Questions for the Client
Question 1: Did you experience a traumatic event at the age of 15 which caused your start of depression and anxiety? The rationale for this is that the patient’s history shows that the client experienced episodes of depression and anxiety, which made her turn to alcohol for self-medication (Stahl, 2015). Research suggests that depression affects woman, particularly when causal factors like reproductive hormones and social pressures which are unique to the life experiences of a woman.
Question 2: Do you sometimes worry about experiencing a panic attack? The rationale for this question is that generalized anxiety disorder is characterized by major symptoms of generalized anxiety and worry, increased fatigue, arousal, sleep problems, difficulty concentrating, muscle tension, and irritability (Stahl, 2015).
Delegate your assignment to our experts and they will do the rest.
Question 3: Dou you experience thoughts of harming yourself? The rationale for this question is that the life of the client has been changed because of effects of ECT therapy and the debilitating effects of depression which has made her disabled ( Stahl & Schwartz, 2016 ).
The People I would peak to
The first person I would speak to assess the patient’s situation further is her husband. The question I would ask him is “How is your life between you and your wife? What do you think could be the cause of severe anxiety and depression to your wife? The second person I would speak to is the patient’s parents. The question I would ask them is, “Has your daughter suffered from any traumatic event when she was around fifteen years old or younger?
Physical Exams and Diagnostic Tests
Mental health exam: A mental health status and history, as well as, basic psychological assessments could be part of the initial examination.
Actigraphy: it is a test for assessing sleep-wake patterns over time. It is a small, wrist-worn device, a wristwatch’s size, which measures movement.
Polysomnogram: a test used for diagnosing sleep disorders.
Sleep habits review: the patient’s sleep patterns could help in reaching a diagnosis.
Physical exam: Look for nasal congestion, a deviated nasal septum, a narrowed airway, or an enlarged tonsil which could give clues to sleep apnea. I would also carry out a blood test to check for thyroid problems or other conditions which could be related to poor sleep.
Multiple Sleep Latency Testing (MSLT): a lab test comprising 20 minutes nap opportunities that are spread throughout the day and measure sleepiness.
Differential Diagnosis
Generalized Anxiety Disorder (GAD): it is an anxiety disorder that has symptoms of prolonged anxiety, increased tension and worry. Rationale: the patient experiences of depression and anxiety.
Post-Traumatic Stress Disorder (PSTD): it is an anxiety condition which may develop after being exposed to a traumatic ordeal whereby severe physical injury happened. Traumatic ordeals which might trigger PSTD are violent personal attacks, and human-caused or natural disasters (Stahl, 2015). Rationale: The patient might have severely harmed herself physically while she was drunk and depressed.
Panic Disorder: It is an anxiety disorder in which a person regularly experiences sudden fear or panic. It is characterized by repeated and unexpected episodes of extreme fear and physical symptoms such as heart tremors, chest pain, and shortness of breath, abdominal pain or dizziness ( Equihua-Benítez & Drucker-Colín, 2019) . Rationale: When she was studying abroad, the patient suffered from a panic attack and got treated.
Pharmacologic Agents
Amitriptyline: One of the pharmacologic agents which would be suitable for the patient’s sleep/wake treatment is amitriptyline. Generally, it is used for treating mood or mental problems like depression. It might help in enhancing feeling of wellbeing and mood, relieve tension and anxiety, help a person sleep better, and improve the level of energy. This medication is classified under a class of drugs known as tricyclic antidepressants ( Equihua-Benítez & Drucker-Colín, 2019) . Therefore, for the patient in the case, this medication could be beneficial since it treats insomnia, anxiety, depression, and depression that is treatment resistant. It enhances neurotransmitters serotonin as well as norepinephrine, and also blocks serotonin reuptake pump to increase serotonergic neurotransmission. The dose that would be appropriate for a start is 25mg/day at bedtime, and this could be increased after some days.
Trazodone: It is a medication used for treating depression. It might help in improving appetite, mood, energy levels and reducing insomnia and anxiety associated with depression. The medication works by facilitating the restoration of the balance of serotonin in the brain. The medication will benefit the client as it blocks serotonin 2A receptors potently and could assist the patient with the anxiety reported (Stahl, 2015). The client may start with a dosage of 25mg/day at bedtime. The drug has a biphasic half-life that could be highly beneficial to the patient by enabling her get a full night sleep (Stahl, 2014).
Rationale
Trazodone would be chosen over amitriptyline because it may be the best for the patient as she tends to abuse medications and amitriptyline normally leads to a tolerance to sedative effects with time.
Checkpoints and Lessons Learned
The most crucial lesson from this case study is to the need to always assess all aspects of a patient’s care. Besides, for diagnostic purpose, it is important to base the differential diagnosis particularly on the patient’s history, as this will guide to know the various possible disorders which the patient could be suffering from. However, the patient might have suffered from narcolepsy and it would be vital to confirm that diagnosis. Consequently, a VNS therapy could benefit the patient as one of the therapeutic changes. This case is useful because it could be used as a basis for future diagnosis.
References
Equihua-Benítez, A. C., & Drucker-Colín, R. (2019). Drug Discovery and Emerging Treatments for Sleep Disorders. In Handbook of Behavioral Neuroscience (Vol. 30, pp. 623-637). Elsevier.
Stahl, S. M. (2015). Stahl’s Essential Psychopharmacology: Prescriber’s Guide. J Clin Psychiatry , 76 (5), e667.
Stahl, S. M., & Schwartz, T. L. (2016). Stahl's essential psychopharmacology: Case studies (Vol. 2). Cambridge university press.
