: 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
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.
Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
- Chapter 7, “Antidepressants”
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.
Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.
Review the following medications:
- amitriptyline
- bupropion
- citalopram
- clomipramine
- desipramine
- desvenlafaxine
- doxepin
- duloxetine
- escitalopram
- fluoxetine
- fluvoxamine
- imipramine
- ketamine
- mirtazapine
- nortriptyline
- paroxetine
- selegiline
- sertraline
- trazodone
- venlafaxine
- vilazodone
- vortioxetine
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Note: Retrieved from Walden Library databases.
Howland, R. H. (2008a). Sequenced treatment alternatives to relieve depression (STAR*D). Part 1: Study design. Journal of Psychosocial Nursing and Mental Health Services, 46(9), 21–24. doi:10.3928/02793695-20080901-06
Note: Retrieved from Walden Library databases.
Howland, R. H. (2008a). Sequenced treatment alternatives to relieve depression (STAR*D). Part 2: Study outcomes. Journal of Psychosocial Nursing and Mental Health Services, 46(19), 21–24. doi:10.3928/02793695-20081001-05
Note: Retrieved from Walden Library databases.
To prepare for this Discussion:
Note: By Day 1 of this week, your Instructor will have assigned you to one of the following case studies to review for this Discussion. To access the following case studies, click on the Case Studies tab on the Stahl Online website and select the appropriate volume and case number
Case 2: Volume 1, Case #7: The case of physician do not heal thyself
- Review this week’s Learning Resources and reflect on the insights they provide.
- Go to the Stahl Online website and examine the case study you were assigned.
- Take the pretest for the case study.
- Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office.
- Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).
- Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.
- Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.
- Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.
- Review the posttest for the case study.
By Day 3
Post a response to the following:
- Provide the case number in the subject line of the Discussion thread.
- List three questions you might ask the patient if he or 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 physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.
- List three differential diagnoses 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?
- If your assigned case includes “check points” (i.e., follow-up data at week 4, 8, 12, etc.), indicate any therapeutic changes that you might make based on the data provided.
- Explain “lessons learned” from this case study, including how you might apply this case to your own practice when providing care to patients with similar clinical presentations
Expert Solution Preview
Answer:
Subject: Case Study #7: The Case of Physician Do Not Heal Thyself
1. Three questions that might be asked to the patient if he or she were in the office are:
– How long have you been experiencing the symptoms of depression?
– Have you ever received any treatment for depression in the past? If yes, what was the outcome of the treatment?
– Do you have any past medical or psychiatric history that might be relevant to the current symptoms?
These questions would help in assessing the severity and duration of depression, previous treatment modalities tried, and identifying any comorbidities or psychosocial stressors that might be contributing to the current presentation.
2. People in the patient’s life that need to be spoken to or get feedback from would be:
– Family Members
– Friends/Coworkers
– Primary Care Physician
– Therapist/Counselor
Questions that might be asked to these people include:
– What changes have you noticed in the patient’s behavior or mood lately?
– Has the patient talked to you about any problems that are causing distress?
– Does the patient have any history of substance abuse?
Speaking to these individuals would provide valuable insights into the patient’s functioning, interpersonal relationships, and social support network that could help in developing a comprehensive treatment plan.
3. The physical exams and diagnostic tests that would be appropriate for the patient would include:
– Complete blood count (CBC)
– Thyroid function test
– Liver function test
– Electrocardiogram (ECG)
These tests would help in ruling out any underlying medical conditions that could be contributing to or mimicking the symptoms of depression.
4. Differential diagnoses for the patient could include:
– Major Depressive Disorder
– Adjustment Disorder with depressed mood
– Bipolar Disorder
The most likely diagnosis in this case would be Major Depressive Disorder, given the severity and duration of the symptoms.
5. Pharmacologic agents and their dosing that could be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics include:
– Escitalopram (10-20 mg/day)
– Venlafaxine (75-150 mg/day)
Escitalopram is a selective serotonin reuptake inhibitor (SSRI) that increases serotonin levels in the brain, while Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI) that increases both serotonin and norepinephrine levels. The choice between these two agents would depend on the patient’s comorbid conditions, medication history, and potential side effects.
6. Contraindication/alteration in dosing that may need to be considered based on the client’s ethnicity for the selected drug therapy would be:
– Venlafaxine has been associated with an increased risk of adverse effects, such as hypertension, in patients of African American ethnicity. Hence, cautious dosing and monitoring may be required in such patients to avoid potential complications.
7. Therapeutic changes that might be made based on the check points provided in the case study could include:
– Adjusting the dosage of the medication based on the patient’s response and side effects
– Adding psychotherapy or other non-pharmacologic interventions to the treatment plan
– Referring the patient to a specialist or higher level of care if symptoms persist or worsen
8. Lessons learned from this case study include:
– The importance of a comprehensive evaluation and utilization of various assessment tools to arrive at an accurate diagnosis and treatment plan for depression.
– The potential challenges and limitations of antidepressant therapy, including the need for careful monitoring of side effects and adjusting the dosage as needed.
– The value of an integrated approach that incorporates both pharmacologic and non-pharmacologic interventions for optimal outcomes in treating depression.
