ANSWER
Weekly Clinical Communication: Presentation of a 16-Year-Old Patient with Major Depressive Disorder
According to the DSM-5-TR criteria, a 16-year-old girl had symptoms that were typical of major depressive disorder (MDD). For more than two months, the patient experienced persistently poor mood, decreased interest in once-enjoyed activities, exhaustion, changes in appetite, and trouble focusing. She also rejected active suicide intent but accepted feelings of worthlessness and sporadic thoughts of self-harm. Substance abuse and serious medical comorbidities were not reported.
Evaluation and Diagnosis
A thorough clinical interview based on the ideas of The mental Interview was part of the mental examination (Carlat, 2023). Important components included:
Subjective Data: The patient’s description of emotional suffering and functional deficits in social and academic settings.
Significant social disengagement and heightened irritation were noted by family members.
Objective Information:
Assessment of Mental Status (MSE): There is no sign of cognitive deficits or psychosis, yet there is a flat affect, delayed speaking, and poor eye contact.
Scales of diagnosis: The patient scored 18, which indicates moderately severe depression, on the Patient Health Questionnaire-9 (PHQ-9).
The patient satisfied MDD criteria, which include at least five symptoms over a two-week period and severe functional impairment, according to the DSM-5-TR.
Plan of Treatment for Psychotherapy:
To address cognitive distortions, develop emotional resilience, and improve coping mechanisms, start weekly Cognitive Behavioral Therapy (CBT) sessions.
Intervention using Pharmacology:
After a week, titrate to 20 mg/day of fluoxetine, depending on response and tolerability. Start with 10 mg/day. Adolescent MDD can be effectively treated with fluoxetine, which has FDA approval (Stahl, 2021).
Participation of the Family:
Involve parents in family therapy to enhance communication and create a nurturing atmosphere.
To reduce stigma and promote treatment plan adherence, offer psychoeducation about depression.
Plan for Monitoring and Safety:
Initially, conduct follow-ups every two weeks to evaluate the effectiveness of the medicine, track side effects, and handle any new safety issues.
Provide emergency services’ and crisis hotlines’ contact details in your crisis plan.
Talk and Justification
In order to avoid chronicity and enhance long-term results, early intervention is essential for adolescents with MDD. Adolescent depression symptoms can be reduced with psychotherapy, especially cognitive behavioral therapy (CBT) (Dulcan, 2021). Because of their good safety and efficacy profiles, SSRIs, such as fluoxetine, are advised as the first-line pharmaceutical treatment for moderate to severe symptoms (Stahl, 2022).
Adolescence is a developmental stage where family dynamics can affect symptomatology and recovery. Including family in the treatment plan recognizes this. Addressing the possible risk of self-harm requires routine monitoring and the creation of a safety strategy.
In conclusion
This instance emphasizes how crucial it is to manage MDD in teenagers using a thorough, evidence-based strategy. A comprehensive and patient-centered approach catered to the individual developmental and psychosocial requirements of the adolescent is ensured by the integration of psychotherapy, medication, and family engagement.
Citations
Psychiatric Association of America, 2022. Text revision of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5-TR). APA Publishing.
D. J. Carlat (2023). The Interview in Psychiatry, Fifth Edition. Kluwer Wolters.
M. K. Dulcan (2021). The third edition of Dulcan’s textbook on child and adolescent psychiatry. Published by the American Psychiatric Association.
S. M. Stahl (2022). The neuroscientific foundation and real-world applications of Stahl’s basic psychopharmacology (5th ed.). Cambridge University Press.
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QUESTION
NU674 Psychiatric Mental Healthcare II-Unit 6 Weekly Clinical Communication Due 10-9. 400w and 3 references. Week 6 Patient is 16 y/o with depression/ major depressive disorder . Must Use the attached template and sample. Please use course resource/ textbook and DSM5 as reference.
Course information
NU674 Psychiatric Mental Healthcare II
Course Description
This purpose of this course is to provide students further studies related psychiatric/mental health care management of patients across the life span to include underlying acute and chronic psychiatric/mental health disorders. Clinical opportunities will be utilized to apply concepts in primary and acute care settings with adults and families.
