Anxiety and depression are the most common psychiatric problems you will encounter in your primary care practice.
Review this case study
HPI: CM, 58-year-old female has arrived for an office visit with complaints of “fatigue, no energy & feeling depressed”. These symptoms have been present for about 5-6 months. It is hard to get out of bed and get the day started because CM does not feel rested when she gets up in the morning. CM reports “deep sadness & depression over the loss of her partner & soulmate”. Our last conversation was an argument. I wish I could go back in time. CM States” I really don’t feel like eating or leaving the house”. She makes plans with close friends because they insist that she needs to get out of the house, but it can be really exhausting because everyone asks the same questions leading to the same discussions about the loss of her partner. Reports she also has difficulty completing calls and charting at work and cannot concentrate. CM reports not eating regularly and has lost 10lbs since the last office visit. CM lost her partner about 8 months ago. Her partner died as a result of injuries due to an MVA. Her oldest son has a 5-year-old daughter who just started kindergarten, her son asked her to pick up her granddaughter from school. CM thought it would help with the loneliness, but leaving the house to pick up and take care of her granddaughter seems overwhelming at times. Driving the car causes anxiety. CM’s neighbor has been asking her to walk around the block 2-3 times a week but she has declined. CM states, even though it might help distract from my sadness, I am not interested in activities or exercise, it is too much effort to get up and go. CM has not tried any medications, prescribed or OTC for symptoms. She reports drinking dark roast coffee and green tea but there is no improvement in energy levels.
Current medications: Melatonin, 1-2 times a week
PMH: no major illnesses. Appendectomy 12 years old, Immunizations up to date. COVID Vaccinated x2 Pfizer.
SH: employed part time as a case manager. Drinks 1 glass of wine 3-4 nights a week. No tobacco use, no illicit drug use.
FH: Partner of 38 years suddenly passed due to MVA, reports a chaotic relationship. They were separated at the time of the MVA. Parents are alive and live in another state. Minimal contact with parents for 10 years. Has a 30-year-old daughter. They have not spoken due to a disagreement for 4 years. 28-year-old son, 22-year-old son, 4 grandchildren.
CONSTITUTIONAL: reports weight loss of 10 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 6 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, depressed, and anxious after loss of partner. Sad about not speaking to parents and daughter. Did not seek treatment. Started to feel better about the loss of partner after 3 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.
- Research screening tools for anxiety and depression. Choose one screening tool for anxiety and one screening tool for depression that you feel are appropriate to screen patient.
- Explain in detail why each screening tool was chosen. Include the purpose and time frame of each chosen tool.
- Score patient 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 your patient. Remember to consider both physical and mental health differential diagnoses when answering this question. (2-3 sentences).
- What medication or treatment is appropriate for your patient 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 your patient. Include initial prescribing information.
- If the medication works as expected, when should your patient expect to start feeling better?
For patient C.M., I chose the Generalized Anxiety Disorder scale (GAD-7) to assess for anxiety and the Patient Health Questionnaire- 9 (PHQ-9) to assess for depression. The GAD-7 is an assessment of 7 items which help to accurately diagnose generalized anxiety disorder (GAD) (Dhira, et al., 2021). This scale includes questions regarding feeling nervous, annoyed, irritable, or afraid within the last 2 weeks (Dhira, et al., 2021). This is a brief screening tool a provider can use in the office to diagnose a patient with minimal, mild, moderate, or severe anxiety (Dhira, et al., 2021).
The PHQ-9 screening tool is used to screen at risk populations and monitor the severity of depression to determine a proper treatment plan (Cumbe, et al., 2020). The PHQ-9 consists of nine-items that refer to the patients past 2 weeks (Cumbe, et al., 2020). The items include evaluating the patient’s appetite, sleep, energy, interest in doing things and mood (Cumbe, et al., 2020). This screening tool determines if the patient is suffering from minimal, mild, moderate, moderately severe, or severe depression….Kindly click the purchase icon to purchase the full solution at $5