Clinical Case Summary:DSM 5-TR diagnosis
Answer the questions below based on the following case study.
A 41-year-old man presents to his PCP with feelings of hopelessness, sadness, and helplessness. He says that he cries for no reason, and has difficulty sleeping. He noticed that the problems began about 6 weeks before, and he did not feel able to shrug them off. He has been drinking more alcohol than usual and has stopped going to work. When on his own, he admitted that he had thought of driving his car into the nearest canal.
Summarize the clinical case.
What is the DSM 5-TR diagnosis based on the information provided in the case?
Which pharmacological treatment would you prescribe including the name, dose, route and frequency of the drug in accordance with the clinical guidelines? Include the rationale for this treatment.
Which non-pharmacological treatment would you prescribe according to the clinical guidelines? Include the rationale for this treatment excluding a psychotherapeutic modality.
Include an assessment of the treatment’s appropriateness, cost, effectiveness, safety, and potential for patient adherence to the chosen medication. Use a local pharmacy to research the cost of the medication and provide the most cost-effective choice for the patient. Use great detail when answering questions 3-5.
Clinical Case Summary
In this case, a 41-year-old man presents with symptoms of depression, including feelings of hopelessness, sadness, and helplessness. He also reports crying for no reason, difficulty sleeping, increased alcohol consumption, and thoughts of self-harm. These symptoms have been present for about six weeks and have negatively impacted his functioning, causing him to stop going to work.
DSM 5-TR Diagnosis
Based on the information provided in the case, the DSM 5-TR diagnosis for this patient would be Major Depressive Disorder (MDD). The criteria met include the presence of five or more of the following symptoms for at least two weeks: depressed mood, loss of interest or pleasure in activities, significant weight loss or gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive guilt, decreased concentration or indecisiveness, and recurrent thoughts of death or suicidal ideation.
Pharmacological Treatment
The pharmacological treatment for Major Depressive Disorder (MDD) typically involves the use of antidepressant medications. In this case, I would prescribe a selective serotonin reuptake inhibitor (SSRI) called sertraline (Zoloft). The initial dose would be 50mg once daily taken orally. This can be gradually increased to a maximum of 200mg per day if necessary. The rationale for choosing sertraline is that it is a commonly prescribed SSRI with proven efficacy in treating MDD. It works by increasing the levels of serotonin in the brain, which helps regulate mood. Sertraline has a well-established safety profile and is generally well-tolerated by most patients.
Non-Pharmacological Treatment
In addition to pharmacological treatment, non-pharmacological interventions are also important in managing depression. In this case, I would recommend cognitive-behavioral therapy (CBT) as a non-pharmacological treatment option. CBT is a form of psychotherapy that focuses on identifying and changing negative thought patterns and behaviors associated with depression. It has been shown to be effective in reducing depressive symptoms and improving overall functioning in individuals with MDD. The rationale for choosing CBT is that it provides the patient with practical tools and strategies to cope with negative emotions and helps address underlying issues contributing to the depression.
Excluding psychotherapeutic modalities, another non-pharmacological treatment option that can be considered is exercise therapy. Regular physical activity has been shown to have mood-enhancing effects and can help alleviate symptoms of depression. Engaging in moderate-intensity aerobic exercise for at least 150 minutes per week has been recommended as an adjunctive treatment for depression.
Assessment of Treatment Appropriateness, Cost, Effectiveness, Safety, and Adherence
Appropriateness: The chosen pharmacological treatment (sertraline) and non-pharmacological treatment (CBT or exercise therapy) are appropriate for the diagnosis of Major Depressive Disorder (MDD). Both options have evidence supporting their efficacy in treating depression.
Cost: The cost of sertraline may vary depending on the pharmacy and location. To determine the most cost-effective choice for the patient, I would research local pharmacies to compare prices. However, generic versions of sertraline are generally more affordable compared to brand-name options.
Effectiveness: Both sertraline and CBT have been shown to be effective in treating depression. Sertraline has a high response rate in reducing depressive symptoms, while CBT helps address underlying cognitive and behavioral factors contributing to depression. Exercise therapy has also been found to be effective as an adjunctive treatment for depression.
Safety: Sertraline is generally safe when taken as prescribed. Common side effects may include nausea, diarrhea, insomnia, or sexual dysfunction. However, it is important to monitor the patient closely for any potential adverse effects and adjust the dosage if necessary.
Adherence: Patient adherence to medication is crucial for the success of treatment. The chosen medication (sertraline) is usually taken once daily, which may improve adherence compared to medications that require multiple doses throughout the day. Additionally, providing the patient with education about the importance of adherence and regular follow-up appointments can help enhance compliance.
In conclusion, based on the clinical case presented, a combination of pharmacological treatment with sertraline and non-pharmacological treatment with cognitive-behavioral therapy or exercise therapy would be appropriate for managing Major Depressive Disorder (MDD). The choice of sertraline as an antidepressant medication is supported by its efficacy, safety profile, and potential for patient adherence. The cost-effectiveness can be determined by researching local pharmacies for the most affordable option.