Psych NP Case Studies - Episode 1: 36 Year old Depressed Female
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- Опубліковано 28 вер 2024
- Hey guys this is Episode 1 in a new video series called Case Studies!
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Nice! Was thinking Lexapro too. More of these please.
The Psych NP thank you !
1st, great channel, and i really like the 2 providers in the video, i subscribed :-)
What would I do?
Any medication in these types of situations will not cure her. They can only assist in providing the actual cure(s). She is a very very very clear case to me.
1- She needs better/ more effective coping mechanisms/ techniques, that someone needs to teach her (in your cases as the providers, you would have to teach her. Where as with other people, 1 reason they were able to avoid progressing into her stage is because they had/ have others in their life who DO have the effective coping techniques, and those other people teach/ share it. Be it a friend, sibling, parent, teacher, etc. Since she didn't/ doesn't have that, you providers have to be the one to teach her).
2- She needs actual guidance and direction regarding her life and circumstances. Specific advices, tips, instructions, that will help her improve her specific situation/ circumstance(s). In her particular case....her loosing her job/ LACK OF WORK/ lack of success in finding another job, is the biggest problem/ trigger in her life (that plus the fact that shes lacking effective coping mechanisms, which if she had, she would have lost her job but still not have fallen into a deep, or AS deep, of depression, that she has fallen into. Aside from the fact that I would say that she hasn't even fallen into an actual deep, severe depression, it may just appear that way since it's noticeably far from her baseline and she knows it. Conveying this to her (along with the fact that its not as bad as she may think, and that her feelings and situation can definitely be improved and fixed, will let her feel some level of new found control, empowerment, and hope/ hopefulness, which in itself can lift her overall mood/ spirits, tremendously. And there's a reason why, but I won't turn this into a Lecture lol). But as I was saying, the specific advice, tips and directions to improve her actual situation and circumstance, she lost her CNA job. Informing and guiding her with the following information: As a CNA, 1 of the CHEAT CODES (also as a nurse), is getting with a nursing/ healthcare AGENCY! If you have 6 months to a years experience, they are SO easy to get into, and QUICK to get into. They even pay more, along with so many other positives/ perks/ benefits (in relation to working with 1 company/ facility). She would find a job almost immediately this way ("Search for CNA agency's near you"). As the provider, (your own judgment call), if you felt she would be a good worker, to help her even more, could even offer to be 1 of her professional and/ or personal references.
Another thing that's causing some of her feelings or depression, anxiety and discomfort, is her getting into arguments with her mate.........as a result of money issues, and as a result of HER adverse, negative, undesirable thoughts, feelings, etc...from her loosing her job. Also from her feeling guilty about the arguments. Also from her feeling somewhat nervous or uneasy about these arguments eventually leading into losing him. This is another area that needs to be targeted. I would ASK her if I was there (and not assume, but since i'm not there, i'll assume this time) if she was usually the cause of the start of those arguments with her mate. If that's the case, then it's even more reason why I also suspect and suggest that she needs to learn better communication skills, which in her case will probably have to include expressing and communicating her thoughts, feelings and discomforts better, and learning to gently and considerately communicate and not: argue, yell, insult, blame, taking out her bad feelings on him (I would 1st ask if she does this, instead of assuming), listen to respond (instead of listen to understand). All things to be conveyed and taught to her. Even include role play communications/ arguments, between you the provider, and her...to practice, and not just once..repeatedly.
3- The medication aspect, in THIS particular case it's not even really needed, but it can be used as an assist, to either possibly speed the process up, or to make her feel more comfortable during the process, with a very brief antidepressant, or anti-anxiety medication (JUST to start with/ taken just a small small small few times to start with, not something for her to continue taking more than a few rounds/ doses. We want her to actually get better, not start to avoid/ dismiss what will get her better while growing reliant on the med that only temporarily masks the problem and not get rid of it).
With this said, its 1 of the many reasons i wish (and want) Psych NP's and Psychiatrists to be doing more therapy along with the Medication Management (for many many reasons). BUT, we know why that is....get paid WAYYYYYY more money to just do medication management. Which in turn is why we need to fight to change some of these laws and policies so that Therapy + Medication Management/ combo, pays WAY more/ get reimbursed way more, than just doing medication management. Then we'd be moving into the right directions. Which I plan on soon starting the work work to change. :-)
Good luck and God bless guys.
