NRNP 6640 Major Depressive & Anxiety Disorder Diagnosis
Respond to at least two of your colleagues by providing one alternative therapeutic approach. Explain why you suggest this alternative and support your suggestion with evidence-based literature.
5-6 Sentences each paragraph
Therapy with Older Adults
Many individuals live a long and happy life without mental health issues. Although the increasingly common impression of sad, slow, and forgetful elders, mental disorders are not an inevitable result of aging. More than 20 percent of people aged 55 and over may have some sort of mental health problem. Biological changes may hinder the brain’s functioning, social changes may lead to loneliness or hopelessness, and somatic diseases also play a crucial contributory factor (de Mendonça Lima & Ivbijaro, 2013). Mental health issues can substantially impact an older person’s ability to perform basic daily living activities, decreasing their independence, individuality, and quality of life. The first step in mitigating these damaging consequences is proper diagnosis.
Patient is a 69-year-old, widowed African American male with a chief complaint of depression and anxiety. He is brought himself to an outpatient clinic and seeking psychiatric evaluation at his sons advice. The patient does not enjoy being with his family. He also had difficulty in falling asleep but spends all day lying on the couch and reports feeling tired all the time. He also quit volunteering at the nursing home. He denies a history of alcohol or drug abuse. Had received psychotherapy this year after being diagnosed and treated for prostate cancer. He is currently on Lorazepam 1 mg BID by his PCP which he has been taking for several years.
Patient showing signs and symptoms of Major Depressive Disorder (MDD) (F32.5) as well as Anxiety Disorders (GAD) (F41.1) The rationale for MDD diagnosis is because the patient-reported not enjoying being around his family and having difficulty falling asleep. Always laying on his couch and feeling tired. He also stopped doing activities he used to enjoy doing such as working as a volunteer in a nursing home. According to the DSM?5, three or more of the problems described below should be evident over the same 2?week time period that characterizes changes in the inability to function. At least one symptom is either a depressed mood or losing interest. The client should have a depressed mood most of the day and almost every day. Substantially decreased interest or enjoyment for most of the usual activities. Substantial weight loss or gain. Insomnia. Fatigue or loss of energy (DSM-5, 2017). MDD and ADD are highly co-morbid to each other. The patient is experiencing GAD as evidenced by excessive anxiety and worry that occur more day than not for at least six months. Patient feeling tired, sleep disturbance or difficulty falling asleep (Bystritsky, Khalsa, Cameron & Schiffman, 2013). The patient was recently diagnosed and treated for prostate cancer and worrying about the end of life issues. Now he worries about the imminent death of his father.
Mood Disorder due to other medical conditions– The person has a medical condition and is also experiencing depression. A clinician must understand if a person is depressed because of a valid mood disorder or a medical condition. Adjustment Disorder with depressed mood: This is used when not all the criteria are met for MDD. The depressive episode happens in response to a stressful event involving other people, such as a death or loss and divorce (SAMHSA, 2016).
Cognitive-behavioral therapy (CBT) because is one of the most evidence-based psychological approaches for treating several psychiatric disorders such as depression, anxiety disorders, somatoform disorder, and substance use disorder. Recently, psychotic disorders, behavioral medicine, marital disorders, traumatic life situations and many other psychiatric issues have been covered (Gautam, Tripathi, Deshmukh & Gaur, 2020). Interpersonal Psychotherapy (IPT) is preferred in most depression treatment guidelines and consistently proven to be an effective treatment for elderly depressed patients (van Schaik, van Marwijk, Beekman, de Haan & van Dyck, 2007).
Tranylcypromine is an FDA approved for the treatment of Treatment-Resistant Depression. Some patients may experience stimulant like actions early in dosing. Therapeutic actions typically occur not immediately, but sometimes 2-4 weeks delayed. If it is not working within 6-8 weeks, it may necessitate a dosage increase or it may not work at all. May continue working for many years to prevent relapse of symptoms (Stahl, 2017 p.735.)
The ingestion of high tyramine foods could cause a response that has serious consequences. The patient should educate that tyramine can increase as food ages; foods prepared hours earlier should be fresh instead of leftovers. The types of fish and even types of meat, such as sausage, turkey, liver, and salami, are examples of high food tyramine levels. There may also be tyramines in such fruits, such as overripe fruit, avocados, bananas, raisins, or figs. Cheeses and alcohol are also examples.
Family psychoeducation is considered an integral part of optimal treatment, along with traditional medication and counseling. Family psychoeducation has been shown to decrease the occurrence of relapse and hospitalization (Katsuki et al., 2018)
Clinical Note: Is depression a normal part of aging.
Depression is a common problem among older adults, but it is not a normal part of aging. Studies show that these older adults feel satisfied with their lives despite having more illnesses or medical issues. However, significant life changes that happen as we get older may provoke uneasiness, stress, and sadness. For example, a loved one’s death, retirement, or dealing with a critical illness can make people feel sad or anxious. Many older adults can recover and regain emotional balance after an adjusting period, while others may not develop depression.
Bystritsky, A., Khalsa, S. S., Cameron, M. E., & Schiffman, J. (2013). Current diagnosis and treatment of anxiety disorders. P & T : a peer-reviewed journal for formulary management, 38(1), 3057.
de Mendonça Lima, C. A., & Ivbijaro, G. (2013). Mental health and wellbeing of older people: opportunities and challenges. Mental health in family medicine, 10(3), 125127.