Topic: Anxiety And Depression—Common Mental Health Problems

Topic: Anxiety and Depression Common mental health problems such as depression

Jerome, a 35-year-old welder with a history of anxiety and depression, presents with symptoms of persistent fatigue, low energy, sleep disruption, increased alcohol consumption, and emotional distress. His previous treatment included sertraline for depression and panic attacks, which he discontinued six months ago. His current presentation requires a comprehensive assessment and a strategic plan tailored to his mental health needs. The approach involves detailed clinical evaluation, appropriate screening tools, understanding of physiological and psychological factors, diagnosis according to DSM-5 criteria, and evidence-based management strategies.

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The management of Jerome's presentation involves a multifaceted approach that combines thorough assessment, identification of underlying physiological and psychological factors, accurate diagnosis, and evidence-based intervention. Given his history and current symptoms, it is essential to evaluate his mental health comprehensively to determine the most appropriate course of action.

Initial assessment begins with establishing rapport through effective communication. Active listening, empathetic engagement, and patient education are key to fostering trust and collaboration (Snyder et al., 2016). It is crucial to explore Jerome’s current symptoms, sleep patterns, alcohol use, functional impairment, and psychosocial stressors, including work-related stress and family dynamics. An open-ended inquiry allows the patient to express concerns while providing essential details for diagnosis.

To support diagnosis, several validated screening tools are recommended. The Patient Health Questionnaire-9 (PHQ-9) is a widely used instrument for assessing depressive symptoms severity, while the Generalized Anxiety Disorder-7 (GAD-7) provides a reliable measure of anxiety severity (Kroenke et al., 2001; Spitzer et al., 2006). These tools facilitate quantification of symptoms and monitor treatment progress. Additionally, evaluating for alcohol use disorders with instruments such as the Alcohol Use Disorders Identification Test (AUDIT) may be pertinent, given Jerome’s increased alcohol consumption, which can exacerbate depressive and anxiety symptoms.

Physiologically, Jerome’s symptoms may stem from dysregulation of neurochemical systems, notably serotonergic, noradrenergic, and hypothalamic-pituitary-adrenal (HPA) axis abnormalities. Chronic stress and alcohol consumption can further impair neuronal functioning, leading to persistent mood disturbances (Gold et al., 2015). The disrupted sleep patterns and increased alcohol use are both contributory and maintaining factors, creating a vicious cycle that exacerbates fatigue and emotional symptoms.

According to the DSM-5 classification, Jerome’s presentation aligns with Major Depressive Disorder (MDD), particularly given his persistent low mood, anhedonia, fatigue, feelings of worthlessness, and sleep disturbances over a two-week period (American Psychiatric Association, 2013). His history of panic attacks suggests comorbid panic disorder, which can complicate treatment strategies. The recurrence of symptoms after medication discontinuation points to a relapse of MDD, warranting re-evaluation and possibly reinstating pharmacotherapy and psychotherapy.

Management of Jerome's depression and anxiety should adhere to current evidence-based guidelines, such as those from the National Institute for Health and Care Excellence (NICE) and the American Psychiatric Association (APA). Pharmacologically, selective serotonin reuptake inhibitors (SSRIs), such as sertraline, are first-line treatments for both depression and comorbid anxiety disorders (NICE, 2019). Given his previous positive response, reinitiating sertraline alongside careful monitoring is prudent. Psychotherapy options include cognitive-behavioral therapy (CBT), which effectively addresses maladaptive thought patterns, behavioral activation, and coping skills (Cuijpers et al., 2013). Interventions should be collaborative, emphasizing patient engagement to enhance adherence and outcomes (Fiske et al., 2019).

Addressing lifestyle factors is also vital. Reducing alcohol intake through brief interventions or referral to addiction services can significantly improve depressive and anxiety symptoms. Sleep hygiene education and stress management techniques, such as relaxation training and mindfulness, can further support recovery. Regular follow-up to assess treatment response, side effects, and adherence is essential, with adjustments made as necessary.

In cases of moderate to severe depression with functional impairment, pharmacotherapy combined with psychotherapy is recommended. If Jerome’s symptoms do not respond adequately to initial treatment, augmentation strategies like adding psychotherapy or considering other pharmacologic options, such as serotonin-norepinephrine reuptake inhibitors (SNRIs), may be necessary (APA, 2019). For suicidal ideation or persistent severe symptoms, immediate safety planning and potential hospitalization might be warranted.

In conclusion, Jerome’s case exemplifies the importance of a holistic, patient-centered approach that integrates clinical assessment, evidence-based screening tools, physiological understanding, and treatment guidelines. Reinitiating pharmacotherapy with SSRIs, providing psychological support, addressing alcohol misuse, and supporting lifestyle modifications form the cornerstone of his management plan, with ongoing monitoring to ensure optimal recovery and prevent relapse.

References

  • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
  • American Psychiatric Association. (2019). Practice guideline for the treatment of patients with major depressive disorder (3rd ed.).
  • Cuijpers, P., van Straten, A., et al. (2013). The effectiveness of psychotherapy for adult depression: meta-analysis of randomized controlled trials. The British Journal of Psychiatry, 202(4), 273-280.
  • Fiske, A., Wetherell, J. L., et al. (2019). A meta-analytic review of interventions for depression in older adults. The American Journal of Geriatric Psychiatry, 27(3), 255-268.
  • Gold, P. W., Chrousos, G. P., et al. (2015). The stress response and depression: what do we know? Biological Psychiatry, 76(6), 420-422.
  • Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613.
  • NICE. (2019). Depression in adults: recognition and management. National Institute for Health and Care Excellence.
  • Silva, S. G., & Erickson, D. J. (2017). Alcohol and the stress response. Alcohol Research: Current Reviews, 38(1), 27–36.
  • Spitzer, R. L., Kroenke, K., et al. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166(10), 1092–1097.
  • Snyder, C. R., Rand, K. L., & Sigmon, D. R. (2016). Hope theory: A member of the positive psychology family. In C. R. Snyder (Ed.), The Oxford Handbook of Positive Psychology (pp. 189-197). Oxford University Press.

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