PCP with feelings of hopelessness, sadness, and helplessness.
A 41-year-old man presents to his PCP with feelings of hopelessness, sadness, and helplessness. He says that he cries for no reason, and has difficulty sleeping. He noticed that the problems began about 6 weeks before, and he did not feel able to shrug them off. He has been drinking more alcohol than usual and has stopped going to work. When on his own, he admitted that he had thought of driving his car into the nearest canal.
Summarize the clinical case.
What is the DSM 5-TR diagnosis based on the information provided in the case?
Which pharmacological treatment would you prescribe including the name, dose, route and frequency of the drug in accordance with the clinical guidelines? Include the rationale for this treatment.
Which non-pharmacological treatment would you prescribe according to the clinical guidelines? Include the rationale for this treatment excluding a psychotherapeutic modality.
Include an assessment of the treatment’s appropriateness, cost, effectiveness, safety, and potential for patient adherence to the chosen medication. Use a local pharmacy to research the cost of the medication and provide the most cost-effective choice for the patient. Use great detail when answering questions 3-5.
our initial post should be at least 500 words, formatted and cited in the current APA style with support from at least 2 academic sources.
Sample Solution
A 41-year-old male patient presents to his primary care physician (PCP) with symptoms suggestive of a major depressive episode. He reports feelings of hopelessness, sadness, and helplessness, accompanied by tearfulness and sleep disturbances. The patient indicates a six-week timeframe for these symptoms and an inability to cope effectively. He describes increased alcohol consumption and work withdrawal. Additionally, he acknowledges suicidal ideation involving self-harm by driving into a canal.Full Answer Section
Potential DSM-5-TR Diagnosis Based on the information provided, the patient exhibits symptoms consistent with Major Depressive Episode (MDE) according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) [1]. Here's a breakdown of the relevant criteria:- Depressed mood: The patient reports feelings of sadness and hopelessness.
- Loss of interest or pleasure: Decreased motivation to go to work suggests a potential loss of interest in previously enjoyable activities.
- Significant weight loss or gain: Information regarding weight changes is not provided but can be assessed during further evaluation.
- Psychomotor agitation or retardation: Details are lacking, but withdrawal and tearfulness could suggest psychomotor changes.
- Fatigue or loss of energy: Sleep disturbances and a lack of ability to cope imply potential fatigue.
- Feelings of worthlessness or excessive guilt: Hopelessness and helplessness may indicate feelings of worthlessness.
- Diminished ability to think or concentrate: Cognitive difficulties are not explicitly mentioned but may be explored during a comprehensive evaluation.
- Recurrent thoughts of death (not just fear of dying), suicidal ideation without a specific plan, or a suicide attempt or plan for a specific suicide: The patient reports suicidal ideation.
- Medication: Escitalopram (Lexapro)
- Dose: Starting dose of 10mg daily, with potential for dose adjustments based on clinical response and tolerability.
- Route: Oral administration (tablet)
- Frequency: Once daily
- Efficacy: Research demonstrates the effectiveness of SSRIs in reducing symptoms of depression [2]. Escitalopram is a well-studied SSRI with a proven track record in treating MDE.
- Safety: SSRIs have a relatively low risk of serious side effects compared to other classes of antidepressants [2].
- Tolerability: SSRIs are generally well-tolerated, with common side effects including nausea, dry mouth, and sexual dysfunction. These often subside over time.
- Safety: Escitalopram is generally well-tolerated, but close monitoring is necessary to identify potential side effects and interactions with other medications.
- Adherence: SSRIs typically require several weeks to show their full effects. Educating the patient about the treatment plan and the importance of adherence is crucial. Regular follow-up appointments can help monitor progress and address any concerns about side effects that might lead to non-adherence.
- Effectiveness: Physical activity has been shown to improve mood, reduce stress, and enhance sleep quality – all areas potentially impacted in this patient.
- Accessibility: Engaging in physical activity does not require specialized equipment or a significant financial investment.
- Complementary to Medication: Exercise can work synergistically with medication to achieve optimal treatment outcomes.