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Assignment 1: Captain of the Ship Project – Depressive Disorder.

Assignment 1: “Captain of the Ship” Project – Depressive Disorder.

 

As nurse practitioners strive to achieve full-autonomous practice across the country, it should be noted that many states grant this ability to practice independently to psychiatric mental health nurse practitioners. To that end, you will be engaging in projects this semester that assume that you are practicing in a state that allows full-practice authority for NPs, meaning that the PMHNP may be the “captain of the ship” concerning caring for a patient population. Assignment 1: “Captain of the Ship” Project – Depressive Disorder.

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The “captain of the ship” is the one who makes referrals to specialists, coordinates care for their patients/clients, and is responsible and accountable for patient/client outcomes overall. This is a decided change from a few decades ago when physicians were the “captain of the ship” and NPs played a peripheral role. In this Assignment, you will become the “captain of the ship” as you provide treatment recommendations and identify medical management, community support resources, and follow-up plans for a client with a depression disorder. Learning Objectives Students will: Recommend psychopharmacologic treatments based on therapeutic endpoints for clients with depression disorders Recommend psychotherapy based on therapeutic endpoints for clients with depression disorders Identify medical management needs for clients with depression disorders Identify community support resources for clients with depression disorders Recommend follow-up plans for clients with depression disorders To prepare for this Assignment: Assignment 1: “Captain of the Ship” Project – Depressive Disorder.  Select an adult or older adult client with a depressive disorder you have seen in your practicum. In 3–4 pages, write a treatment plan for your client in which you do the following: Describe the HPI and clinical impression for the client. Recommend psychopharmacologic treatments and describe specific and therapeutic endpoints for your psychopharmacologic agent. (This should relate to HPI and clinical impression.) Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices. Identify medical management needs, including primary care needs, specific to this client. Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client. Recommend a plan for follow-up intensity and frequency and collaboration with other providers. Assignment 1: “Captain of the Ship” Project – Depressive Disorder.

Introduction

The focus of this paper is on a client with the major depressive disorder as manifested by symptoms such as sadness, irritability, appetite loss, agitation, the feeling of hopelessness, among other symptoms (Sadock et al, 2014). Therefore, the HPI for the client will be provided as well as the clinical impression. Additionally, the appropriate psychotherapy and psychopharmacologic treatments will be discussed. The paper will finally discuss the client’s medical management needs, the available community support resources, and a follow-up plan. The HPI and Clinical Impression for the Client. Assignment 1: “Captain of the Ship” Project – Depressive Disorder.

Client XX aged 32 years presented for treatment with complaints of depression associated with financial difficulties, academic pressures, and difficult relationship. XX reported symptoms of sadness throughout the day, agitation, irritability, loss of appetite, weight loss, academic difficulties, difficulty in concentration, and feeling hopeless.

Three years ago, XX started her master’s degree and was working as a banker. One year after she enrolled the bank underwent downsizing and she was among the affected employees. Paying for her education and meeting her daily obligations became difficult after she lost her job. She is also a divorcee and currently in an abusive relationship with her current boyfriend. She also reported that she grew up in an abusive home. XX reported that the symptoms had progressively become worse after she started her master’s degree and was denied the loan and at the same time lost her job. XX described her current stressors as financial woes, relationship problems, and pending bankruptcy.  Assignment 1: “Captain of the Ship” Project – Depressive Disorder.

According to DSM-5 criteria, the client manifests symptoms of the major depressive disorder as indicated by symptoms such as sadness, agitation, irritability, loss of appetite, weight loss, academic difficulties, difficulty in concentration, hopelessness, and feelings of worthlessness (Sadock et al, 2014).

Psychopharmacologic Treatment

Citalopram: This medication is an SSRI antidepressant that is used in treating the major depressive disorder. The rationale for selecting citalopram is because the medication is FDA approved as the first-line treatment for major depressive disorder (Hudson et al, 2015). Citalopram works by elevating serotonin levels within the brain. Evidence shows that citalopram is effective in improving depression and anxiety symptoms manifested by client XX in individuals with major depressive disorder (Wilson & Lader, 2015). Assignment 1: “Captain of the Ship” Project – Depressive Disorder.

Psychotherapy Choices

Group Cognitive behavioral therapy (CBT): Group CBT is the recommended psychotherapy choice for the client. CBT is a goal-oriented psychotherapy treatment that aims to change thinking and behavior patterns and therefore change the way the person feels (David et al, 2018). Accordingly, CBT will work by changing the client’s feelings, attitudes and her behavior by focusing on her beliefs, thoughts, feelings and attitudes and how the processes influence her behavior and the way she handles emotional problems. Evidence shows that CBT is an effective psychotherapy in the treatment of depression and it also reduces the rate of relapse after treatment (Cuijpers et al, 2016). Group therapy was selected for the client because the client will get an opportunity to interact with other group members going through similar challenges. Assignment 1: “Captain of the Ship” Project – Depressive Disorder.

Medical Management Needs

Adherence to treatment is a vital medical management need. Therefore, it will be important to implement the necessary measures to ensure that the client will not skip her medication or skip the psychotherapy sessions even when she starts feeling better. This is because skipping treatment may lead to the depression symptoms coming back or the client experiencing withdrawal symptoms if she stops taking her medication. It will also be important to monitor the client for side effects of the medication (Citalopram) and also monitor her response to treatment. Finally, psychoeducation is also necessary in order to ensure the client is aware of the nature of the illness (Mark et al, 2017). Assignment 1: “Captain of the Ship” Project – Depressive Disorder.

Community Support Resources

The available support resources for the client include the community peer support groups where she will be able to interact and get moral support from individuals having similar mental health challenges. In addition, the client will also be referred to organizations that provide educative materials and information to people with psychiatric problems. Since the client is undergoing financial challenges, she will be referred to a local organization that can provide the client with direct help to ensure that she is able to afford her medications as well as other healthcare expenses. Finally, the client will be provided with educational materials and referred to websites and online resources where she can easily access educative information about her condition and how to cope with it. Assignment 1: “Captain of the Ship” Project – Depressive Disorder.

Follow-up Plan

The client will be reviewed after every two weeks by a primary mental health practitioner to assess the treatment progress and to have the treatment regimen reviewed. She will be attending her psychotherapy sessions weekly. Regarding collaboration, the client will be managed by a psychiatrist who will be evaluating the client and prescribing the medication; a primary mental health nurse responsible for reviewing the client and collaborating with other team members regarding his treatment; a psychotherapist who will provide the CBT sessions; a case manager who will be liaising with the team members regarding the client’s progress; and lastly a social worker who will be monitoring the client while at home (Harter et al, 2018).  Assignment 1: “Captain of the Ship” Project – Depressive Disorder.

Conclusion

According to the HPI and the client’s presenting symptoms, the client has major depressive disorder. The recommended psychopharmacologic treatment for the client is citalopram while the psychotherapy choice is group CBT. Medical management needs for the client include adherence to treatment regimen, monitoring side effects, and educating the client about the treatment and her illness. Community support resources include community peer support groups, organizations providing free treatment and educative materials, as well as websites with helpful information about depression. Finally, the client will be reviewed after every two weeks and the multidisciplinary team managing the client will include a psychiatrist, mental health nurse, social worker, and a case manager. Assignment 1: “Captain of the Ship” Project – Depressive Disorder.

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