Pakistani Female With Delusional Thought Processes

Running head: THE DEPRESSED HISPANIC MAN

THE DEPRESSED HISPANIC MAN WITH MDD 5

Hispanic Male with MDD

Background

My client is a 32 year old Hispanic American male with chief compliant of depression. His mother died while he was still in Mexico at a younger age. He grew up with his dad who has 8 children. He kept to him self while in high school because he was being teased of being black. He also has pains in is back and shoulder due to the nature of his job, he works as a labourer. He also complained of gaining more weight 15 pounds in 2 months and difficulty sleeping which began 6 months earlier and getting worst. He nolonger has the interest in activities he normally like and difficulty concentrating which gets him introble at work. He denies visual and auditory hallucination, denies homoscidal and suicidal ideations. Scored a 51 in Montgomery Äsberg Depression Rating Scale. This paper seeks to demonstrate my skills in conducting an effective decision in the treatment of patient presenting symptoms of depression (Laureate Education, 2016g).

My first decision.

My first decision was to begin my client with 25mg Zoloft orally daily.

Reason for this decision.

I made this choice because depression is a common mental health disorder affecting a large group of people in the country. It is a mental or mood disorder that results in feelings of sadness, loss, anger, or frustration interfering with our normal life for an extended period of time. According to the World Health Organization, the global prevalence of depression and depressive symptoms has been increasing over the last few years. The lifetime prevalence of depression in women is approximately 25% while that of men is 12% (Schmaal et al.,2016).

Zoloft belong to a group of antidepressant called Selective serotonin reuptake inhibitors (SSRIs) they have become the first-line treatment for major depressive disorder. They are considered safe, few side effects, and more effective compared to other antidepressants (Voineskos, Daskalakis & Blumberger, 2020).

What I’m hoping to achieve.

What I expected to achieve is to help my client feel better and have interest in his daily activities. Zoloft works by boosting the serotonin in the brain which can help enhance mood, improve sleep, improve energy (Stahl, & Stahl, 2013).

The difference of what I expected to achieve with Decision #1 the results and difference

My decision is based on my patient subjective and objective informative such as depressed mood, difficulty sleeping and problem with concentration. I hope that I would achive substancial reduduction of patient undesired symtoms. After 4 weeks my client had a 25% improvement, but with a new unset of erectile dysfunction. This new unset of erectile dysfuction requires patient education which is a very important aspect of trusting relationship between the PMHNP and patient. One of the side effect of Zoloft is to reduce the feeling of sexual desire. This medication acts by reducing the actions of the desire and arousal neurotransmiter called dopamine and norepinephrine; it also blocks the action of nitric oxide; a vasodilator that relaxes the muscles and blood vessels, it widens the vessels allowing enough blood to flow to your sexual organs (WHO, 2009). Without enough blood being sent to your sex organ, you can not get or maintain an erection.

Decision 2

Continue with same dose and counsel client.

Reason for this decision.

My decision for client to continue with same medication and dosage was based on the fact that patient adult dosage for this medication is 25mg then it increases, and since it is a new medication and already shown 25% decrease in symptoms and for full benefits of this medication it is required to take Zoloft at least 6weeks of continuous treatment (Stahl, & Stahl, 2013).

What I’m hoping to achieve.

I was hoping the medication will be fully absorbed in my client body, and he will experience the therapeutic effect of the drug such as reduction in depression or anxiety, improved mood, improve energy also help with weightloos by decressing appetie (Stahl, & Stahl, 2013). Since patient has add 15lb in 2 months I feel he should continue with the medication.

The difference of what I expected to achieve with Decision #2 the results and difference.

