Assessing And Treating Adult And Geriatric Clients With Mood

Assessing And Treating Adult And Geriatric Clients With Mood Disorders

Assessing and Treating Adult and Geriatric Clients With Mood Disorders for this Assignment, you consider best practices for assessing and treating adult and geriatric clients presenting with mood disorders.

BACKGROUND INFORMATION:

The client is a 32-year-old Hispanic American male who came to the United States when he was in high school with his father. His mother died back in Mexico when he was in school. He presents today to the PMHNPs office for an initial appointment for complaints of depression. The client was referred by his PCP after “routine” medical work-up to rule out an organic basis for his depression. He has no other health issues with the exception of some occasional back pain and “stiff” shoulders which he attributes to his current work as a laborer in a warehouse.

SUBJECTIVE:

During today’s clinical interview, the client reports that he always felt like an outsider as he was “teased” a lot for being “black” in high school. He states that he had few friends and basically kept to himself. He describes his home life as “good,” with his father doing what he could for the family, which includes eight siblings. He also reports a remarkably diminished interest in engaging in usual activities and states he has gained 15 pounds in the last 2 months. He is also troubled with insomnia that began about 6 months ago and has been progressively worsening. Additionally, he reports poor concentration, stating that it is causing trouble at work.

MENTAL STATUS EXAM:

The client is alert, oriented to person, place, time, and event. He is casually dressed, with clear speech that is soft. He does not readily make eye contact, but when he does, it is only for a few moments. He endorses feelings of depression, with somewhat constricted affect that improves during the interview. He denies visual or auditory hallucinations, delusional, or paranoid thought processes. Judgment and insight appear grossly intact. He denies suicidal or homicidal ideation.

The PMHNP administered the Montgomery-Asberg Depression Rating Scale (MADRS) and obtained a score of 51, indicating severe depression.

RESOURCES:

Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134,

Decision Point One:

Begin Zoloft 25 mg orally daily.

RESULTS OF DECISION POINT ONE:**

The client returns in four weeks, reporting a 25% decrease in symptoms. However, he is concerned about the new onset of erectile dysfunction.

Decision Point Two:

Select what the nurse should do next: Decrease the dose to Zoloft 12.5 mg daily.

RESULTS OF DECISION POINT TWO:**

The client returns in four weeks; erectile dysfunction has subsided, but depressive symptoms have worsened.

Decision Point Three:

Change to Paxil 20 mg orally daily.

GUIDANCE:

Increasing the dose back to 25 mg orally daily may be appropriate if side effects do not reappear. If they do, switching to another drug is advisable. Switching to Paxil may be suitable, as different SSRIs have varying side effect profiles. Transitioning to an SNRI would not be appropriate at this stage, considering the side effect profile rather than treatment response.

Analysis of Case Study: Elderly Hispanic Man with Major Depressive Disorder

This case requires decision-making concerning antidepressant therapy, considering age-related pharmacokinetic and pharmacodynamic changes, comorbidities, polypharmacy, and cultural considerations.

Paper For Above instruction

The management of mood disorders in adult and geriatric clients demands a nuanced understanding of pharmacology, individual patient factors, and cultural context. Effective assessment hinges on comprehensive history-taking, mental status examination, and standardized rating scales like the MADRS, which guides diagnosis and treatment monitoring (Rush et al., 2006). This paper discusses clinical decision-making processes in treating a young adult male with severe depression and explores treatment adjustments based on response and side effects, and then extends to musings on elderly patients with similar diagnoses.

Initial assessment and intervention in the adult client

The initial clinical approach should focus on establishing a diagnosis, evaluating severity, and identifying comorbidities. Given the client’s presentation—diminished interest, weight gain, insomnia, poor concentration, and a high MADRS score—there is clear evidence of severe depression warranting pharmacotherapy. SSRIs are often first-line agents due to their tolerability and safety profile. Zoloft (sertraline), a selective serotonin reuptake inhibitor (SSRI), is an appropriate initial choice (Bruno & Nici, 2006).

