Based on the symptoms that the patient is presenting with, the patient is most likely suffering from a major depressive disorder. Psychoeducation in patients with depression helps to reduce incidences of relapse. The family and friends of the depressive patients are taught on problem-solving and how to overcome stressful interactions, especially those that involve the patient.
DSM-V Coding and Standard Guidelines for Depression
The DSM-V coding for this diagnosis involves various symptoms that must be present within the same two-week period. There must be diminished pleasure or interest among the signs, just as in the case study. This is the primary criteria used in the diagnosis of clinical depression. For instance, the patient may present with loss of energy or fatigue, retardation or psychomotor agitation, hypersomnia or insomnia, or in other words, referred to as sleep disturbances and feelings of worthlessness (Nuckols & Nuckols, 2013). Moreover, the patient may present with a depressed mood, loss of pleasure, or interest in almost all the other activities, especially those they found fascinating before. Appetite disturbance and significant weight change are also listed in the DSM-V criteria.
Delegate your assignment to our experts and they will do the rest.
Rationale for Diagnosis
Most adult patients with major depressive disorder look normal on assessment. However, in advanced cases, there may be an issue with the dressing or grooming the patient. In the case study, the patient appears appropriately dressed and well-groomed with excellent psychomotor activity and behavior on examination of his eye contact and cooperation. However, the patient also presents with a slightly unsteady gait and obesity (a significant change in weight), which is part of the DSM-V criteria for the diagnosis of hypertension.
Other symptoms of the criteria that the patient presented with was that the patient reported having difficulty in concentrating while reading even though his concentration appeared to be good during the interview. On examination of the patient, he also presents with depressive symptomatology because he has rumination and shows guilt. Besides, his mood is anxious and depressed and expresses thoughts of frustration and sadness, especially with regards to the anticipated death of his father and his prostate cancer diagnosis (Iyer & Khan, 2012) . Besides, the patient most likely had depression because his mother had suffered from depression, and sometimes it can be a family thing. The patient also reports using anti-depressive drugs that had initially worked either partially or negatively in the past years.
Tools for Correct Diagnosis/ Diagnostic Tests
According to Behera et al. (2017), some significant tools and tests have been identified for the correct diagnosis of depression. They entail; Cornell Scale for Depression in Dementia (CSDD), Patient Health Questionnaire (PHQ), Hamilton Depression Rating Scale (HDRS), Geriatric Depression Scale (GDS), Major Depression Inventory (MDI), Beck Depression Inventory (BDI), Zung Self-Rating Depression Scale (SDS), Center for Epidemiologic Studies Depression Scale (CES-D).
Differential Diagnosis
There is a wide variety of medical disorders that can be a differential diagnosis for major depressive disorder. For example, endocrine disorders such as hypothyroidism and hyperthyroidism. Others include; infectious diseases such as mononucleosis, drug-related conditions such as side effects of some CNS depressants, and cocaine abuse. Also, there are diseases of the CNS, including neoplastic lesions, dementia, Parkinson's disease, and multiple sclerosis.
Treatment and Psychotherapy
Psychotherapy is usually conducted in about 60 minutes' sessions on an outpatient basis. It tends to be time-limited even though there is variation between sessions. Medication and psychotherapy are usually effective in treating about 80% of patients with MDD 4-6 weeks after initiating therapy. Examples of drugs used are tricyclic anti-depressants, which is a first-generation class of anti-depressants and include clomipramine, amitriptyline, desipramine, and nortriptyline which are effective in depressive patients (Gautam et al., 2004). Monoamine oxidase inhibitors are mostly used in patients who do not respond to other classes of medications. Examples include tranylcypromine and phenelzine. Selective serotonin reuptake inhibitors are another class of drugs that are appropriate in depression treatment and is the first-line treatment since it is newer in the market and with milder side effects. Examples include fluoxetine, fluvoxamine, and sertraline.
Clinical Notes
-In elderly patients, depression may have a typical diagnosis and hence is acknowledged to be complicated.
-Even though there are several rating scales for depression, only a few have been validated in geriatric populations (Iyer & Khan, 2012).
-Depression in the elderly is usually left untreated or undiagnosed despite increases research and interest in the geriatric population. Hence it may be a part of aging.
References
Behera, P., Gupta, S. K., Nongkynrih, B., Kant, S., Mishra, A. K., & Sharan, P. (2017). Screening instruments for assessment of depression. Indian Journal of Medical Specialties , 8 (1), 31-37.
Gautam, S., Batra, L., Gada, M. L., Bhojak, M. M., Jhanwar, V. G., Tambi, A., . . . Gautam, M. (2004). CLINICAL PRACTICE GUIDELINES FOR THE MANAGEMENT OF DEPRESSION. Indian Journal of Psychiatry , 1-37.
Iyer, K., & Khan, Z. (2012). Depression - A Review. Research Journal of Recent Sciences, 1 (4), 79-87.
Nuckols, C. C., & Nuckols, C. C. (2013). The Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Philadelphia: American Psychiatric Association .
