Critical thinking skills in the psychopathology of mental health patients
Analyze and apply critical thinking skills in the psychopathology of mental health patients and provide treatment and health promotion while applying evidence-based research.Scenario:
Kel is a 42-year-old certified public accountant (CPA) who dreams each year that she will board a cruise ship the day after Tax Day and go somewhere, anywhere, except Portsmouth, Virginia. Each year the dream, like the ocean, ebbs and flows, but this year she is not even going to think about such a “ridiculous idea.” In fact, she does not even have the energy to dream; getting out of bed and preparing to go to work is simply too labor intensive.
Each evening Kel retires to bed with a lack of energy to complete her normal tasks such as readying her clothes for work and making a lunch. She lacks the energy to shop in the evening; consequently, she eats mostly crackers and canned soup. She is not hungry, and her scale reflects this. She has lost 15 pounds over the last 2 months. She does not attend to her makeup or clothes; she finds both too taxing. The clothes she selects are drab and not ironed. At work she makes no effort to talk with her co-workers and does not initiate new contacts with clients. The normal work of filing taxes and writing reports, which she used to enjoy, are overwhelming, and she feels too disorganized to complete them. Telephone calls and e-mail messages from friends are ignored. Attendance at work is spotty.
Sue, her sister, becomes alarmed with Kel’s unanswered telephone calls and e-mails. Worried, she decides to visit her sister at home. She finds the apartment unclean and in disarray. Kel is unkempt, disheveled, and looks sad. Her voice is monotone and flat. Kel tells Sue that she feels “sad and hopeless. Nothing is ever going to change. I am a bad person and I can’t even do my work right. Although I sleep for many hours, I am still tired all the time.” Sue is alarmed at the changes in her sister and arranges for Kel to visit a health care worker at the medical clinic.
Questions:
Remember to answer these questions from your textbooks and NP guidelines. At all times, explain your answers.
Describe the presenting problems.
Generate a primary and differential diagnosis using the DSM5 and ICD 10 codes.
Formulate and prioritize a treatment plan.
Identify and discuss appropriate screening instruments for a patient who has suicidal ideation.
Sample Solution
Kel's presenting problems include:
- Lack of energy
- Difficulty concentrating and completing tasks
- Loss of interest in previously enjoyable activities
- Social withdrawal
- Sadness and hopelessness
- Negative self-talk
- Suicidal ideation
Full Answer Section
Generating a primary and differential diagnosis using the DSM-5 and ICD-10 codes Primary diagnosis: Major depressive disorder, single episode, moderate (DSM-5 code: 296.33, ICD-10 code: F32.1) Differential diagnoses:- Generalized anxiety disorder
- Persistent depressive disorder (dysthymia)
- Bipolar disorder, depressed phase
- Substance-induced mood disorder
- Adjustment disorder with depressed mood
- Medical illness with depressive symptoms
- Psychotherapy: Psychotherapy can help Kel to understand and manage her symptoms, develop coping skills, and improve her overall quality of life. Cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT) are two particularly effective forms of therapy for depression.
- Medication: Antidepressant medications can be helpful for some people with depression. However, it is important to note that antidepressants can take several weeks to start working, and they can have side effects.
- Lifestyle changes: Lifestyle changes such as getting regular exercise, eating a healthy diet, and getting enough sleep can also help to improve symptoms of depression.
- Assess Kel's risk of suicide. This can be done using a screening instrument such as the Columbia Suicide Severity Rating Scale (C-SSRS). If Kel is at high risk of suicide, she may need to be hospitalized for safety.
- Start Kel on psychotherapy. CBT and IPT are two particularly effective forms of therapy for depression.
- Consider starting Kel on antidepressant medication. Antidepressants can take several weeks to start working, and they can have side effects. However, they can be helpful for some people with depression.
- Encourage Kel to make lifestyle changes. This includes getting regular exercise, eating a healthy diet, and getting enough sleep.