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.
Sample Answer
Case Scenario
The patient BT is experiencing a depressive condition which is worsening as time goes by. Numerous screening tools can be used to screen the patient on depression and anxiety. One of the screening tools that can be used to screen the patient is the Hospital Anxiety and Depression Scale (HADS). The screening tool has some questions on how a person enjoys the things they used to do, fears something bad happening, losing interest in most of the things, among many others (SVRI, 2020). This is effective in establishing the patient’s wellbeing for the last six months. The patient has been experiencing the condition for months, and numerous factors such as divorce and the inability to see his children make him depressive. This is a general screening tool that can be used for either anxiety or depression. Anxiety can be screened by using the Generalized Anxiety Disorder 7-Item (GAD-7). This is an effective tool for assessing a two-week health condition. This tool includes tests such as inability to stop worrying, feeling anxious, and trouble relaxing, among other factors (National HIV Curriculum, 2020). The patient is experiencing some of the factors.
The patient scored 17 on the GAD-7 scale for anxiety, indicating that he has severe anxiety according to the scale. Some of the key scale questions that led to high readings of the scale included worrying too much about different things, trouble relaxing, and being afraid of something awful happening. The HAD scale for depression shows that the patient is depressive. The patient scored 21, which is an abnormal case according to the rating of the scale. Most of the factors that hit the scale of 3 include not feeling cheerful, being over-worried, lack of enjoyment on the things he used to enjoy before, and the feeling of being slowed down. The patient requires a combination of pharmacological and psychotherapeutic interventions to reduce the high episodes of anxiety and depression.
The medications suitable for the patient under chronic anxiety and depressive conditions include Sertraline 50 mg/day, which can be titrated depending on the condition. Sertraline encourages relaxation and sleep and effectively controls anxiety, depression, and trauma (Drugs.com, 2019). Sertraline belongs to the selective serotonin reuptake inhibitors (SSRIs) class and works by inhibiting the CNS neuronal uptake of serotonin (Then et al., 2017). Sertraline also causes weight gain and thus balances the physical body loss due to the depressive condition. I would also prescribe Oxandrolone 10 mg/day to increase the appetite for eating. The drug belongs to the class of Androgens and Anabolic steroids and works by binding androgen receptors to the cytoplasm of the muscle cells. The effectiveness of each of the medications becomes effective in nine to 14 days, and thus the patient is expected to recover within two weeks.