Excellent video! I can tell you as a clinical pharmacist, I wouldn't touch any psychotropic drugs before first getting a full panel of thyroid and hormone levels. I'd want to make sure her estrogen, progesterone AND testosterone levels were good, as well as T3 , TSH and T4. If that is all good, then Lexapro is a good choice to start.
Thank you both !
Please post more!
I’m a PMHNP student . I have not started clinical yet! Thanks again!
I’m only 15 I wanna be a psych np though .I would try to refer her to a therapist before starting her on medication if that’s an option
Please post more of these!!!!!! Looooove them!
Adjustment disorder with chronic anxiety and mild to moderate depressive symptoms. I would start her on 10mg of Lexapro and 0.5 mg Xanax to take as needed when her anxiety and stress spikes. Discontinuation of xanax would take place after the lexapro is seen to be affective. After she is stable on the Lexapro and is off the xanax, I would do an ADHD exam to rule out ADHD. If ADHD is present a stimulant medication may be necessary. A very low starting dose of whatever stimulant I choose would be given as to not trigger more anxiety.
THANK YOU ALWAYS-ALEXIS KIRONDE
First I’d ween her off all meds they’re obviously not helping. Query her relationship, 6 hr sleep patterns and focus on diet and activities. Possible low self esteem issues pushing towards antisocial behaviour. Family relationships and query the alcohol intake (1 glass of wine every 2 weeks) sounds very specific if not fictional. Query blood tests for deficiencies in vitamins and iron.
Focus on her degree of sport, it must interest her if she completed the degree. Maybe a change in career direction steer away from nursing.
Hey guys, so the biggest issue is that the pt was sold the lie that if she goes to college and graduates, she will get a good job. BA in sports management, but fired as a CNA, definitely because of subconscious unhappiness with the outcome. Years of wasted effort, and presumably a high debt load. Compound that with financial responsibility of a child, and inability to find another job after three months of searching, acute anxiety, depression, and inability to focus are expected outcomes. This pt does not need medication. She needs to accept that she was sold a lie, and fully come to terms with that betrayal before she is able to perform successfully at the next job. She has two options: apply across the country to get a foot in the door to sports management and move, or apply locally to assistant manager and manager positions. Once the patient is living up to her own expectations, I would expect symptoms to subside. Introverts think too much to the point of negative and useless outcomes. This is mediated by finding purpose. Medication maybe required after requisites for actualization are met.
No PHMNP, but I want to be. Just a first year nursing student with love and experience with mh. Thanks for the case study. It was fun!
I`m curious what her attachment style is, what childhood trauma she experienced?..:) this from a psychology point of view.
I’m late to the party but adjustment d/o most likely (ICD-10: F43.25). Medications will most likely not work; find a therapist that can properly implement CBT.
Differential dx:
Bipolar II disorder d/t irritability, anxiety, severe lows, impulsive shopping, etc.
Plan/impression: lamotrigine 25mg daily and titrate up, watch for SJS
Good case. Can you guys be saying the medication dosage. And why you are giving that medication over others in the medication class. Thank you
In clinicals now and really want to get more independent experience diagnosing so I'm so excited to see this channel!!! I was thinking Adjustment disorder, R/O MDD. WIth her hx of ADHD I would look at Wellbutrin. It is known to be activating in the case of anxiety it does not help but the anxiety seems to be warranted given the situations described. I think anxiety is not a bad thing and we shouldn't be quick to medicate it. Depressive symptoms seem to be dominant and wellbutrin can treat the ADHD as well. I like the recommendation of starting Lexapro, though, and given that information would like to do that and see if her concentration improves. If it does not then look into wellbutrin as an adjunct. Lexapro causes sexual dysfunction and wellbutrin could counteract such a s/e.
Remember that Wellbutrin can increase BP. It would be safer to try other meds first.
More of these please 🙏
More case studies please 🙏
What about Wellbutrin 150mg and Clonidine 0.1mg? I'm an RN about to start NP school. My son set my picture so ignore that
Can psych NPs record their sessions for transcribing later or no?
I AM ALWAYS LOVING-ALEXIS KIRONDE
LOVE YOU ALWAYS-ALEXIS KIRONDE
Thanks for the Vid.