The patient in the case study is a seventy-year-old woman who is exhibiting the full symptoms of clinical depression. These symptoms may be heightened owing to the fact that she stays alone and her declining mobility, which limits her going out.
Questions to ask the patient
How is your sleep? Do you experience a lack of sleep, especially during the night? This question is essential in analyzing the patient’s sleep patterns due to stress, anxiety or depression, and any other temporary interruptions to her routine (Davidson, 2016) . Greater sleep disturbance characteristics would indicate a greater risk for depression.
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In the past two weeks, how often have you felt depressed, down, or hapless? If the patient feels low or hopeless for more than half of the days over the past two weeks is an indication of depression (Davidson, 2016) .
How is your energy? Declining energy levels in patients is a common sign of depression. The more the patient lacks energy, the higher are her chances of depression. (Davidson, 2016)
People in the Patients Life to Speak to
The patient’s son.
The patient’s home aide.
The facilitators at the local elders center.
Diagnostic Tests and Physical Exams
A blood test would be conducted on the patient to check for medical conditions that are associated with depressive symptoms such as calcium and vitamin D levels and anaemia, as well as electrolytes and liver function. I would also recommend an ECG (electrocardiogram) to diagnose if the patient is experiencing heart complications such as CHF (congestive heart failure), CAD (coronary artery disease), and cardiomyopathy (American Psychiatric Association, 2013) . The patient will also require an EEG (electroencephalogram) to measure the brainwave activity of the patient to identify brain signals that match with anxiety depression.
Differential Diagnoses for the Patient
Major Depressive Disorder (MDD)
The prevalence of MDD is associated with morbidity and mortality, contributing to adverse outcomes of medical illnesses (American Psychiatric Association, 2013) . The patient feels sad and depressed because she is lonely and rarely goes out. The patient has also diminished interest in the things that she used to enjoy. It can be concluded that the patient is experiencing persistence and intense feelings of sadness, resulting in MDD.
Hyperthyroidism and Thyrotoxicosis
Hyperthyroidism is a disorder that involves the excess synthesis and secretion of thyroid hormones, which results in a state of thyrotoxicosis (American Psychiatric Association, 2013) . Thyrotoxicosis correlates with various psychiatric symptoms such as restlessness, emotional lability ad anxiety. Hyperthyroidism is related to fatigue, irritability, insomnia, and anxiety. The patient has a medical history of hypothyroidism, which is associated with depression.
Restless Leg Syndrome (RLS)
Restless leg syndrome causes insomnia and depression. The patient in the case vignette experiences uncomfortable and unpleasant sensations when she is moving her legs. The unpleasantness seems to worsen during periods of inactivity (American Psychiatric Association, 2013) . Other symptoms that may mimic RLS include leg cramps, anxiety, arthritis, and positional discomfort.
The preferred diagnosis for the patient is MDD because the patient is experiencing loneliness, diminished interest in the things she used to love, and intense feelings of sadness.
Pharmacologic Agents
The patient will be placed on Citalopram, which is used to treat depression. Citalopram will be used to increase the feelings of well-being and energy levels in the patient. In addition, Citalopram will help restore the balance of serotonin in the brain. The initial dosage will be 10 mg/day, taken orally for at least one week.
The patient will also be placed on Eszopiclone to improve anxiety, insomnia, and depressive symptoms. The initial dosage will be 3 mg/day, taken orally for at least one week.
Lessons Learned
A patient’s underlying psychological challenges make it difficult for clinicians to provide the right treatment for clinical depression, resulting in increased side effects. There needs to be proper collaboration among healthcare providers, patients, and their guardians to treat patients with clinical depression effectively.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders . American Psychiatric Publishing.
Davidson, J. (2016). Pharmacotherapy of post-traumatic stress disorder: going beyond the guidelines. Bjpsych Open , 2 (6), e16-e18. https://doi.org/10.1192/bjpo.bp.116.003707
