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.
Submission Instructions:
Your initial post should be at least 500 words, formatted and cited in the current APA style with support from at least 2 academic sources.
Based on the clinical case provided, here is a detailed response addressing each question:
### Clinical Case Summary
The 41-year-old man presents with symptoms of depression, including feelings of hopelessness, sadness, helplessness, and crying spells. He also experiences sleep disturbances and has thoughts of suicide, as evidenced by considering driving his car into a canal. He has increased alcohol consumption and has stopped going to work, indicating significant functional impairment.
### DSM-5 Diagnosis
Based on the information provided, the DSM-5 diagnosis for this case is **Major Depressive Disorder (MDD), Severe, with Psychotic Features**, due to the presence of suicidal ideation.
### Pharmacological Treatment
According to clinical guidelines, the first-line treatment for Major Depressive Disorder with psychotic features includes an antidepressant combined with an antipsychotic medication.
**Pharmacological Treatment Plan:**
– **Antidepressant**: **Sertraline** (Zoloft)
– **Dose**: Start with 50 mg once daily, titrating up to 100-200 mg/day as tolerated.
– **Route**: Oral administration.
– **Frequency**: Once daily.
– **Rationale**: Sertraline is a selective serotonin reuptake inhibitor (SSRI) with established efficacy in treating depression. It helps alleviate depressive symptoms, including sadness, hopelessness, and sleep disturbances, which are prominent in this case. The gradual titration helps minimize side effects.
– **Antipsychotic**: **Aripiprazole** (Abilify)
– **Dose**: Start with 2-5 mg once daily, titrating up to 10-15 mg/day as tolerated.
– **Route**: Oral administration.
– **Frequency**: Once daily.
– **Rationale**: Aripiprazole is a second-generation antipsychotic known for its efficacy in managing psychotic symptoms without significant sedation. It can help reduce suicidal ideation and stabilize mood in combination with an antidepressant.
### Non-Pharmacological Treatment
**Non-Pharmacological Treatment Plan:**
– **Electroconvulsive Therapy (ECT)**
– **Rationale**: ECT is considered in cases of severe depression with psychotic features, particularly when there is a risk of suicide or when other treatments have not been effective. It provides rapid relief of symptoms and can be life-saving in acute situations.
### Assessment of Treatment
1. **Appropriateness**: The chosen pharmacological and non-pharmacological treatments are appropriate based on the severity of the patient’s symptoms, including suicidal ideation and functional impairment.
2. **Cost**: Using local pharmacy data:
– Sertraline costs approximately $20-$30 per month.
– Aripiprazole costs around $600-$800 per month.
– ECT costs vary widely depending on location and insurance coverage, typically ranging from $1,000 to $3,000 per session.
3. **Effectiveness**: Both sertraline and aripiprazole have high efficacy rates in treating MDD with psychotic features. ECT is highly effective for rapid symptom relief, especially in severe cases.
4. **Safety**: Sertraline and aripiprazole are generally well-tolerated, but monitoring for side effects such as gastrointestinal upset and metabolic changes is important. ECT is safe when administered by trained professionals but carries risks associated with anesthesia and temporary memory loss.
5. **Patient Adherence**: Sertraline’s once-daily dosing and the structured nature of ECT sessions can enhance adherence. Aripiprazole’s once-daily dosing also supports adherence, but its cost may be a barrier for some patients without adequate insurance coverage.
### Conclusion
In conclusion, for the 41-year-old man with severe MDD and psychotic features, a combination of sertraline, aripiprazole, and ECT represents a comprehensive treatment approach. This approach addresses acute symptoms, reduces the risk of suicide, and aims for long-term stabilization of mood. Consideration of treatment costs, effectiveness, safety, and patient adherence supports the chosen pharmacological and non-pharmacological interventions.
### References
Include references cited in APA format to support the clinical and treatment recommendations provided.
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