Case 2: The case of physician do not heal thyself

60-year-old man with chief complaint of “being unstable”

Walden University – NURS 6630 wk 3 discussion c.docx

Case 2: The case of physician do not heal thyself

60-year-old man with chief complaint of “being unstable”

Three Questions with Rationale

1.      How long were you on lithium before you stopped taking it, and did you experience any adverse effects to the TCAs you were originally prescribed when first diagnosed with depression? 

1.      Please describe what you are feeling/experiencing during your depressed state, and how long are these episodes lasting?

1.      Are you irritable during your depressed state also, or only when you are experiencing inflated self-esteem, increased goal-directed activity, overtalkativeness, racing thoughts, psychomotor agitation, less need for sleep and so on?

Additional Questions to Ask the People in the Client’s Life

·         When my client was diagnosed with depression while in medical school at the age of 23, did anything happen that could have possibly triggered this depressive state that my client stated was his worst one?

o     It is important to distinguish between Bipolar Disorder (BPAD) and Borderline Personality Disorder (BPD) and if the client’s depression was induced from his personality disorder or if this was an initial onset of a major depressive episode.  The DSM-5 states that BPAD typically starts in or around the mid-20s (APA, 2013).

                        Please describe the client’s mood when he is not depressed, and how long do these episodes last?

o    According to Stahl (2013), it is not uncommon for individuals suffering with bipolar to downplay their manic symptoms.  It is also important to determine the length of time of these episodes as that will help determine a diagnosis.

                        Can you describe the client’s depressed state?  In other words, does he lose interest in activities he usually enjoys?  Does he appear as though he cannot concentrate?  Has he lost or gained a significant amount of weight?  Does he acquire enough sleep?  Does he seem frequently tired? Has he voiced thoughts of suicide?

o    It is important to discover the extent of his depression and if additional interventions are appropriate.  It is important to note if the patient is displaying signs and symptoms for a major depressive episode.  Also, if the patient appears to be at risk for harming himself, hospitalization may be necessary.

                        Inquire from mother and father any more details to the family history of mental illness such as depression and bipolar disorder

o    First-degree relatives who also have bipolar disorder can indicated the possibility the patient also has a form of bipolar disorder (Stahl, 2013).  It is also important to inquire about specific treatments, medications, and any hospitalizations that occurred with the family members who suffered from bipolar disorder (Stahl, 2013). 

                        It would also be important to ask the client’s coworkers if his depressed state in any way affects his performance at work due to a lack of concentration, fatigue, or depressed mood (APA, 2013).