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.
Describe the presenting problems.
Generate a primary and differential diagnosis using the DSM5 and ICD 10 codes.
Formulate and prioritize a treatment plan.
Identify and discuss appropriate screening instruments for a patient who has suicidal ideation.
Expert Solution Preview
Introduction:
In this case study, we are presented with Kel, a 42-year-old certified public accountant who is experiencing a variety of mental health symptoms. The purpose of this case study is to analyze and apply critical thinking skills in understanding the psychopathology of mental health patients, develop a treatment plan, and apply evidence-based research.
Answer 1:
The presenting problems in this case include a lack of energy, difficulty completing daily tasks, loss of appetite, weight loss, neglect of personal appearance, isolation from others, decreased work productivity, feelings of sadness and hopelessness, and persistent fatigue.
Answer 2:
Primary Diagnosis: Major Depressive Disorder
DSM-5 Code: 296.20 (F32.0)
ICD-10 Code: F32.0
Differential Diagnosis:
1. Persistent Depressive Disorder (DSM-5 Code: 300.4, ICD-10 Code: F34.1)
2. Bipolar II Disorder (DSM-5 Code: 296.89, ICD-10 Code: F31.81)
3. Adjustment Disorder with Depressed Mood (DSM-5 Code: 309.0, ICD-10 Code: F43.21)
Explanation: The primary diagnosis is Major Depressive Disorder as it aligns with the symptoms and duration described in the case. The differential diagnoses are included to consider alternative possibilities that may account for Kel’s symptoms.
Answer 3:
Treatment Plan:
1. Psychotherapy: Cognitive Behavioral Therapy (CBT) to address negative thoughts and behaviors associated with depression.
2. Medication: Antidepressant medication (SSRIs) to alleviate symptoms of depression.
3. Psychoeducation: Provide information about depression, its causes, and coping strategies.
4. Lifestyle changes: Encourage regular exercise, a balanced diet, and good sleep hygiene.
5. Social support: Facilitate connections with support networks, such as friends, family, or support groups.
6. Regular follow-up: Monitor treatment progress and adjust the treatment plan as needed.
Explanation: The treatment plan focuses on a combination of psychotherapy and medication, which is commonly recommended for Major Depressive Disorder. Psychoeducation, lifestyle changes, social support, and regular follow-up are important aspects to support overall well-being and recovery.
Answer 4:
Appropriate screening instruments for a patient with suicidal ideation include:
1. Columbia-Suicide Severity Rating Scale (C-SSRS)
2. Beck Scale for Suicidal Ideation (SSI)
3. Suicide Ideation Questionnaire (SIQ)
Explanation: These screening instruments are commonly used to assess and measure the severity of suicidal ideation. They provide valuable information to determine the immediate risk level and guide appropriate interventions for the patient’s safety. It is important to select a screening instrument that is validated, reliable, and aligns with the specific needs of the patient population.
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