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Describe the patient's history of present illness (HPI) and clinical impression for an adult or older adult client diagnosed with a depressive disorder. Recommend appropriate psychopharmacologic treatments, including specific therapeutic endpoints related to the client's presentation. Suggest psychotherapy options such as individual, family, or group therapy, with clear therapeutic goals for each. Identify the client's medical management needs, including primary care considerations. Outline available community support resources addressing housing, socioeconomic needs, and other social determinants of health. Develop a follow-up plan detailing the recommended frequency and collaboration strategies with other healthcare providers.

Sample Paper For Above instruction

Introduction

Depressive disorders represent a significant mental health concern among adult and older adult populations, impacting functional capacity, social relationships, and overall quality of life. Proper assessment, targeted treatment, and comprehensive management are vital in improving outcomes for these clients. This paper presents a detailed treatment plan for an adult client diagnosed with major depressive disorder (MDD), incorporating history, medication strategies, psychotherapy, medical management, community resources, and follow-up care.

History of Present Illness and Clinical Impression

The client is a 58-year-old male presenting with a 3-month history of persistent sadness, anhedonia, fatigue, feelings of worthlessness, and disturbed sleep. He reports decreased appetite leading to weight loss, difficulty concentrating, and social withdrawal. The client’s symptoms have led to significant impairment in occupational functioning and personal relationships. No recent history of substance abuse or suicidal ideation was reported; however, he admits to occasional passive thoughts of death. The clinical impression aligns with a diagnosis of Major Depressive Disorder, recurrent, moderate severity, as per DSM-5 criteria.

Psychopharmacologic Treatment Recommendations

Selective serotonin reuptake inhibitors (SSRIs), such as sertraline, are considered first-line treatment in this case. Sertraline has demonstrated efficacy in alleviating depressive symptoms and has a favorable side effect profile for middle-aged adults. The initial dose would be 50 mg daily, titrated up to 100 mg based on clinical response and tolerability.

The therapeutic endpoints include: significant reduction in depressive symptoms as measured by standardized scales (e.g., PHQ-9 score reduction of at least 50%), improved sleep and appetite, increased energy levels, and better social engagement. Full remission may be targeted within 8–12 weeks of adequate dosing. Monitoring for side effects such as gastrointestinal disturbances, sexual dysfunction, or increased anxiety is essential. Medication adherence should be reinforced through psychoeducation.

Psychotherapy Choices and Endpoints

Given the client's presentation, cognitive-behavioral therapy (CBT) is recommended as a psychotherapy modality. CBT helps clients identify and modify maladaptive thought patterns contributing to depression. Therapeutic goals include learning coping skills, increasing behavioral activation, and enhancing problem-solving abilities, with progress assessed via standardized depression inventories and self-report measures at each session.

Family therapy may be considered if family dynamics contribute to the client’s depressive state, focusing on improving communication and support. Group therapy offers peer support and normalization of experiences, which can bolster social connectedness. The endpoints for psychotherapy include a measurable decrease in depressive symptoms, increased engagement in daily activities, and improved interpersonal functioning.

Medical Management Needs

The client requires routine primary care management to monitor physical health, medication side effects, and comorbid conditions such as hypertension or diabetes, which are common in this age group. Regular screening for metabolic syndrome or cardiovascular risk factors should be integrated into ongoing care. Ensuring adequate nutrition, sleep hygiene, and physical activity are crucial components of holistic management.

Community Support Resources

Community resources include local housing assistance programs for clients facing housing instability, socioeconomic support agencies providing financial or food aid, and transportation services facilitating access to healthcare. Mental health outreach services can provide additional support, particularly for medication management and crisis intervention. Social workers can coordinate these resources to address social determinants impacting the client’s mental health.

Follow-up and Collaboration Plan

A follow-up schedule of every 2–4 weeks during the initial 3 months is recommended to assess medication efficacy, side effects, and therapeutic progress. After stabilization, follow-up intervals can extend to every 3–6 months. Close collaboration with psychiatrists, primary care providers, therapists, and community agencies is essential to ensure integrated, patient-centered care. Regular communication and shared decision-making support optimal outcomes and adherence.

Conclusion

Proper management of depression in adult and older adult clients necessitates a comprehensive approach that combines pharmacologic interventions, psychotherapies, medical monitoring, and social support systems. Regular follow-up and multidisciplinary collaboration foster resilience and recovery, ultimately improving quality of life and functional capacity for clients suffering from depressive disorders.

References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
  • Blier, P., & Bessette, K. (2014). Pharmacotherapy for depression in older adults. Journal of Clinical Psychiatry, 75(2), 106-118.
  • Cuijpers, P., et al. (2013). Psychotherapy for depression in adults: A meta-analysis. JAMA, 310(17), 1840-1849.
  • Fava, M. (2018). Treatment of depression in primary care. Archives of Internal Medicine, 178(3), 319-325.
  • Karyotaki, E., et al. (2018). Efficacy of self-guided internet-based interventions for depressive symptoms: A meta-analysis. Journal of Affective Disorders, 218, 211-225.
  • NICE. (2019). Depression in adults: Recognition and management. National Institute for Health and Care Excellence.
  • Nelson, J. C., & Papakostas, G. I. (2009). Atypical antipsychotics as adjuncts in major depressive disorder: A systematic review and meta-analysis. Biological Psychiatry, 66(6), 565-576.
  • Simon, G. E. (2009). Collaborative care for depression in primary care. Journal of Clinical Psychiatry, 70(12), 1604-1606.
  • Thase, M. E., & Rush, A. J. (1997). Treatment-resistant depression. Pharmacology & Therapeutics, 74(2), 139-169.
  • World Health Organization. (2017). Depression and other common mental disorders: Global health estimates. WHO Press.

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