Case Presentation Patient Intake and Symptom History The patient is a 41-year-old woman with longstanding and treatment-resistant depression She had

Question Answered step-by-step Case PresentationPatient Intake and Symptom History ?Patient History The patient is a 41-year-old woman with longstanding and treatment-resistant depression ? She had her first major depressive episode at age 13; in her words, she “checked out,” by which she means that she had difficulty concentrating, always felt sleepy, had bouts of crying, and was generally miserable ? This episode lasted nearly a year and eventually resolved without treatment ? The patient had a second major depressive episode with the same symptoms at age 18, during her first semester of college ? This episode may have been precipitated by major life eventsnamely, leaving for college and the death of her grandmother ? The patient had depression on and off for the next 3 years before she eventually sought help ? She was treated with fluoxetine, which was quite helpful, and she started psychotherapy, which provided further benefit. ? At age 25, despite continuing treatment, the patient relapsed into another episode of depression ? Bupropion was added without benefit and thus was discontinued ? Fluoxetine was then switched to paroxetine, which was effective for a couple of years; however, the patient discontinued and unfortunately relapsed at age 28 ? Over the next 2 years, the patient tried venlafaxine, escitalopram, and other standard antidepressants, all with minimal response; her course was also complicated by unhappiness with her job and loneliness ? At age 30, the patient moved to another state, earned another degree, and began teaching ? She also began sertraline treatment and experienced some improvement in her symptoms ? Over the next 11 years, she tried various antidepressants, all of which seemed to work partially and transiently ? The patient feels that she has not been truly well since her late twenties and that it has been a long time since she has laughed or had a good time ? She is not interested in dating or having children, she has fulfilling friendships, and she has a good relationship with her mother; nonetheless, she suffers from anhedonia, lack of pleasure, and lack of interest; she also feels a sense of loss over not having joy or laughter in her life ? Her family history is significant for depression (mother, brother, first cousin); there is no known bipolar disorder in the familyMedical HistoryThe patient was overweight beginning in early adolescence; 2 years ago (at age 39), she had gastric bypass surgery; after losing 100 lbs, she is now at a normal body mass index (BMI) ? She had back surgery at ages 32, 33, and 40; she continues to have chronic back pain, for which she takes multiple pain medicationsCurrent medications ? Acetaminophen/hydrocodone 10 mg/325 mg (1 or 2 per day as needed) Fentanyl patch 75 mcg/hour continuously Carisoprodol (muscle relaxant) 350 mg twice per day Diclofenac patch (NSAID) twice per day Gabapentin 1200 mg/day ? Prilosec 20 mg/day for gastric reflux related to her gastric bypass ? Sertraline 100 mg/day ? Aripiprazole 5 mg/dayCase Questions1.What is the patient’s diagnosis? What other differentials would you consider and why? What screening instruments would you use? 2. What medications are documented to treat both chronic central pain and depression? 3. What is the significance of gastric bypass in a client who is not responding to medications? 4. What would you do first when treating this patient? (Hint: involves question #3) 5. How could the patient’s current analgesic regimen be contributing to her depressive symptoms and antidepressant response? What could be done about the patient’s chronic pain? How would you educate the patient and her family? 6. Suppose the patient’s analgesic regimen is adjusted, but the patient’s depressive symptoms persist and worsen. Her therapeutic drug monitoring reveals sertraline is 70 ng/ml, aripiprazole 100 ng/ml. What would you do? 7. What other non-pharmacologic interventions could be considered to address the patient’s psychiatric symptoms? Health Science Science Nursing NURS 713 Share QuestionEmailCopy link Comments (0)