Discussion: Treatment for a Patient With a Common Condition

Discussion: Treatment for a Patient With a Common Condition

Respond to at least two of your colleagues on two different days in one of the following ways:

If your colleagues’ posts influenced your understanding of these concepts, be sure to share how and why. Include additional insights you gained.

If you think your colleagues might have misunderstood these concepts, offer your alternative perspective and be sure to provide an explanation for them. Include resources to support your perspective.

 

The specific question to ask patient relative to get required feedback that helps in examining the patient situation

The case study informs us about the means of ambulation by which the patient arrives at the clinic, i.e., a private vehicle. However, we are not told whether the patient was driving by herself or being driven by a family member or anybody close to her. This leaves us with suspense if she has children if she lives alone or in a facility. I would bring forth this information to ascertain if she has children and or her confidant person. I would then gather more information about what she does for a living and probably about her living situation concerning the provided responses. I would ask about her sleep patterns, sleep habits, what she does before retiring to bed, and daytime naps? Does she yawn a lot during the daytime? Does she abuse substances?

Appropriate physical exam and diagnostic test for the patient and how to use results.

Thorough health history, including demographical data, past medical and social history, family history, is crucial. In line with comprehensive health, histories are physical examination, mental health assessment, and diagnostic tests (Newson et al., 2020). The appropriate diagnostic tests are RBS/FBS/hba1c to assess glycemic control. Ordering of a sleep polysomnogram and reviewing of the patient with results. Lipid profile test plays a crucial role in detecting the amount of cholesterol in the body. Investigate when the patient takes the antihypertensives, especially the diuretics, e.g., HCTZ, which causes nocturia when taken in night hours that could contribute to her insomnia and uncontrolled diabetes.

Differential diagnosis and the most likely diagnosis for the patient

1.       MDD – from the patient’s past medical history, there is evidence that the patient had MDD exacerbated by her husband’s demise. According to APA, the signs and symptoms should be present for at least two weeks, depressed mood, insomnia or hypersomnia, anhedonia, fatigue, and other symptoms. This is most likely because our patient has insomnia (Maurer et al., 2018).

2.       Insomnia- patient experiences problems initiating and maintaining naps at night (Riemann et al., 2017).

3.       GAD- our patient is probably experiencing GAD that might be contributing to insomnia.

Antidepressant drugs, dosage, and rationale for choosing to add another SSRI

The patient is currently on peroral Sertraline 100 mg for her MDD; however, she is reporting worsening of her depression since the demise of her husband that occurred ten months ago. Sertraline should not be tapered off but instead augmented with a second-line drug to reach the desired efficacy. Another SSRI should not be added, for it may elicit an antagonistic effect to the antidepressants (Hofmann et al., 2017). The patient might be experiencing some anxiety that tampers with her sleeping. This implies that anxiety disorder co-occurs with depression or could be depression is manifesting with features of depression and Benzodiazepines specifically low doses of b) P.O Alprazolam 0.25 mg TID onwards. The patient should be scheduled for subsequent checkups.

Contraindication of the above drugs used.

Sertraline is contraindicated in Liver problems- because sertraline is excreted mainly by the liver. Liver problems will increase toxicity. For example, sertraline toxicity inhibits plate aggregation Causing the risk of bleeding, while a narrow-angle of the anterior eye chamber increases the risk of angle-closure glaucoma. On the other hand, Alprazolam causes respiratory depression, especially seen with coexistent respiratory disease.

Follow-ups were done at weeks 4,8 and 12, and the therapeutic changes were based on treatment options outcome.

During the first 4-weeks of follow-up of our patient, it is essential to ask about: drug compliance, the present BP and RBS/FBS/hba1c, whether the MDD symptoms are subsiding or worsening, and any severe side effects of the current medications. If the patient is doing well, maintain the prescription and book her for a next check-up at week 8.

If the patient progresses well, adjust the dosages of antihypertensives and antihyperglycemics by reducing them into halves (Demirtürk, & Aşılar,2018). Adjust the dosage of the augmented second-line medication of Sertraline and emphasize lifestyle modification, close monitoring of BP, RBS/FBS/hba1c, and drug compliance. Book the client for the subsequent follow-up but make it clear that in case of any cause of alarm, the patient should come to the clinic regardless of the due check-up date. If the patient is doing good at week 12 of the follow-up, think of tapering off the 2nd line medication of Sertraline and maintain the other drugs. Book for the next clinic.

 

 

 
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