Module 3 Discussion: Chapter 5, Case 2- Helen is a 45-year-old African American female)

Goal: To analyze and apply critical thinking skills in the psychopathology of mental health patients and provide treatment and health promotion while applying evidence-based research.

Chapter 5, Case 2-Helen is a 45-year-old African American female who separated two months ago from her husband of 25 years after he had an extramarital affair. In addition to running the household and managing 18-year-old fraternal twins, she works part-time at a local dry cleaning business. Helen started experiencing increased anxiety, lack of ability to fall asleep, and daytime tiredness over the last three months. The symptoms have progressed over the last four weeks to increasing sadness, inappropriate guilt, poor appetite, and decreased energy levels. Helen is struggling to maintain her usual activities and is starting to feel that “life is not worth living,” but she has not had any suicide ideation per se. Helen has no personal or family history of psychiatric illness. She uses alcohol once or twice a month but not to excess. Helen’s medical history is significant for lower-extremity neuropathy of unknown origin.

Questions:

Remember to answer these questions from your textbooks and clinical guidelines to create your evidence based treatment plan. At all times, explain your answers.

1. Summarize the clinical case.
2. Create a list of the patient’s problems and prioritize them.
3. Which pharmacological treatment would you prescribe? Include the rationale for this treatment.
4. Which non-pharmacological treatment would you prescribe? Include the rationale for this treatment.
5. Include an assessment of treatment’s appropriateness, cost, effectiveness, safety, and potential for patient adherence.

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.  Your initial post is worth 8 points.
• You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)
• All replies must be constructive and use literature where possible.
• Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.
• Late work policies, expectations regarding proper citations, acceptable means of responding to peer feedback, and other expectations are at the discretion of the instructor.
• You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.

Sample Essay

A 45 y/o African-American female patient presents to the clinic. The patient started with symptoms such as increased anxiety, insomnia, and daytime tiredness three ago. However, the patient began experiencing increased sadness, decreased energy levels, poor appetite, and inappropriate guilt in the last four weeks. Although the patient has no suicidal ideations and takes moderate alcohol quantities at most twice a month, she struggles with activities of daily living (ADLs) and feels life unworthy. The patient separated with spouse two months back after the latter engage in extramarital affairs. She takes care of her 18 y/o twins and all household needs with the money she gets after working part-time in a dry-cleaning business. The symptoms show the patient may have depression (major depressive disorder) triggered by marriage problems and difficulties meeting financial needs since she has no history of psychiatric illnesses. On the mnemonic SIGECAPS diagnostic tool, a patient is diagnosed with MDD if the patient shows five or more of the following for two or more weeks (Maurer et al., 2018).

S=Sleep decreased (Insomnia with 2-4 am awakening) or hypersomnia.

I=Interest decreased in activities (anhedonia)

G=Guilt or worthlessness

E=Energy decreased

C=Concentration difficulties

A=Appetite disturbance or weight loss/weight gain

P=Psychomotor retardation/agitation

S=Suicidal thoughts or plans

The subject patient (Helen) shows five of the highlighted SIGECAPS symptoms; sleep decrease/insomnia, guilt or worthlessness, energy decrease, appetite disturbance, and agitation.

List of the Patient’s Problems and Priorities

           The feeling that “life is not worth living” shows that the patient requires professional health assistance to treat her condition to avoid escalation to suicidal idealities or even suicide. Lower-extremity neuropathy condition also requires immediate treatment to prevent the patient from permanently losing the ability to work. The lack of appetite is the major contributor to the reduced energy levels, and the patient requires assistance with improving appetite to avoid weight loss. The patient needs help from her daughters or caregiver in performing activities of daily living. Further, the difficulty of falling asleep needs to be addressed immediately to ensure the patient gets enough sleep and rest to work efficiently and avoid tiredness during the daytime. According to Gartlehner et al. (2017), pharmacological and non-pharmacological interventions are recommended for treatment of the condition and helping the patient learn the coping strategies for major depressive disorder.

Pharmacological Treatment to Prescribe and Rationale for the Treatment

The student would prescribe Celexa (citalopram) to the patient’s treatment. Celexa is an SSRI antidepressant approved by the U.S. Food and Drug Administration (FDA) approved for the treatment of the major depressive disorder (MDD) (RxList, 2021). It is orally administered and can be taken alone or with other drugs but with the primary physician’s approval. The recommended dosage for Helen would be to start with 20mg/daily and increase to 40mg/daily after one week (7 days). The rationale for the choice of Celexa is because SSRI antidepressant has minimal side effects, and the dosage is based on her being an adult with MDD. For treatment of lower-extremity neuropathy condition, the student would recommend Capsaicin cream as a topical treatment.

Non-pharmacological Treatment to Prescribe and Rationale for the Treatment

The student would recommend cognitive behavioural therapy (CBT) for major depressive disorder (MDD) and physical therapy for lower-extremity neuropathy treatment. Cognitive-behavioural therapy (CBT) is a talk therapy targeting nurturing problem coping techniques and “reprogramming” destructive or negative thoughts since thoughts directly impact people’s feelings and how they eventually behave (Gartlehner et al., 2017). Gartlehner et al. (2017) noted that CBT was the most widely used evidence-based psychotherapy model for improving patient cognition.

Treatment Appropriateness, Cost, Effectiveness, Safety & Potential for Patient Adherence

           The recommended pharmacologic and non-pharmacologic treatment approaches are appropriate in treating MDD and lower-extremity neuropathy and improving the patient’s coping mechanism and quality of life. The treatment plan is effective and safe except for skin burning and irritation when using Capsaicin cream for lower-extremity neuropathy. The average cost for purchasing 30 tablets of Celexa (citalopram) is $16.43, and the GoodRx coupon price of $11.60 (GoodRx, 2021a). Capsaicin cream costs as low as $7.59 in Walgreens outlets (GoodRx, 2021b). Improving potential for patient adherence to the treatment plan requires patient follow-up and patient education.

References

GoodRx (2021a). Celexa Citalopram. https://www.goodrx.com/celexa (Links to an external site.)

GoodRx (2021b). Capsaicin. https://www.goodrx.com/capsaicin (Links to an external site.)

Gartlehner, G., Wagner, G., Matyas, N., Titscher, V., Greimel, J., Lux, L., … & Lohr, K. N. (2017). Pharmacological and non-pharmacological treatments for major depressive disorder: A review of systematic reviews. BMJ Open, 7(6), e014912. http://dx.doi.org/10.1136/bmjopen-2016-014912 (Links to an external site.)

Maurer, D. M., Raymond, T. J., & Davis, B. N. (2018). Depression: Screening and diagnosis. American Family Physician, 98(8), 508-515. https://www.aafp.org/afp/2018/1015/afp20181015p508.pdf (Links to an external site.).

RxList (2021). Celexa. https://www.rxlist.com/celexa-drug.htm#description