Adult Client with Depression

1 Adult Client with Depression Healthcare professionals have recognized depression as a significant health problem affecting adults and older people. This disorder is a major contributor to the burden of diseases and poor quality of life (Whiteford, Ferrari & Degenhardt, 2016). Persons suffering from depression experience significant disruptions in their lives. These people face difficulties in making rational decisions and engaging in constructive activities. The impact of depression on mental health varies from one person to another. Some people can overcome challenging events that may lead to depression, whereas others are emotionally overwhelmed by such scenarios (Redd, 2019). The typical symptoms of depressive disorders include decreased energy, lack of interest in social activities, aggression, depressive mood, sadness, and inattentiveness. Memory loss can also occur in depression (Morrison-Valfre, 2016).

Psychiatric mental health practitioners utilize several tools including the geriatric depression scale, physical symptoms checklist, and anxiety depression scale, to diagnose depression. The practitioner then develops a treatment plan that aligns with the mental health needs and interests of the client. The treatment plan comprises both pharmacological and psychotherapeutic interventions.

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2 The practitioner has the responsibility to select the most effective intervention to improve care outcomes, reduce the risk of relapse, and increase functionality (Morrison-Valfre, 2016).

This exercise investigates the treatment plan for an adult with depression. The paper will also highlight the client's management needs and the community support services available for improved outcomes.

History of Present Illness The client is a 26-year-old Caucasian female with depression. The client reported that depression has persisted for several years. She also noted that she has been experiencing anxiety after driving past a fatal accident. The client denies suicidal thoughts. She also noted that she has never harmed anyone in her life. However, she reported overwhelming visions and thoughts of her children being harmed. The intrusive thoughts of harming her children have contributed to anxiety and affected her normal life. The client noted that her marriage is not stable as her husband is ever absent from home. When her husband refused to help with domestic chores, the client decided to seek psychiatric assistance from an outpatient clinic.

Diagnosis Following the assessment of the client’s history, lifestyle, and presenting symptoms, she was diagnosed with Persistent Depressive Disorder. The DSM- Criteria states that depression is diagnosed in individuals with five or more symptoms of this disorder. These symptoms must present over two weeks and lead to significant changes in the client’s functioning (Rosellini et al., 2018). These symptoms include decreased energy and interest to engage in social and normal life activities. The client may also present with anger, sadness, fatigue, agitation, weight loss and poor concentration. A personality disorder was ruled out since she did not present with

3 impulsivity, personality changes, severe mood swings, suicidal thoughts, and unstable selfimage.

Clinical Impression In this case, the client presented with a history of depression, anger, and sadness. She was also tearful and reported experiencing feelings of emptiness after her husband declined to help her at home. She could not engage in normal life activities such as driving due to overwhelming anxiety of looming danger. She was fearful that she might experience a fatal accident while driving on the freeway. She has an exceptionally depressed temperament, low energy, and depressive mood even though she denies suicidal thoughts. She has been taking Zoloft 50 mg but discontinued after feeling “hyper” for three days.

Psychopharmacologic Intervention Mental health nurse practitioners can use several medications to treat depression. The client, in this case, was initially given Zoloft. This medication is an effective antidepressant but can lead to side effects such as dizziness, nausea, nervousness, and drowsiness. Failure to clear depressive symptoms and the risk of side effects indicate the need to adjust the dose or replace the medication. This medication was replaced with Remeron 15 mg daily at bedtime and Atarax 50 mg 3 times a day. Remeron is a safe and effective antidepressant used with other medications for improved mental health outcomes.

Psychotherapy The psychotherapeutic interventions recommended for the client are milieu therapy and group therapy. Milieu therapy involves using a person’s surroundings to induce positive thinking and positive behaviors (Casher & Bess, 2020). Milieu therapy is appropriate for this client since it creates a platform for positive interactions, thinking and behaving. The nurse immerses the

4 client in a small structured community to help develop skills and behaviors essential for healthier lives. The therapist also recommended Group therapy since it helps individuals develop socialization and communication skills (Barker, 2017). In group therapy, the client interacts with the therapist and other people presenting with similar psychological problems. The client develops self-awareness which is vital in dealing with overwhelming emotional issues.

Medical Management Needs The client's medical management needs include eradicating depressive symptoms, mood, and energy improvement, reducing anxiety, and preventing relapse of the symptoms. The client noted that she had previously been prescribed Zoloft, but this medication was not effective.

Therefore, there is a need to administer an effective medication to alleviate the symptoms without producing side effects. Anxiety and depressive symptoms have affected the client’s social life. The treatment plan should focus on improving communication, behavior, and other aspects of social life.

Community Support Resources The main community support resources available for the client are the family and the healthcare providers. The client lives with her husband and two children. Although she reported that her husband is not helpful with domestic chores, his family's presence is essential for moral and social support. She can also attain social support by interacting positively with her children.

The client can also enroll in community programs for depressive disorders. For instance, the depression and Bipolar alliance provide social support and counseling services to the clients.

Follow-Up Plan A one-month follow-up schedule is appropriate for the client since it would allow the client to participate in therapeutic interventions without interruption. This period is also

5 appropriate for pharmacological result assessment since Remeron and Atarax take approximately three to four weeks to achieve the intended therapeutic effect (Macaluso & Preskorn, 2019). The client needs to notify the nurse practitioner of any adverse effects that might develop before the scheduled appointment.

Conclusion Therapists can use both psychotherapy and pharmacological agents to treat psychological disorders such as depression. These interventions help alleviate the symptoms and reduce the chances of relapse. Clinicians should initiate early treatment for better outcomes. A follow-up plan is also important to monitor the client’s progress.

6 References Barker, P. (2017). Psychiatric and mental health nursing: The craft of caring. CRC Press.

Casher, M. I., & Bess, J. D. (Eds.). (2020). Manual of inpatient psychiatry. Cambridge University Press.

Macaluso, M., & Preskorn, S. H. (Eds.). (2019). Antidepressants: From Biogenic Amines to New Mechanisms of Action (Vol. 250). Springer.

Morrison-Valfre, M. (2016). Foundations of Mental Health Care-E-Book. Elsevier Health Sciences.

Redd, R., (2019). The Little Book Of Mental Health: Remove depression, anxiety, and addiction for good. Lulu.com.

Rosellini, A. J., Bourgeois, M. L., Correa, J., Tung, E. S., Goncharenko, S., & Brown, T. A. (2018). Anxious distress in depressed outpatients: Prevalence, comorbidity, and incremental validity. Journal of psychiatric research, 103, 54-60. https://doi.org/10.1016/j.jpsychires.2018.05.006 Whiteford, H., Ferrari, A., & Degenhardt, L. (2016). Global burden of disease studies: implications for mental and substance use disorders. Health Affairs, 35(6), 1114-1120. https://doi.org/10.1377/hlthaff.2016.0082