Nr601 Week 3: Psychiatric Disorders and Screening
Nr601 Week 3: Psychiatric Disorders Purpose
The purpose of student discussions is to provide the opportunity for application of depression and anxiety screening tools to a selected case patient.
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
Explain the purpose of two selected screening tools (CO7)
Interpret the scoring criteria of two selected screening tools (CO7)
Discuss the mechanism of action, side effects and expected onset of action for a selected medication (CO4)
Requirements:
Anxiety and depression are the most common psychiatric problems you will encounter in your primary care practice.
Review this case study
HPI: KF, 56-year-old Caucasian female presents to office with complaints of “no energy and not wanting to go out.” These symptoms have been present for about 3 months and seem worse in the morning and improve slightly through the day. It is hard to get out of bed and get the day started because does not feel rested when she wakes up in the morning. KF reports a “loss of joy”. States” I really don’t feel like going anywhere or doing anything”.
She tries to do at least one social activity a week, but it can be really exhausting. Reports she also has difficulty completing projects for work, she cannot stay focused anymore. She reports not feeling hungry, so she is not eating regularly and has lost some weight. KB has been a widow for 2 years. Her husband died unexpectedly, he had a MI. She recently got a puppy, which she thought would help with the loneliness, but the care of the puppy seems overwhelming at times.
Rest and exercise, specifically yoga and meditation seem to help her feel better. At this time, she does not want to do either, it seems like too much effort to get up and go. She has not tried any medications, prescribed or otherwise. She reports drinking a lot of coffee, but that does not seem to help with her energy levels.
Current medications: Excedrin PM about once a week when she can’t sleep, seems to help a bit. NKDA.
PMH: no major illnesses. Immunizations up to date.
SH: widowed, employed full time as a consultant. Drinks 1 glass of wine almost every night. No tobacco use, no illicit drug use. Previously married 20 years ago while living in France, reports an abusive relationship. The French government gave custody of her son to the ex-husband. She returned to US without her son 10 years ago. She sees her son two times a year, they skype and text “all the time” but she misses him. Her son is now an adult and is considering moving to the US.Nr601 Week 3: Psychiatric Disorders
FH: Parents are alive and well. Has one son, age 21, he is healthy but lives in France with his father.
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 3 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. Last menstrual period 4 years ago.
PSYCHIATRIC: No history of diagnosed depression or anxiety. Reports history of great anxiety due to verbal and concern for physical abuse, reports feeling very sad and anxious when divorcing and leaving her son in France. Did not seek treatment. She started to feel better after about 4 months.
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 KF.
Explain in detail why each screening tool was chosen. Include the purpose and time frame of each chosen tool.
Score KF 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 KF. Remember to consider both physical and mental health differential diagnoses when answering this question. (2-3 sentences).
What medication or treatment is appropriate for KF based on her 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 KF. Include initial prescribing information.
If the medication works as expected, when should KF expect to start feeling better?
Nr601 Week 3: Psychiatric Disorders Answer
Psychiatric Disorders Screening Tools
In the realm of psychiatric disorders, careful screening is pivotal. Two widely recognized screening tools for depression and anxiety, the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder 7 (GAD-7), are integral in assessing and managing these conditions.Nr601 Week 3: Psychiatric Disorders
Screening Tools:
1. Patient Health Questionnaire (PHQ-9) for Depression
Purpose: PHQ-9 is a versatile instrument designed to screen, diagnose, monitor, and gauge the severity of depression. It seamlessly incorporates DSM-V diagnostic criteria for depression symptoms, providing a concise self-report mechanism (Moriarty, Gilbody, McMillan, & Manea, 2015). Importantly, it evaluates symptom frequency, contributing to a severity index score.
The ninth question specifically addresses suicide ideation, enhancing its comprehensive nature. PHQ-9 is chosen due to its applicability across various age groups, including adolescents like K.F. Additionally, its non-scored follow-up question aids in assessing the impact of depressive symptoms on overall functionality.
Its efficiency in follow-up assessments allows for tracking patient progress. The tool demonstrates high validity in mental health, supporting accurate diagnosis and treatment monitoring. Notably, it is user-friendly, requiring just a few minutes for completion (Moriarty et al., 2015).Nr601 Week 3: Psychiatric Disorders
2. Generalized Anxiety Disorder 7 (GAD-7) for Anxiety
Purpose: GAD-7 is a 7-item survey tailored for evaluating Generalized Anxiety Disorder (GAD) and its severity. Each item prompts respondents to assess the severity of anxiety symptoms over the preceding two weeks. Response options range from “not at all” to “nearly every day.” The tool is chosen for its brevity and effectiveness in capturing the nuances of anxiety symptoms. Its simplicity facilitates quick administration, making it suitable for routine use in clinical settings. GAD-7 provides valuable insights into the severity of anxiety, aiding in timely intervention and personalized treatment plans (Spitzer, Kroenke, Williams, & Löwe, 2006).Nr601 Week 3: Psychiatric Disorders
Utilizing these screening tools ensures a systematic and comprehensive approach to identifying and addressing depressive and anxiety-related symptoms, contributing to enhanced patient care.Nr601 Week 3: Psychiatric Disorders
References:
Moriarty, A. S., Gilbody, S., McMillan, D., & Manea, L. (2015). Screening and case finding for major depressive disorder using the Patient Health Questionnaire (PHQ-9): a meta-analysis. General Hospital Psychiatry, 37(6), 567-576.
Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166(10), 1092-1097.
