Discussion: Depressive-like symptoms.

Discussion: Depressive-like symptoms.

Discussion: Depressive-like symptoms.

The purpose of this paper is to read, assess, and analyze a patient presenting with depressive-like symptoms. The patient presents as a first initial visit. Her presentation and reported history suggest a diagnosis of a cyclothymic disorder and an appropriate treatment plan must be created based on the diagnosis assumed.

Decision #1

Which Decision did you select?

The first decision that I made was to diagnose this patient with cyclothymic disorder. This patient meets criteria for a diagnosis of cyclothymic disorder based on her persistent depressed mood with periodic episodes of feeling “on top of the world,” going 3 days without much sleep and then finally feeling fatigued stating that she eventually “crashes,” her decreased ability to concentrate when she feels sad, and inability to get things done with periodic “bursts of energy.”

Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

I selected this diagnosis because the patient meets criteria, according to the DSM-5, for cyclothymic disorder. The patient reports she has been struggling with these symptoms for years and an individual with cyclomania must have had the symptoms for at least 2 years with many episodes of hypomanic symptoms and depressive symptoms without meeting criteria for an episode of either. Also, cyclothymic disorder can have a significant negative impact on functioning in the individual’s social, occupational, or other facets of their life. No other mental illness meets criteria in the DSM-5 with this presentation (American Psychiatric Association, 2013). Because Stefanie does not meet criteria for either hypomanic episode or major depressive episode and because she is not using substance while exhibiting these symptoms, she meets criteria for cyclothymic disorder

What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

I was hoping to confirm a diagnosis for this patient so she could be treated accordingly with the appropriate medication based on her symptoms. The patient is not getting an adequate amount of sleep and is not completing daily required tasks by allowing them to pile up. The instability in her mood can be managed with a medication to help stabilize her mood which is why a proper diagnosis is so important.

Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?

I expected that this patient would get some clarity by receiving her diagnosis. It may help her make sense of her behaviors and why she struggling in certain areas of her life, This could also give her hope that her troublesome symptoms can be alleviated with pharmacotherapy treatment options.

Why did you select this Decision 2? Support your response with evidence and references to the Learning Resources. Discussion: Depressive-like symptoms.

The second decision that I made was to start this patient on 10 mg of Abilify by mouth daily. Cyclothymic disorder is similar to bipolar disorder and is treated accordingly. Abilify is FDA approved for acute mania/mixed mania, and bipolar maintenance. It works by decreasing dopamine when dopamine is high and increasing dopamine output when dopamine levels are low (Stahl, 2014). Abilify is a good choice because it tends to work sooner than mood stabilizers and can take effect as soon as 1 week.

What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

By starting this patient on 10 mg of Abilify, I was hoping that this patient would haveremission of her symptoms. I was hoping she would be able to get some consistent sleep, her mood would be improved mood and more consistent without random ups and downs, and that she would be able to consistently complete more goal directed activities on a daily basis.

Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?

After Stefanie returned to the clinic in four weeks for a follow-up, she reported that her mood was more stable. I did expect the Abilify to stabilize her mood at least some. The patient reported, she has not felt as sad which goes hand in hand with her mood being more consistent. Stefanie reported that she felt lightheaded upon standing up for the first two weeks of taking the medication which is a common side effect so that was not too surprising. Common initial side effects include dizziness, insomnia, akathisia, activation, nausea, vomiting, and orthostatic hypotension (Stahl, 2014).

 

Decision #3

Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

Stefanie reported orthostatic hypotension after the initial doses for the first 2 weeks but reports that the symptoms have subsided. Therefore, I made the decision to maintain the current dose of Abilify. Orthostatic hypotension is a common side effect when starting the medication and should just be monitored. At this point, because it has not happened in a few weeks and the medication seems to be working well by stabilizing her mood, maintaining the current dose of Abilify at this point seems like the appropriate choice.

What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

I was hoping that the patient would not have any more dizziness upon standing and that the medication would continue to relieve her symptoms related to her cyclothymic disorder and stabilize her mood. It appears to be working well without major side effects at this point.

Ethical considerations might impact treatment plan

An ethical consideration to keep in mind with this patient is her potential to not comply to treatment and medication regimen. Individuals with cyclothymic disorder can have irregular moods and unpredictable behaviors which can make it hard to tell what the patient might do or decide to do. She also could start feeling better and stop taking her medication which would not be productive or benefit a positive prognosis. Before starting a medication, the pros and cons of taking the medication need to be weighed out and the potential side effects must be considered (Newhouse-Oisten, 2017). Considering the patient’s medical history or problems should be considered ethically. For example, if the presents with diabetes mellitus already, an antipsychotic for this disorder may not be the best decision with its potential for negative metabolic effects. Also, monitoring the patient for any movement disorders after taking the medications is important as the patient could potentially develop a movement disorder that could be life-long and interfere with their quality of life.

Conclusion

In conclusion, this patient ended up being diagnosed with cyclothymic disorder. She did not meet criteria for bipolar or depressive disorder. Her symptoms were interfering with her daily life as she was not sleeping or getting daily tasks performed appropriately. Her up and down mood swings was confusing for her as well, and all of her combined symptoms made her want to seek treatment and tell someone what was going on with her. Abilify was the chosen pharmacological treatment options as it can help to stabilize her mood and allow her to get some more consistent sleep. Discussion: Depressive-like symptoms.