Medication management is the core concept of any mental health disorder. As the PMHNP treatment options should be discuss with patient and family so patient can adhere to treatment. My client came back stating he stopped medication because of his inability to perform sexually has worsen. What I was expecting to active was different; I didn’t expect for the sexual desire to worsen I expected after the 6weeks the side effect would lessen. Since my client stopped taking the medication, treatment adhereance is a problem. I have to get family involved and also some psycotheraphy. Psychotheraphy also known as “talk theraphy” this is where the phychotherapist sit with the client talking to resolve personal issues and create desired changes. Combination of Psychotherapy and antidepressant has shown to be the best effective treatment for depression, because with psycotheraphy the client can learn new coping skills to approach mood disorder (Schimelpfening, Bottom of Form

2020).

Decision 3.

Restart Zoloft at 50% of initial dose.

Reason for this decision.

50% of initial dose is 12.5mg orally daily. I made this decision so I will know if the effect of erectile disfunction is dose dependate. This is another opportunity for patient education. Educating my client not to abruptly stop his medication due to reocurrance of symptoms (Stahl, & Stahl, 2013). It is also very important to tiltrate any psychoactive drugs gradually instead of discountinuing, because of relapse of psychotic symptoms or development of rebound effect.Top of Form

What I’m hoping to achieve.

I was hoping my client will have fewer side effect of the medication, his depression would be reduced, his sexual desire and errection will be improved, and he would trust me and stick to the treatment regeim.

The difference of what I expected to achieve with Decision #3 the results and difference.

I decided to reduce the dosage to 12.5mg instead of the initial dose of 25mg. In my second decision above I wanted my client to continue same dose expecting him to get the therapeutic effect of the drug not knowing side effect such as erectile disfuction will get worsen, making my client stop the medication. Swicthing should be done with caustion. If my client do not show improvement with this new dose. I would opt to change the medication to wellbutrine XL 150mg orally, daily and increase dose if tolerated (Stahl, & Stahl, 2013). Wellbutrine can treat depression by improving mood it take 4 to 6 week to see effect according to reviews researcher call this drug “the sexy, horny happy drug” (Escobar. A. 2020). That is the way wellbutrine make one feel, unlike Zoloft wellbutrine does not cause decrease in sexual desire, some of it side effect is insomnia I’ll make sure patient get all the education needed and support from family and community resource.

Ethical issue

As a PMHNP my client safety is an ethical and legal issue. I will abide by the non-maleficence principle preventing any injury or damage to my client. Ensuring my client safety and creating a safe and trusting atmosphere ( Kadivar, et. al. 2017).

References

Escobar. A. (2020).Wellbutrin Addiction. Retrieved from https://www.drugaddictiontreatment.com/types-of-addiction/prescription-drug-addiction/wellbutrin-addiction

Kadivar, M., Manookian, A., Asghari, F., Niknafs, N., Okazi, A., & Zarvani, A. (2017). Ethical and legal aspects of patient's safety: a clinical case report. Journal of medical ethics and history of medicine, 10, 15. Laureate Education. (2016g). Case study: An elderly Hispanic man with major depressive disorder [Interactive media file]. Baltimore, MD: Author.

 Schmaal, L., Veltman, D. J., van Erp, T. G., Sämann, P. G., Frodl, T., Jahanshad, N., ... & Vernooij, M. W. (2016). Subcortical brain alterations in major depressive disorder: findings from the ENIGMA Major Depressive Disorder working group. Molecular psychiatry, 21(6), 806-812.

Schimelpfening. N. (Bottom of Form

2020). Types of Psychotherapy for depression. Retrieved from https://www.verywellmind.com/types-of-psychotherapy-for-depression-1067407

Stahl, S. M., & Stahl, S. M. (2013). Stahl's essential psychopharmacology: neuroscientific basis and practical applications. Cambridge university press.

Voineskos, D., Daskalakis, Z. J., & Blumberger, D. M. (2020). Management of Treatment Resistant Depression: Challenges and Strategies. Neuropsychiatric Disease and Treatment, 16, 221.

World Health Organization (WHO). 2009 Basic principles of prescribing retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK143207/