Requirements:
Anxiety and depression are the most common psychiatric problems you will encounter in your primary care practice.
Review this case study
HPI: BT, 50-year-old Caucasian male presents to office with complaints of “no energy and staying in bed all day.” These symptoms have been present for about 4 months and seem worse in the morning. It is hard to get out of bed and get the day started because he does not feel rested when he gets up in the morning. BT reports “deep sadness & heartache over the loss of his wife”. States” I really don’t feel like making plans or going out”. He tries to make plans with family or friends once a week, but it can be really exhausting because everyone asks about how he is handling the loss. Reports he also has difficulty completing projects for work, he cannot stay focused anymore. He reports not eating regularly and has lost some weight. BT has been a widower for 10 months. His wife died unexpectedly, she had an MI. His oldest daughter has a 2-year-old daughter, she asked him to babysit a couple of times, which he thought would help with the loneliness, but the care of his granddaughter seems overwhelming at times. Rest, evening walks, & lifting weights 2 days a week help him feel better. At this time, he does not want to do any activities or exercise, it seems like too much effort to get up and go. He has not tried any medications, prescribed or otherwise. He reports drinking a lot of coffee, but that does not seem to help with his energy levels.
Current medications: Tylenol PM about once a week when he can’t sleep, does not help.
NKDA.
PMH: no major illnesses. Immunizations up to date. COVID Vaccinated.
SH: widowed, employed part time as a computer programmer. Drinks 1 beer almost every night. No tobacco use, no illicit drug use. Previously married 25 years ago, reports a passive aggressive, abusive relationship that ended in divorce. The judge gave full custody of his children to his ex-wife. The last time he saw his son was10 years ago. He lives in another stated. He sees his daughter 1-2 times a month. He would like to talk to his son but he is concerned the relationship cannot be repaired because he moved out during the divorce.
FH: Parents are alive and well. Has a daughter 20 and a son 18.
ROS
CONSTITUTIONAL: reports weight loss of 4-5 pounds, no fever, chills, or weakness reported. Daily fatigue.
HEENT: Eyes: No visual loss, blurred vision, double vision or yellow sclera. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose or sore throat.
CARDIOVASCULAR: No chest pain, chest pressure or chest discomfort. No palpitations or edema.
RESPIRATORY: No shortness of breath, cough or sputum.
GASTROINTESTINAL: Reports decreased appetite for about 4 months. No nausea, vomiting or diarrhea. No abdominal pain or blood.
NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.
GENITOURINARY: no burning on urination.
PSYCHIATRIC: No history of diagnosed depression or anxiety. Reports history feeling very sad and anxious about loss of wife. Sad about not speaking to his son. Did not seek treatment. He started to feel better about the loss of his wife after 6 months but the grief and depression has returned.
ENDOCRINOLOGIC: No reports of sweating, cold or heat intolerance. No polyuria or polydipsia
ALLERGIES: No history of asthma, hives, eczema or rhinitis.
Discussion Questions:
Research screening tools for depression and anxiety. Choose one screening tool for depression and one screening tool for anxiety that you feel are appropriate to screen BT.
Explain in detail why each screening tool was chosen. Include the purpose and time frame of each chosen tool.
Score BT using both of your chosen screening tools based on the information provided (not all data may be provided, those areas can be scored as not present). Pay close attention to the listed symptom time frame for your chosen assessment tool. In your response include what questions could be scored, and your chosen score. Interpret the score according to the screening tool scoring instructions. Assume that any question topics not mentioned are not a concern at this time.
Identify your next step for evaluation and treatment for BT. Remember to consider both physical and mental health differential diagnoses when answering this question. (2-3 sentences).
What medication or treatment is appropriate for BT based on his screening score today? Provide the rationale. Any medications should include the medication class, mechanism of action of the medication and why this medication is appropriate for BT. Include initial prescribing information.
If the medication works as expected, when should BT expect to start feeling better?
