NUR 620 Florida International University Psychiatric Management Discussion
ANSWER
Clinical Case Summary: Ms. Z is a 28-year-old assistant store manager presenting with symptoms of sadness, fatigue, oversleeping, difficulty getting out of bed, difficulty concentrating, and guilt following a recent breakup with her boyfriend. She has a history of failed romantic relationships, expresses low self-esteem related to her perceived inability to find a significant other, and reports late arrivals at work due to oversleeping. Although she denies suicidal ideation, she has become tearful in front of clients. Ms. Z spends long hours in bed but does not report significant changes in appetite or weight. She exhibits some brightening when discussing positive aspects of her life.
Subjective Data:
- Recent breakup with boyfriend.
- History of failed romantic relationships.
- Difficulty getting out of bed.
- Fatigue despite long hours of sleep.
- Difficulty concentrating.
- Feelings of guilt and inadequacy.
- Isolation from friends.
- Tearfulness at work.
- Brightening when discussing positive aspects.
Objective Data:
- Late arrivals at work.
- Spending over 12 hours in bed.
- No significant changes in appetite or weight.
- Denies suicidal ideation.
Primary Diagnosis: Major Depressive Disorder, Recurrent (ICD-10: F33.0)
- Ms. Z exhibits several symptoms consistent with Major Depressive Disorder, including sadness, fatigue, oversleeping, difficulty concentrating, guilt, and impaired social functioning. These symptoms have persisted for at least two weeks, indicating a recurrent episode.
Differential Diagnoses:
- Persistent Depressive Disorder (Dysthymia) (ICD-10: F34.1)
- Although the symptoms meet criteria for Major Depressive Disorder, it’s important to consider Persistent Depressive Disorder due to Ms. Z’s history of failed relationships and prolonged duration of depressive symptoms.
- Adjustment Disorder with Depressed Mood (ICD-10: F43.21)
- Given the recent breakup and the impact on Ms. Z’s emotional well-being, an adjustment disorder should be considered. However, the duration and severity of her symptoms may not entirely fit this diagnosis.
Pharmacological Treatment: Considering the severity of Ms. Z’s symptoms, especially the impact on her daily functioning and the possibility of a recurrent depressive episode, an antidepressant medication may be appropriate. Selective Serotonin Reuptake Inhibitors (SSRIs), such as Sertraline (Zoloft), may be considered as a first-line treatment (based on clinical guidelines) to alleviate her depressive symptoms.
Non-Pharmacological Treatment:
- Cognitive-Behavioral Therapy (CBT): CBT is recommended as a non-pharmacological treatment for depression. It can help Ms. Z address negative thought patterns, low self-esteem, and provide coping strategies for managing her breakup and relationship difficulties.
- Interpersonal Therapy (IPT): IPT may be beneficial for Ms. Z given her focus on relationship issues. It can help her improve her interpersonal skills and cope with the loss of her relationship.
Health Promotion Intervention: To promote overall well-being, Ms. Z could benefit from a holistic approach. One suitable health promotion intervention could be:
- Physical Activity and Exercise: Encouraging Ms. Z to engage in regular physical activity can help boost her mood, alleviate fatigue, and improve her overall health. She can start with a manageable exercise routine and gradually increase intensity over time.
In summary, Ms. Z presents with symptoms of Major Depressive Disorder, recurrent, but it’s important to consider differential diagnoses and provide comprehensive treatment. A combination of pharmacological (e.g., SSRIs) and non-pharmacological interventions (e.g., CBT, IPT) is recommended, along with a health promotion intervention focused on physical activity to enhance her well-being. It’s essential to monitor her progress and adjust the treatment plan as needed.
QUESTION
Description
After studying Module 4: Lecture Materials & Resources, discuss the following:
Case StudyMs. Z is a 28-year-old assistant store manager who arrives at your outpatient clinic complaining of sadness after her boyfriend of 6 months ended their relationship 1 month ago. She describes a history of failed romantic relationships, and says, “I don’t do well with breakups.” Ms. Z reports that, although she has no prior psychiatric treatment, she was urged by her employer to seek therapy. Ms. Z has arrived late to work on several occasions because of oversleeping. She also has difficulty in getting out of bed stating, “It’s difficult to walk; it’s like my legs weigh a ton.” She feels fatigued during the day despite spending over 12 hours in bed and is concerned that she might be suffering from a serious medical condition. She denies any significant changes in appetite or weight since these symptoms began.
Ms. Z reports that, although she has not missed workdays, she has difficulty concentrating and has become tearful in front of clients while worrying about not finding a significant other. She feels tremendous guilt over “not being good enough to get married,” and says that her close friends are concerned because she has been spending her weekends in bed and not answering their calls. Although during your evaluation Ms. Z appeared tearful, she brightened up when talking about her newborn nephew and her plans of visiting a college friend next summer. Ms. Z denied suicidal ideation.
Questions:Remember to answer these questions from your textbooks and clinical guidelines to create your evidence-based treatment plan. At all times, explain your answers.
Summarize the clinical case including the significant subjective and objective data.
Generate a primary and two differential diagnoses. Use the DSM5 to support the assessment. Include the DSM5 and ICD 10 codes.
Discuss a pharmacological treatment would you prescribe? Use the clinical guidelines to support the rationale for this treatment.
Discuss non-pharmacological treatment would you prescribe? Use the clinical guidelines to support the rationale for this treatment.
Describe a health promotion intervention that would be appropriate for this patient.