D. R. is a 24-year-old who has tried three times to complete his college education. While he initially is engaged and excited about classes, he struggles with keeping up with homework. He has had test anxiety in the past and once failed a midterm because he did not show up and did not email the instructor to make up the test. Currently, D. R. cannot continue in school because past failures of classes have stopped government assistance with school. D.R. has felt he never measured up to his other family members who all seem to do just fine in life. D.R. has been on antidepressants since graduating from high school when he was diagnosed with major depression. D. R. lives with 4 other young men who are supportive but are busy with their own lives and really don’t understand why D.R. doesn’t just get out of bed even though he is tired. D. R. used to like hiking, playing guitar, biking, and hanging out with friends. Now he states is tired, tired of being depressed all the time and feels stuck emotionally. Medically, D. R. has tried various antidepressants with varying success. Sometimes he has run out of his medication or the insurance company has messed up and not sent them in time. If he has the medication, D. R. takes them as directed. Alcohol use is occasional, and he also sometimes smokes or uses a hookah Write down your assessment of D. R. and signs of depression he is exhibiting: Write 8 questions you would ask D. R. (not necessarily all at once) to conduct further assessment (things you would like to know about him, how he feels, what his goals are, etc.): Of the following treatments the doctor is offering, list pros and cons of each treatment and indicate which one you would recommend for D. R. at this stage: 1. Continue adding/changing antidepressants 2. Add Lithium to medication regime 3. TMS 4. ECT 5. Holistic options List 10 small steps you would recommend for D. R. (again, not necessarily attempted all at the same time): List areas of cognitive behavior therapy you would address if you were seeing D. R. on a regular basis:
Assessment:
Assess patient present mental illness and medication followup
duration, signs and symptoms of depression, and cause depression
and anxiety.
Signs of depression
-Struggle to complete his homework
-Test anxiety
-Low self-esteem
-lack of social interaction
-Confusion
-Mood swings
Questions:
-why did you struggle with keeping up with homework?
-What is the cause of test anxiety in the past?
-Do you show any interest for make up the test which you
failed?
-At which age exactly you started your antidepressant
medication?
-why did you lose your interest in your daily activities?
-Do you have jealous of your friends they are fine in life?
-Did different types of antidepressants work for you to relieve the
symptoms?
-Why are you not regularly followup the medication regimen?
-do you exercise regularly?
-Do you have any interest or pleasure in doing anything for the
past months?
-when do you feel you are worthless?
Pros and cons:
1, Continue adding antidepressants
-It relieves the symptoms of the long term depression
-Antidepressants have side effects one of the drugs can cause side
effects of other one worse
-it also causes suicidal thoughts
2, Add lithium of medication regimen
-It protects against depression and mania and reduces suicidal and
short term mortality
-Lithium increase weight gain, cause kidney failure and skin
problem
3, TMS
-It treats depression
-Its efficacy in patients who have struggled with medication
-can cause side effects
-It is expensive treatment with long duration for follow-up
4, ECT
-It treats depression and psychotic illness
-It causes side effects and medical complications like physical
pain, memory loss
-It treats treatment-resistant depression
-It covered by insurance
5, Holistic options:
-It improves physical, emotional and spiritual wellbeing
-It is a preventive treatment for depression illness
-It Increases in demand
-It interacts with over the counter medication and prescription
drugs.
Recommendation:
-A patient can reduce his variety of antidepressants and increase
the dose of present medication
-Cognitive-behavioral therapy can provide a positive way for
depression patient
-Increase the social interaction with group therapy
-Provide counseling
-TMS help improves symptoms of depression when antidepressants not
work.
-ECT can cause changes in brain chemistry and relive major
depression
-Do regular exercise
-Try with yoga, meditation and mindfulness therapy
-Take adequate rest to fresh-up the mind
-Stop drinking and smoking
-
D. R. is a 24-year-old who has tried three times to complete his college education. While...
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