorder because the patient meet the criteria (Otte et al., 2016)
The next step once the patient is diagnosed with depression is for her to work closely with a medical practitioner to identify the best treatment options. The treatment method can be either counseling, lifestyle modifications, drug therapy or electroconvulsive therapy depending on the severity of the condition. In our case, the woman should be involved in counseling sessions to help her understand her environment and improve her self-esteem. As well, she should be given some medication such as anti-depressants and frequently pay visits to a therapist to be checked for her progression. Moreover, she should be advised to at least change her lifestyle and surroundings so that she can relax somewhere away from the influencers (Goldney, Fisher, & Wilson, 2001). Furthermore, the woman should be encouraged to go for a walk or pay a visit to an orphanage instead of staying indoors throughout the day. This will be a good strategy to help her fight stress. Also, she can be advised to surround herself with good friends who have positive thinking so that they can support, encourage and help her recover. All these options will significantly help improve her insomnia and depression status.
There are various significant considerations that should be taken into account during the treatment period. When one is depressed, she may refuse to take the drugs or pay visits to the therapists as advised and this will, as a result, worsen her situation. The patient may suffer from social stigma which may make her tend to hide her condition or fail to follow the treatment procedure basically because of fearing what people and friends will say. It is therefore important to inform, encourage and follow the patient to ensure that she accepts her condition. In some cases, she may fail to trust the treatment recommended and as a result ignore them and thus it is completely vital to inform the patient on the importance of the medication. Last and not least, the woman may fail to adequately meet the financial requirements for the medication processes and this will mean that the woman will not get the proper treatment and as a result, her condition will worsen. In the worst cases, escalation of depression may make the woman have suicidal thoughts and also when patient is taking some antidepressants like tricycles need to be monitored for Suicide Risk. Interactions can occur between antidepressant and alcohol, foods, herbal medicine and another drugs like SSRIs (Selective Serotonin Reuptake Inhibitors) and MAO Inhibitors that together can develop the Serotonin Syndrome and hypertensive crisis. (Abuse, 2013).
Second example.
The 38 year old woman although denies any use of illicit drugs or alcohol, she is suffering from depression. Depression kick starts after a long period of sadness and feeling hopeless, as noted by Ng, How, and Ng (2016). Murphy and Peterson (2015) put forth that depressed people tend to have sleeping problems. In this case our patient explains that she had lack of sleep for 3 months, has trouble remembering things and has had a weight loss. The patient explains that she does not remember the last time she went out with friends. This explains why she stays indoors and does not engage herself to any social gatherings. The other reason why it can be argued that the client is depressed is attributable to guilt she faces due to past break ups. Al laboratory tests show normality but her mental examination shows depressed moods as she also answers questions while on tears (Kanter et al., 2008).
After diagnosis and establishing that the patient is suffering from depression, necessary considerations can be taken to help treat the patient. Ionescu, Rosenbaum, and Alpert (2015) perceive that medications such as antidepressants, antipsychotics and mood stabilizers can be prescribed for the patient with depression. Besides, therapy sessions or counseling can be arranged for easy and quick treatment.
Effective treatment for patients suffering from depression is important because the more the patient is depressed the more it is hard to treat them. Medication alone is not enough to treat and manage depression, according to Ionescu, Rosenbaum, and Alpert (2015). Combination of both medication and therapy should be the key consideration for the patients as it does not only quicken their treatment but also ensure the depression does not come back. Korczak together with Canadian Paediatric Society, Mental Health and Developmental Disabilities Committee (2015) warn that the major complications that should be taken care of are suicidal thoughts which tend to haunt them. Family and friends should be able to stay with the patient to avoid any feeling of unworthiness which might result to the suicidal thoughts.
