L.s symptoms match the DSM-5 diagnostic criteria for major depressive disorder described in the paragraph above. However, the patient’s partner has reported that he also presents with dysphoria, low energy/fatgue, increased anxiety, and decreased concentration. This indicates that G. L. has another mental condition that is co-occuring with major depressive disorder. Therefore, it is inappropriate to conclude that he has major depressive disorder alone.

L.s symptoms match the DSM-5 diagnostic criteria for major depressive disorder described in the paragraph above. However, the patient’s partner has reported that he also presents with dysphoria, low energy/fatgue, increased anxiety, and decreased concentration. This indicates that G. L. has another mental condition that is co-occuring with major depressive disorder. Therefore, it is inappropriate to conclude that he has major depressive disorder alone.

Generalized anxiety disorder alone

1. L.s symptoms match the DSM-5 diagnostic criteria for generalized anxiety disorder described in the paragraph above. In addition to these symptoms, the patient also has depressed mood, poor appetite, weight loss, low energy, decresed concentration, anhedonia, lack of motivation, feelings of hopelessness, intermittent suicidal ideation, and a passive death wish. This indicates that G. L. has another mental condition that is co-occuring with generalized anxiety disorder. Therefore, it is inappropriate to conclude that he has generalized anxiety disorder alone.

Reflections:

After reviewing the patient’s symptoms together with my preceptor, we have agreed that he has an acute risk to self due to suicidal thoughts. Again, G. L. is unable to take good care of himself in the community owing to the lack of a proper support system. Therefore, he requires inpatient hospitalization. From this case, I have learned that older adults can present with multiple mental illnesses which require careful evaluation, diagnosis, and treatment. If I were the provider who met the patient first, I would conduct a comprehensive assessment to make an accurate diagnosis before administering any medications.

Case Formulation and Treatment Plan:

• Addmit the patient for further evaluation and treatment
• Stabilize the patient with psychopharmacologic and psychopharmacologic interventions
• Psychopharmacologic treatment: Aripiprazole 10 mg p.o. every morning, Taper bupropion XL to 150 mg p.o. daily, Initiated mirtazapine 7.5 mg p.o. nightly, Taper sertraline to 50 mg p.o. every morning (Avasthi & Grover, 2018).
• Non-pharmacologic treatment: Provide psychoeducation (individual therapy) daily (Carlat, 2017).
• Alternative therapy: Provide psychoeducation (group therapy) involving significant others (Carlat, 2017).
• Referral: Refer the patient to a primary care physician for further physiological evaluation.
• Follow-up: Conduct follow-up after every 4 weeks to monitor patient’s progress.

Rationale: The rationale for the chosen treatment or management plan is to ensure that G. L. experiences an improvement in symptoms and he is able to attain good quality of life (Avasthi & Grover, 2018).

Discussion Prompts

• Do you think social support from family members and significant others can help to improve G. L.’s symptoms?
• Describe members of interprofessional teams that you would involve in the care of the patient to ensure better health outcomes.
• Considering the patient’s age, would individual psychotherapy produce better outcomes when compared to a group therapy?

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Avasthi, A., & Grover, S. (2018). Clinical practice guidelines for management of depression in elderly. Indian Journal of Psychiatry, 60(Suppl 3), S341–S362. https://doi.org/10.4103/0019-5545.224474

Badireddy, M., & Baradhi, K. M. (2020). Chronic anemia. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK534803/

Botturi, A., Ciappolino, V., Delvecchio, G., Boscutti, A., Viscardi, B., & Brambilla, P. (2020). The role and the effect of magnesium in mental disorders: A systematic review. Nutrients, 12(6), 1661. https://doi.org/10.3390/nu12061661

Carlat, D. J. (2017). The psychiatric history and the psychiatric review of symptoms. The psychiatric interview (4th ed. Ch 14-18 & Ch 23-24). Wolters Kluwer.

Centers for Disease Control and Prevention. (2020). Heart disease and mental health disorders. https://www.cdc.gov/heartdisease/mentalhealth.htm

Polcwiartek, C., Atwater, B. D., Kragholm, K., Friedman, D. J., Barcella, C. A., Attar, R., Graff, C., Nielsen, J. B., Pietersen, A., Søgaard, P., Torp-Pedersen, C., & Jensen, S. E. (2021). Association between ECG abnormalities and fatal cardiovascular disease among patients with and without severe mental illness. Journal of the American Heart Association, 10(2), e019416.  Order A Similar Paper