Nurs 6670 A woman with depression

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Decision Tree

The purpose of this paper is to read, assess, and analyze a patient
presenting with depressive-like symptoms. The patient presents as a
first initial visit. Her presentation and reported history suggest a
diagnosis of a cyclothymic disorder and an appropriate treatment plan
must be created based on the diagnosis assumed.

Decision #1

Which Decision did you select?

The
first decision that I made was to diagnose this patient with
cyclothymic disorder. This patient meets criteria for a diagnosis of
cyclothymic disorder based on her persistent depressed mood with
periodic episodes of feeling “on top of the world,” going 3 days without
much sleep and then finally feeling fatigued stating that she
eventually “crashes,” her decreased ability to concentrate when she
feels sad, and inability to get things done with periodic “bursts of
energy.”

Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

I
selected this diagnosis because the patient meets criteria, according
to the DSM-5, for cyclothymic disorder. The patient reports she has been
struggling with these symptoms for years and an individual with
cyclomania must have had the symptoms for at least 2 years with many
episodes of hypomanic symptoms and depressive symptoms without meeting
criteria for an episode of either. Also, cyclothymic disorder can have a
significant negative impact on functioning in the individual’s social,
occupational, or other facets of their life. No other mental illness
meets criteria in the DSM-5 with this presentation (American Psychiatric
Association, 2013). Because Stefanie does not meet criteria for either
hypomanic episode or major depressive episode and because she is not
using substance while exhibiting these symptoms, she meets criteria for
cyclothymic disorder

What were you hoping to achieve by
making this Decision? Support your response with evidence and references
to the Learning Resources.

I was hoping to confirm a
diagnosis for this patient so she could be treated accordingly with the
appropriate medication based on her symptoms. The patient is not getting
an adequate amount of sleep and is not completing daily required tasks
by allowing them to pile up. The instability in her mood can be managed
with a medication to help stabilize her mood which is why a proper
diagnosis is so important.

Explain any difference
between what you expected to achieve with Decision #1 and the results of
the Decision. Why were they different?

I expected that
this patient would get some clarity by receiving her diagnosis. It may
help her make sense of her behaviors and why she struggling in certain
areas of her life, This could also give her hope that her troublesome
symptoms can be alleviated with pharmacotherapy treatment options.

Why did you select this Decision 2? Support your response with evidence and references to the Learning Resources.

The
second decision that I made was to start this patient on 10 mg of
Abilify by mouth daily. Cyclothymic disorder is similar to bipolar
disorder and is treated accordingly. Abilify is FDA approved for acute
mania/mixed mania, and bipolar maintenance. It works by decreasing
dopamine when dopamine is high and increasing dopamine output when
dopamine levels are low (Stahl, 2014). Abilify is a good choice because
it tends to work sooner than mood stabilizers and can take effect as
soon as 1 week.

What were you hoping to achieve by
making this Decision? Support your response with evidence and references
to the Learning Resources.

By starting this patient on
10 mg of Abilify, I was hoping that this patient would haveremission of
her symptoms. I was hoping she would be able to get some consistent
sleep, her mood would be improved mood and more consistent without
random ups and downs, and that she would be able to consistently
complete more goal directed activities on a daily basis.

Explain
any difference between what you expected to achieve with Decision #2
and the results of the Decision. Why were they different?

After
Stefanie returned to the clinic in four weeks for a follow-up, she
reported that her mood was more stable. I did expect the Abilify to
stabilize her mood at least some. The patient reported, she has not felt
as sad which goes hand in hand with her mood being more consistent.
Stefanie reported that she felt lightheaded upon standing up for the
first two weeks of taking the medication which is a common side effect
so that was not too surprising. Common initial side effects include
dizziness, insomnia, akathisia, activation, nausea, vomiting, and
orthostatic hypotension (Stahl, 2014).

Decision #3

Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

Stefanie
reported orthostatic hypotension after the initial doses for the first 2
weeks but reports that the symptoms have subsided. Therefore, I made
the decision to maintain the current dose of Abilify. Orthostatic
hypotension is a common side effect when starting the medication and
should just be monitored. At this point, because it has not happened in a
few weeks and the medication seems to be working well by stabilizing
her mood, maintaining the current dose of Abilify at this point seems
like the appropriate choice.

What were you hoping to
achieve by making this Decision? Support your response with evidence and
references to the Learning Resources.

I was hoping
that the patient would not have any more dizziness upon standing and
that the medication would continue to relieve her symptoms related to
her cyclothymic disorder and stabilize her mood. It appears to be
working well without major side effects at this point.

Ethical considerations might impact treatment plan

An
ethical consideration to keep in mind with this patient is her
potential to not comply to treatment and medication regimen. Individuals
with cyclothymic disorder can have irregular moods and unpredictable
behaviors which can make it hard to tell what the patient might do or
decide to do. She also could start feeling better and stop taking her
medication which would not be productive or benefit a positive
prognosis. Before starting a medication, the pros and cons of taking the
medication need to be weighed out and the potential side effects must
be considered (Newhouse-Oisten, 2017). Considering the patient’s medical
history or problems should be considered ethically. For example, if the
presents with diabetes mellitus already, an antipsychotic for this
disorder may not be the best decision with its potential for negative
metabolic effects. Also, monitoring the patient for any movement
disorders after taking the medications is important as the patient could
potentially develop a movement disorder that could be life-long and
interfere with their quality of life.

Conclusion

In
conclusion, this patient ended up being diagnosed with cyclothymic
disorder. She did not meet criteria for bipolar or depressive disorder.
Her symptoms were interfering with her daily life as she was not
sleeping or getting daily tasks performed appropriately. Her up and down
mood swings was confusing for her as well, and all of her combined
symptoms made her want to seek treatment and tell someone what was going
on with her. Abilify was the chosen pharmacological treatment options
as it can help to stabilize her mood and allow her to get some more
consistent sleep.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders

(5th edition). Wahsington, D.C: Author.

Laureate Education. (2017d). A young woman with depression [Interactive media file].

Baltimore, MD: Author.

Newhouse-Oisten, M. K., Peck, K. M., Conway, A. A., & Frieder, J. E. (2017). Ethical

Considerations
for Interdisciplinary Collaboration with Prescribing Professionals.
Behavior analysis in practice, 10(2), 145–153. https://doi.org/10.1007/s40617-017-0184-x

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