Treatment Plan for the Older Adult Client in the Week 10 Case Study

NURS 6640: Psychotherapy with Individuals
Week 10: Case Study

IDENTIFICATION: The patient is a 69-year-old, widowed African American male who is the father of one adult child and grandfather of six grandchildren. The patient is self-referred to a psychiatric outpatient clinic.

CHIEF COMPLAINT: “I need help with depression and anxiety.

HISTORY OF CHIEF COMPLAINT: The patient reports that his father is dying, and he has been experiencing worsening of depression and anxiety symptoms over the past few months. He is seeking a psychiatric evaluation at his son’s advice. The patient does not enjoy being with his family.

He has difficulty falling asleep, but then spends the day lying on the couch and reports feeling like he is “moving in slow motion.” He reports feeling tired all the time. He has also stopped going to his volunteer job at the nursing home.

He responded to the practitioner’s question of “why depressed now?” by saying that with the imminent death of his father, he is losing his main support. In addition to his father’s illness, the patient was diagnosed and treated for prostate cancer this year. He received psychotherapy at that time which focused on his anxiety about the diagnosis, his denial of its severity, his wish to “not know what he knew,” and, ultimately, end-of-life issues.

PAST PSYCHIATRIC HISTORY: The patient was never hospitalized for psychiatric reasons. He has no history of suicidal thoughts, gestures, or attempts. The patient described either a partial or negative response from several medications he had been prescribed from his primary care provider (PCP) over the course of a several years, including Effexor, Prozac, Zoloft Lexapro and Duloxetine.

He is currently prescribed Lorazeapm 1 mg BID by his PCP which he has been taking for several years.

MEDICAL HISTORY: GERD, HTN and hyperlipidemia. History of prostate cancer.

HISTORY OF DRUG OR ALCOHOL ABUSE: The patient denies history of drug and alcohol abuse.

FAMILY PSYCHIATRIC HISTORY: Patient reports that his mother had depression. He is an only child and does not recall any emotional difficulties in grandparents or other relatives.

Personal History
Perinatal: No known perinatal complications.

TRAUMA/ABUSE HISTORY: Denies

Mental Status Examination
Appearance: Well-groomed, appropriately dressed, older Gentleman who is obese
Behavior and psychomotor activity: Good eye contact, pleasant, cooperative. Slightly unsteady gait uses walker.

Consciousness: Alert and able to answer all questions appropriately.

Orientation: Oriented to person, place, time, and situation.

Memory: Intact. Good recent and remote memory.

Concentration and attention: Appears to have good concentration during the interview but reports that he has recently had trouble concentrating while reading.

Visuospatial ability: Not formally assessed.

Abstract thought: Within normal limits, appropriate use of metaphors.

Intellectual functioning: Patient has master’s degree

Speech and language: Normal rate and rhythm.

Perceptions: No abnormalities present.

Thought processes: Goal directed, but evidence of guilt and rumination consistent with depressive symptomatology.

Thought content: Patient is highly anxious and expresses thoughts of sadness, frustration. He is preoccupied with thoughts about the anticipated loss of his father.

Mood: Depressed and anxious.

Affect: Congruent with mood.

Impulse control: Good.
Judgment/insight/reliability: Good.
Discussion: Therapy with Older Adults
Clients who are older have often times been dealing with their mental health disorder their entire lives, whiles other disorders may be brought on through the aging process or the trauma of losing a lifelong partner. Treatment can be challenging for both the client and the therapist. For this Discussion, you will focus on therapeutic approaches for an older adult presented in a case study.
Learning Objectives
Students will:
• Assess clients presenting with depression
• Analyze therapeutic approaches for treating clients presenting with depression
• Evaluate outcomes for clients presenting with depression

To prepare: •
• Download and review the Week 10: Case Study from this week’s Learning Resources.
• Review this week’s Learning Resources and reflect on the insights they provide.