Program: Graduate Nursing
Semester Credit Hours: 4.0
Contact Hours: 30/0/90/120 (Lecture Hours/Lab Hours/Clinical Hours/Total Hours)
Program Outcomes
Students are expected to meet all the core MSN program outcomes as well as the Psychiatric Mental Health program outcomes.
Upon completion of their program, the student should be able to:
1. Demonstrate critical thinking and holistic caring as an advanced practice
2. Analyze scientific literature for application to selected diagnoses and treatment
3. Synthesize ethical principles into the management and evaluation of healthcare delivery concerns in culturally diverse care settings.
4. Articulate a personal philosophy and framework acknowledging professional and accrediting agency competencies relating to the role and scope of practice of the psychiatric mental health nurse practitioner.
5. Implement the role of the psychiatric mental health nurse practitioner in selected clinical settings
Course Learning Objectives
By the end of this course, you will be able to:
3. Apply knowledge, with mentor supervision and minimal prompting, of chronic and acute psychiatric mental health disorders using the current edition of the Diagnostic and Statistical Manual for Mental Disorders diagnostic criteria to assess, diagnose and manage the patient populations across the lifespan including a focus on vulnerable populations at risk for mental health disorders.
4. Integrate, with mentor supervision and minimal prompting, complete mental health assessment, interview, history and physical exam data collection with the knowledge of pathophysiology and psychopathology of psychiatric mental health disorders across the life span to form differential diagnoses and implement therapeutic, patient-centered treatment plans and interventions for patient populations across the lifespan.
5. Merge, with mentor supervision and minimal prompting, traditional and complementary pharmacological/non-pharmaceutical interventions into the treatment and management of psychiatric mental health disorders for patient populations across the lifespan.
6. Examine, evaluate, and demonstrate, with mentor supervision and minimal prompting, professional development in the role of the nurse practitioner in the diagnosis and management of health and wellness as well as acute and chronic psychiatric mental health disorders illnesses for patient populations across the lifespan as a member of an interprofessional team.
7. Integrate, with mentor supervision and minimal prompting, cultural, spiritual, and social competencies into therapeutic patient-centered treatment plans in connection with evidence-based findings to the diagnosis and management of individuals, groups and families across the lifespan with acute, complex, and chronic psychiatric mental health disorders illnesses for patient populations across the lifespan as a member of an interprofessional team.
8. Analyze, with mentor supervision and minimal prompting, professional values and core ethical/legal standards into the practice of the Psychiatric Mental Health Nurse Practitioner role with relation to patient/staff safety, quality indicators, and health outcome improvement in the delivery of quality psychiatric mental health care to patients.
9. Identifies, with mentor supervision and minimal prompting, the highest level of professionalism and accountability for the PMHNP role for transition into clinical practice.
Resources
Required
American Psychological Association. (2019). Publication manual of the American Psychological Association (7th ed.). Washington, DC: APA Press. ISBN 9781433832161
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders text revision (5th ed. -TR) (DSM-5 -TR). APA. ISBN: 978-0-89042-576-3
Carlat, D. J. (2023). The psychiatric interview (5th ed.). Philadelphia, PA: Wolters Kluwer. ISBN: 9781975212971
Johnson, K., & Vanderhoef, D. (2016). Psychiatric mental health nurse practitioner review manual (4th ed.). Silver Spring, MD: American Nurses Association. ISBN: 978-1-935213- 79-6
Joseph Boland, Verduin, M. L., Ruiz, P., Arya Shah, & Sadock, B. J. (2021). Kaplan and Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (12th ed.). Philadelphia, PA: Lippincott Williams, and Wilkins. ISBN: 9781975145569
Recommended
Dulcan’s Textbook of Child and Adolescent Psychiatry (3rd ed.) by Dulcan, Mina K. M.D. ISBN 9781615373277, 1615373276
Stahl, S. M. (2022). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (5th ed.). Cambridge University Press. ISBN: 978-1-108-97163-8
Stahl, S. M. (2021). Prescriber’s guide: Stahl’s essential psychopharmacology (7th ed.). Cambridge University Press. ISBN: 978-1-108-97163-8