Assignment: “Captain of the Ship” Project – Depressive Disorder

Assignment 1: “Captain of the Ship” Project – Depressive Disorder

Some adults are likely to suffer from depression since there is a possibility that they will be battling chronic disorders, loneliness due to the demise of their spouses, impairment in their physical abilities, and change of roles (Sadock, Sadock, & Ruiz, 2014). Mental impairment is likely to affect the moods of the elderly, their discourse and their ability to remember. Nevertheless, depression can evoke part of the manifestations that are observed with dementia but with no close association with depression (Sadock et al., 2014). This paper aims at reflecting on a client that presented at the care facility and create an impression and plan for the client that will enhance the achievement of treatment objectives.

The client, in this case, is a female 67 years old. She visited the care facility following her primary care provider expressing the possibility of depression in her about 5 months ago. The client's primary care provider recommended 10mg Lexapro orally every day and 25mg Xanax orally two times a day as required for sleep and nervousness. The client expresses that Lexapro was effective for about 4 weeks but of late it is not helping as before. The client reveals sadness feelings, crying episodes, loss of enthusiasm in daily chores, challenges in maintaining the cleanliness of the body and the surrounding, and ideation of dying. The patient likewise expressed that she has suffered from depression for a long time and had tried committing suicide by overdosing medication at the age of 16. She expressed that she is not of the opinion of to harm herself at the moment and she would like to live for her family and spouse. Her depression contributing factors incorporate her spouse's health deterioration since he is battling stage 4 cancer. The patient's spouse is presently a full-time worker and able to care for himself. Nevertheless, the client is worried regarding the measures she will take when he will need more support. The client reveals a reduced capability to sleep. However, she says she gets adequate sleep with her current 25mg Xanax dosage every night together with 10mg melatonin orally nightly. The patient had tried Ambien and Benadryl previously but all in vain. The client likewise expresses that she is presently under potassium nightly for feet cramps. However, she is uncertain of the dosage and states that it is not helping her.

Recommended Pharmacological Treatments and Objectives

At present, the client’s Lexapro is not helping in her depression. The primary concern is to alleviate her depression manifestations. Besides, the client requires her sleeping disorder to be addressed. The client is presently under Xanax medication for sleep and even though it is helpful, Xanax is not an appropriate drug for the client because of its high odds of addiction besides its contraindicated consumption in old patients (Stahl, 2014). It will be appropriate to explore other alternatives to address her sleep disorder. The recommended treatment incorporate raising Lexapro dosage to 15 mg orally every day for depression, maintaining 10mg Melatonin orally every night for sleep, commencing 7.5mg Remeron orally every night for both sleep and depression and start to ween off Xanax by avoiding taking it daily and reducing its use to at most once a day. The client was advised to take daily multivitamins to avoid vitamin insufficiency. Since the client is under potassium every night for muscle cramps, she was counseled on the significance of seeking care counseling regarding OTC potassium. Besides, the client was counseled regarding the dangers and importance of benzos use and the danger of long-term consumption involving addiction (Stahl, 2014). Alternative medications for anxiety were discussed and the client accepts to reduce Xanax gradually to avoid withdrawal.

Recommended Psychotherapy and Goals

The client is battling with the stressors linked with taking care of her husband suffering from a terminal illness and is presently helping him to attend appointments. Nevertheless, the spouse is capable of taking care of himself at present. The client is worried regarding what will transpire a time when he will need additional support and feels incapacitated to meet his daily needs. The client will require support and all through this process she concurs that treatment will enhance her to handle her stressors. Nevertheless, she expresses that she will wait for a few months before she can manage to visit a therapist routinely. The client may profit from group psychotherapy together with other patients experiencing similar stressors of taking care of their spouses suffering from a terminal illness. Group therapy will enhance the client to have healthy rapports to aid support her and identify appropriate approaches to handle their stressors and nervousness and to acknowledge that numerous other individuals are experiencing the same situation (Yalom & Leszcz, 2005).

Medical Management Needs

The client is suffering from hypothyroidism and often consults her primary provider regarding the situation, nevertheless, the client cannot remember the last time her blood level was screened and says that she usually gets it conducted at the time when the pharmacy will refill the drugs no more. The client has no recent labs. Her labs were requested as follows; differential CBC, T4, T3, CMP, TSH, Vitamin D and Vitamin B12. The patient was handed the script to be completed in her primary provider’s office. Laboratory results are very crucial during the treatment of a patient suffering from depression since anomalous levels might turn out to be her manifestations’ contributing factors currently.

Community Support Resources

There is a need for community resources for the client. They include support to take care of her husband, financial aid, food aids, housekeeping, dressing, and bathing. Meals on Wheels, Helping Restore Ability, and Mid Cities Care Corps can help the client in her endeavors to take good care of her spouse.

Recommended Follow up and Collaboration

The client was requested to present back to the care facility after two weeks so that her lab results can be evaluated, review the effectiveness of supplementing her treatment with Remeron, to evaluate her progress with the Xanax weening off, and to closely observe the patient's level of depression. Collaboration between the therapist and the patient's care provider regarding her thyroid levels and therapy apart from regular lab tests and addressing her Vitamin deficiency is necessary. Further, any observation of anomalous values ought to be reported to the psychotherapist to avoid possibilities of severe side effects as a result of drug interaction.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.

Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed.). New York, NY: Basic Books.