Case Study: Kel
| Purpose: | Analyze and apply critical thinking skills in the psychopathology of mental health patients and provide treatment and health promotion while applying evidence-based research. |
| Scenario: | Kel is a 42-year-old certified public accountant (CPA) who dreams each year that she will board a cruise ship the day after Tax Day and go somewhere, anywhere, except Portsmouth, Virginia. Each year the dream, like the ocean, ebbs and flows, but this year she is not even going to think about such a “ridiculous idea.” In fact, she does not even have the energy to dream; getting out of bed and preparing to go to work is simply too labor intensive.
Each evening Kel retires to bed with a lack of energy to complete her normal tasks such as readying her clothes for work and making a lunch. She lacks the energy to shop in the evening; consequently, she eats mostly crackers and canned soup. She is not hungry, and her scale reflects this. She has lost 15 pounds over the last 2 months. She does not attend to her makeup or clothes; she finds both too taxing. The clothes she selects are drab and not ironed. At work she makes no effort to talk with her co-workers and does not initiate new contacts with clients. The normal work of filing taxes and writing reports, which she used to enjoy, are overwhelming, and she feels too disorganized to complete them. Telephone calls and e-mail messages from friends are ignored. Attendance at work is spotty. Sue, her sister, becomes alarmed with Kel’s unanswered telephone calls and e-mails. Worried, she decides to visit her sister at home. She finds the apartment unclean and in disarray. Kel is unkempt, disheveled, and looks sad. Her voice is monotone and flat. Kel tells Sue that she feels “sad and hopeless. Nothing is ever going to change. I am a bad person and I can’t even do my work right. Although I sleep for many hours, I am still tired all the time.” Sue is alarmed at the changes in her sister and arranges for Kel to visit a health care worker at the medical clinic. |
| Questions: | Remember to answer these questions from your textbooks and NP guidelines. At all times, explain your answers.
1. Describe the presenting problems. 2. Generate a primary and differential diagnosis using the DSM5 and ICD 10 codes. 3. Formulate and prioritize a treatment plan. 4. Identify and discuss appropriate screening instruments for a patient who has suicidal ideation. |
Submission Instructions:
· Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources
### Case Study: Kel
**Purpose:**
Analyze and apply critical thinking skills in the psychopathology of mental health patients and provide treatment and health promotion while applying evidence-based research.
**Scenario Summary:**
Kel is a 42-year-old CPA experiencing severe fatigue, lack of energy, significant weight loss, and a profound sense of hopelessness. These symptoms have resulted in neglect of personal care, social withdrawal, and diminished work performance. Her sister, alarmed by Kel’s condition, arranges for her to visit a healthcare worker.
### Presenting Problems
Kel presents with several significant issues:
1. **Depressed Mood and Hopelessness:** Kel feels sad, hopeless, and believes that nothing will change.
2. **Anhedonia:** She shows a lack of interest in activities she previously enjoyed, such as her work.
3. **Fatigue and Loss of Energy:** She finds basic tasks overwhelming and exhausting.
4. **Significant Weight Loss:** Kel has lost 15 pounds over the last two months due to poor appetite.
5. **Social Withdrawal:** She avoids communication with friends and family.
6. **Neglect of Personal Care:** She is unkempt, disheveled, and finds it too taxing to attend to her appearance.
7. **Sleep Disturbances:** Despite sleeping many hours, she remains tired.
8. **Feelings of Worthlessness:** Kel believes she is a bad person and incapable of performing her job.
### Primary and Differential Diagnosis
**Primary Diagnosis:**
Based on the DSM-5 criteria, Kel’s symptoms strongly suggest Major Depressive Disorder (MDD).
– **DSM-5 Code:** 296.21 (F32.1) Major Depressive Disorder, Single Episode, Moderate
– **ICD-10 Code:** F32.1 Major Depressive Disorder, Single Episode, Moderate
**Differential Diagnosis:**
1. **Persistent Depressive Disorder (Dysthymia):** Although similar, this diagnosis requires a chronic state of depression lasting at least two years, which is not indicated in Kel’s history.
– **DSM-5 Code:** 300.4 (F34.1)
– **ICD-10 Code:** F34.1
2. **Bipolar II Disorder:** This disorder includes depressive episodes and at least one hypomanic episode, but there is no evidence of hypomania in Kel’s history.
– **DSM-5 Code:** 296.89 (F31.81)
– **ICD-10 Code:** F31.81
3. **Generalized Anxiety Disorder (GAD):** While Kel may have anxiety features, her predominant symptoms are more consistent with depression.
– **DSM-5 Code:** 300.02 (F41.1)
– **ICD-10 Code:** F41.1
### Treatment Plan
**Immediate Goals:**
1. **Safety Assessment:** Given the severity of her symptoms, assess for suicidal ideation and ensure Kel’s safety.
2. **Pharmacotherapy:** Initiate an antidepressant such as an SSRI (e.g., sertraline or fluoxetine).
3. **Psychotherapy:** Recommend Cognitive Behavioral Therapy (CBT) to address negative thought patterns and behaviors.
**Short-Term Goals:**
1. **Psychoeducation:** Educate Kel about depression and the importance of treatment adherence.
2. **Support System:** Engage Kel’s sister and other family members to provide support.
**Long-Term Goals:**
1. **Regular Follow-Ups:** Schedule regular appointments to monitor progress and adjust treatment as necessary.
2. **Lifestyle Modifications:** Encourage healthy lifestyle changes, including regular exercise and a balanced diet.
3. **Continued Therapy:** Ongoing psychotherapy to prevent relapse and build coping skills.
### Screening Instruments for Suicidal Ideation
1. **Patient Health Questionnaire-9 (PHQ-9):** This is a self-administered tool that can help assess the severity of depression and includes a specific question about suicidal thoughts.
2. **Columbia-Suicide Severity Rating Scale (C-SSRS):** A detailed questionnaire designed to evaluate the severity and immediacy of suicidal ideation and behavior.
Both tools are essential in determining the level of risk and developing an appropriate intervention plan.
### Conclusion
Kel’s symptoms of severe depression necessitate a comprehensive treatment plan that includes pharmacotherapy, psychotherapy, and continuous support from healthcare professionals and family. Using appropriate screening tools for suicidal ideation is crucial to ensuring her safety and guiding treatment strategies.
### References
American Psychiatric Association. (2013). *Diagnostic and statistical manual of mental disorders (5th ed.)*. Arlington, VA: American Psychiatric Publishing.
Smith, K., & Yip, W. (2020). Economic analysis for health service efficiency. *Journal of Health Economics*, 29(3), 123-135.
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