Conduct A Comprehensive Psychiatric Evaluation Template
Conduct A Comprehensive Psychiatric Evaluationsee Template Attached
Conduct a Comprehensive Psychiatric Evaluation(See template attached) on the patient presented (see case study attachment) using the template provided in the Learning Resources. Include at least five (5) scholarly resources to support your assessment and diagnostic reasoning. Case 73 History You are asked to see a 69-year-old woman who complains of feeling constantly tired and not enjoying anything including her grandchildren. She sleeps for 8 hours or more but still never feels rested. She finds herself getting increasingly irritable and snappy with her 37-year-old daughter who is now living with her following the breakdown of her marriage.
The daughter has two children ages 10 and 12 for whom the patient is having to provide care because her daughter is unable to manage this. The patient is finding the demands of her daughter, grandchildren and husband more and more difficult to cope with. She often forgets what needs to be done. Further questioning reveals that her daughter has agoraphobia and depression. She has no previous history of mental health problems.
She has hypertension which is well controlled. Mental state examination The woman looks tired and much older than her 69 years. She is obese and her dress is rather erratic. She has lots of layers of clothing and seems unaware that she has come in her slippers. She looks tired.
Her speech is slow, flat and monosyllabic. She states she feels okay but she looks and sounds low. She does not have any active suicidal ideation but does question whether life is worth living. She feels hopeless about the circumstances she finds herself in. She has no hallucinations or formal thought disorder.
Paper For Above instruction
The presentation of depression in late adulthood often complicates diagnosis and management, particularly when comorbid medical conditions and psychosocial stressors are involved. A comprehensive psychiatric evaluation is essential to accurately identify depressive disorders, differentiate them from other psychiatric or medical conditions, and formulate an appropriate treatment plan. In the case of this 69-year-old woman, her clinical presentation suggests a major depressive episode, potentially intertwined with age-related factors, caregiving stress, and other psychosocial elements.
Initial assessment involves understanding her detailed history, mental status, and psychosocial context. The woman reports persistent fatigue despite adequate sleep, anhedonia, irritability, forgetfulness, and hopelessness—all classic features of depression as outlined by American Psychiatric Association (2013). Her physical appearance—being tired, older-looking, and erratically dressed—further supports her depressive state. Despite denying active suicidal ideation, her questions about life’s worth and hopelessness are significant, indicating at least moderate severity of depression (Kuehner, 2017).
Psychiatric Evaluation Process
The psychiatric assessment begins with a thorough history, including medical, psychiatric, and psychosocial factors. The woman’s medical condition—hypertension—is well controlled but requires ongoing monitoring as comorbidities can influence mood (Alexopoulos et al., 2019). Her psychosocial context, particularly her caregiving responsibilities for her daughter and grandchildren, likely contribute to emotional exhaustion and stress, typical in caregiving-related depression (Pinquart & Sörensen, 2003). The patient's social isolation and her daughter’s mental health issues, particularly her daughter’s agoraphobia and depression, also impact her mental health (Carper et al., 2020).
The mental state examination reveals her tired appearance, slow speech, flat affect, and disinterest, aligning with depressive symptomatology (American Psychiatric Association, 2010). Her lack of hallucinations, formal thought disorder, and suicidal ideation are important to note, as they suggest a non-psychotic depression rather than schizophrenia or bipolar disorder. Although she denies active suicidal thoughts, her questioning about life's worth signifies a risk that warrants close monitoring (Fava & Ruini, 2020).
Diagnostic Considerations
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), criteria for Major Depressive Disorder (MDD) include persistent depressed mood and anhedonia for at least two weeks, along with other symptoms such as fatigue, impaired concentration, and feelings of worthlessness (American Psychiatric Association, 2013). Her presentation satisfies these criteria. It is essential to consider differential diagnoses, including medical conditions like hypothyroidism, anemia, or medication side effects, which can mimic depression (Alexopoulos, 2019). A comprehensive workup, including thyroid function tests, blood counts, and review of medications, is advised.
Supportive and Psychosocial Interventions
Given her caregiving burden and social isolation, psychosocial interventions are vital. Cognitive-behavioral therapy (CBT) tailored for late-life depression can help modify negative thought patterns and improve coping skills (Unützer et al., 2002). Support groups for caregivers and involvement in community activities may reduce isolation and offer social support (Chung et al., 2020). Addressing her physical health remains crucial, as exercise and proper nutrition can positively influence mood (Schuch et al., 2016).
Pharmacological Management
Pharmacotherapy with antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), is effective in late-life depression (Lichtman et al., 2018). However, medication choices must consider her comorbidities, potential drug interactions, and side effect profiles. Starting at a low dose with gradual titration is recommended, alongside regular monitoring for adverse effects such as hyponatremia or falls (Taylor et al., 2020). Collaboration with her primary care provider ensures comprehensive care management.
Conclusion
This case underscores the importance of a multidimensional assessment in elderly patients presenting with depressive symptoms. A combination of pharmacotherapy, psychotherapy, social support, and medical management offers the best chance for symptomatic improvement and functional recovery. Regular follow-up and adaptation of the care plan are essential, considering evolving clinical and psychosocial factors.
References
- American Psychiatric Association. (2010). Diagnostic and statistical manual of mental disorders (5th ed.).
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
- Alexopoulos, G. S. (2019). Geriatric depression. UpToDate.
- Carper, M. V., Schofield, R. L., & Campbell, J. (2020). Caregiving stress and depression among family caregivers of older adults. Journal of Family Issues, 41(2), 101-125.
- Fava, M., & Ruini, C. (2020). Development of clinical guidelines for depression: From DSM to ICD-11. Psychiatric Clinics, 43(3), 417-432.
- Kuehner, C. (2017). Why is depression more common among women than among men? The Lancet Psychiatry, 4(2), 146-158.
- Lichtman, J. H., et al. (2018). Pharmacological treatment in late-life depression. American Journal of Psychiatry, 175(3), 232-245.
- Pinquart, M., & Sörensen, S. (2003). Differences between caregivers and noncaregivers in psychological health and physical health: A meta-analysis. Psychology and Aging, 18(2), 250-267.
- Schuch, F. B., et al. (2016). Physical activity and incident depression: a meta-analysis of prospective cohort studies. American Journal of Preventive Medicine, 51(2), 206-213.
- Taylor, W. D., et al. (2020). Pharmacological treatment of depression in elderly patients. UpToDate.