The decision to begin Zoloft at 25 mg aligns with clinical guidelines, balancing efficacy with tolerability. The four-week follow-up showing a 25% symptom reduction indicates partial response, which is typical in depression management (Trivedi et al., 2006). The emergence of erectile dysfunction, a known side effect of SSRIs, must be considered, affecting medication adherence and overall treatment success (Montejo et al., 2001). In this context, reducing the dose to 12.5 mg is appropriate, aiming to mitigate side effects while maintaining some antidepressant effect.

The subsequent worsening of depressive symptoms despite reduced side effects suggests subtherapeutic dosing. As such, switching to another SSRI like Paxil (paroxetine) becomes a strategic decision, considering its different side effect profile and potency (Baldwin et al., 2014). Given the importance of personalizing treatment, this step exemplifies patient-centered care. It also underscores the necessity to continually reassess and modify treatment plans based on response and tolerability.

Transition to geriatric patients and special considerations

Assessing and treating mood disorders in elderly clients introduces additional layers of complexity. Aging affects pharmacokinetics—reduced renal and hepatic functions alter drug metabolism and excretion—necessitating dose adjustments (Alexopoulos, 2003). Polypharmacy presents risks of drug-drug interactions, and comorbid physical illnesses influence both pharmacodynamic responses and the risk of adverse effects (Licht et al., 2004). As such, SSRIs with favorable side effect profiles and minimal anticholinergic activity are preferred. For instance, sertraline and escitalopram are often first-line choices in older adults (Gum et al., 2009). Cognitive and cultural factors also influence treatment adherence, highlighting the importance of culturally sensitive communication and the involvement of family members where appropriate (Hinton et al., 2012).

From an ethical standpoint, informed consent, confidentiality, and respecting cultural beliefs are vital. Respecting autonomy means clearly communicating risks, benefits, and alternatives, and ensuring the patient or guardian understands the proposed treatments (Appelbaum, 2007). Nonmaleficence drives clinicians to avoid prescribing medications with high side effect burdens or drug interactions that could worsen health outcomes. Beneficence calls for careful monitoring and individualized care. Justice ensures equitable access to mental health services regardless of age, ethnicity, or socioeconomic status.

Conclusion

In conclusion, managing mood disorders across the lifespan requires comprehensive assessment, careful medication selection, vigilant monitoring, and cultural competence. For adults, starting with SSRI therapy such as Zoloft, adjusting doses based on response and side effects, and considering medication switches exemplifies adaptive management. In geriatric populations, adjustments for physiological changes and comorbidities further complicate treatment but are essential to optimizing outcomes. Incorporating ethical considerations ensures respectful, equitable, and patient-centered care, ultimately improving prognosis and quality of life.

References

• Alexopoulos, G. S. (2003). Depression in the elderly. The Lancet, 361(9357), 1216-1225.
• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
• Appelbaum, P. S. (2007). Informed consent in mental illness. World Psychiatry, 6(3), 122–124.
• Baldwin, D. S., et al. (2014). Evidence-based pharmacological treatment of depression in primary care. The World Journal of Biological Psychiatry, 15(4), 308–339.
• Bruno, K. A., & Nici, J. (2006). Pharmacotherapy for depression. Journal of Clinical Psychiatry, 67(7), 1064-1071.
• Gum, A. M., et al. (2009). Antidepressant treatment in late-life depression: A systematic review. CNS Drugs, 23(9), 751–768.
• Hinton, D. E., et al. (2012). Cultural influences on depression diagnosis and treatment in older adults. Psychiatric Services, 63(3), 205-213.
• Licht, S., et al. (2004). Pharmacokinetics changes in older adults. Clinical Pharmacokinetics, 43(10), 679–689.
• Montejo, A. L., et al. (2001). Sexual side effects of antidepressants: An overview. Journal of Clin Psychiatry, 62(5), 349-358.
• Rush, A. J., et al. (2006). The efficacy of pharmacotherapy and psychotherapy in treating depression. The American Journal of Psychiatry, 163(1), 132-139.
• Trivedi, M. H., et al. (2006). Evaluation of the efficacy of antidepressants. American Journal of Psychiatry, 163(8), 1373-1384.