Post a treatment plan for the older adult client in the Week 10: Case Study found in this week’s Learning Resources. Be sure to address the following in your post:
• Which diagnosis should be considered?
• What is the DSM-V Coding for the diagnosis you are considering?
• What is your rationale for the diagnosis? Be sure and link the client’s signs and symptoms to the DSM-V diagnostic criteria to support your diagnosis.
• What tests or tools should be considered to help identify the correct diagnosis?
• What differential diagnosis should be considered?
• What Treatment Strategy would you recommend?
• What treatment would you prescribe and what is the rationale?
• Safety
• Psychopharmacology
• Diagnostic Tests
• Psychotherapy
• Psychoeducation
• What standard guidelines would you use to treat or assess this patient?
• Clinical Note: Is depression a normal part of aging?
Support your approach with evidence-based literature.

APA 7th Edition Note
NOTE: Walden University currently uses the seventh edition of the Publication Manual of the American Psychological Association (APA) as the accepted standard for citations, references, and writing style guidelines. This course was developed when APA’s sixth edition was the standard, and we are in the process of making any necessary updates to the course content. Please be sure to consult the seventh edition of the APA manual, as well as the Walden Writing Center’s APA resources, for all your written assignments.
All references require creditable sources, nothing less than 5 years. References require APA 7th edition http. Please add conclusion.

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Treatment Plan for the Older Adult Client in the Week 10 Case Study:

Diagnosis: Major Depressive Disorder (MDD), Single Episode, Severe with Anxious Distress.

DSM-V Coding: 296.21 (F32.1)
Rationale for the Diagnosis: The client presents with symptoms consistent with MDD, including depressed mood, loss of interest, sleep disturbances, fatigue, psychomotor retardation, guilt, and anxiety. These symptoms have persisted for several months and are associated with significant functional impairment, as evidenced by his withdrawal from family activities and volunteering. The client’s symptoms can be linked to the diagnostic criteria for MDD as outlined in the DSM-V.
Tests or Tools: The diagnosis of MDD can be supported by using standardized depression assessment scales such as the Beck Depression Inventory (BDI) or the Hamilton Rating Scale for Depression (HAM-D). These tools can help evaluate the severity of depression and monitor treatment progress.
Differential Diagnosis:

Adjustment Disorder with Depressed Mood: It is important to rule out an adjustment disorder as a potential diagnosis, considering the recent stressors in the client’s life, such as his father’s illness and his own prostate cancer diagnosis. However, the persistence and severity of the symptoms, as well as the functional impairment, are more consistent with MDD.
Bereavement-related Depression: Although the client anticipates the loss of his father, the symptoms have been present for several months and are not solely related to the normal grieving process. Therefore, bereavement-related depression is less likely as the primary diagnosis.
Treatment Strategy:
The treatment strategy for the older adult client with MDD should include a multimodal approach that addresses the biological, psychological, and social aspects of the disorder. The following components should be considered:

a. Safety: Assess the client’s suicidality and implement appropriate safety measures, including regular suicide risk assessments. Collaborate with the client’s support system to ensure a safe environment.

b. Psychopharmacology: Consider antidepressant medication as an adjunct to psychotherapy. Given the client’s history of partial or negative response to various antidepressants, a thorough review of his previous medication trials should be conducted. Consideration may be given to alternative medication options or augmentation strategies. Consultation with a psychiatrist may be beneficial in managing the client’s medication regimen.

c. Diagnostic Tests: While no specific diagnostic tests can confirm the diagnosis of MDD, it is important to assess the client’s physical health and review his medical history to rule out any underlying medical conditions contributing to depressive symptoms. Regular monitoring of vital signs, laboratory tests, and an evaluation of the client’s overall physical health should be included in the treatment plan.

d. Psychotherapy: Recommend individual psychotherapy, specifically Cognitive-Behavioral Therapy (CBT) or Interpersonal Therapy (IPT), which have been shown to be effective in treating late-life depression. CBT can help the client identify and challenge negative thoughts and behaviors contributing to his depression, while IPT can focus on improving social support and relationships.

e. Psychoeducation: Provide psychoeducation to the client and his family about depression, its causes, and available treatment options. Education can help reduce stigma, increase treatment adherence, and facilitate the client’s engagement in his own recovery.

Standard Guidelines:
Treatment and assessment of this patient should follow evidence-based guidelines such as those provided by the American Psychiatric Association (APA) and the American Association for Geriatric Psychiatry (AAGP). These guidelines offer recommendations for the assessment, diagnosis, and treatment of depression in older adults, taking into account age-related factors and comorbidities.