Which of the following patients best represents the DSM-5 criteria for major depressive episode?
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If you are presented with the case of a patient referred by his physician for lack of energy and feelings of sadness, with a self-reported history of being depressed for the past week, and decreased eating and sleeping, without thoughts of death, self-discharge from work after being denied a requested leave of absence, and thinking that her husband is having an affair because he has not been around much lately, the patient is meeting DSM-5 criteria for major depressive episode.
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It is common for patients presenting in first level Mental Health Clinic to present with a mood disorder. With the DSM-5 criteria, you are required to look for the presence of 5 symptoms for at least two weeks (one symptom needs to be depressed mood or loss of interest/pleasure). A patient that best fits this description is James, an Irish man in his mid 50’s who is an alcoholic with no family support so he came to the US 2 years ago on a work visa to support his family back home. He has been unemployed and experiencing marital problems since he arrived in the US and tells you he feels stressed, overwhelmed, hopeless, and guilty.
You are a practicing psychiatric nurse practitioner working at an outpatient mental health clinic. A patient that you have been treating for the past three weeks, Mr. Jones, is referred by his general physician for treatment of depression. He is a middle-aged married man who works as a security officer in a local shopping mall. This may be the oldest essay I have read yet and it was written by a student of the University of Phoenix with an instructor named L. Williams (Linda). I can’t say much about the writing style or content because it is intended to be submitted anonymously to a test on the subject. The exam took place somewhere at sometime and the reader had to submit their response through BlackBoard (I think). Below are some excerpts from this paper:
A 27-year-old female, Kristi, presents to the clinic for her regularly scheduled appointment. She has been feeling depressed since the death of her mother four months prior. She has been unable to enjoy going out with her friends and family as she used to and has lost interest in hobbies that were once enjoyable. Kristi is sleeping excessively but also having difficulty falling asleep at night. It is taking her much longer to wake up in the morning and she wakes frequently throughout the night. Her appetite is decreased but thirst is increased. She was able to work through most of her grieving process over the time period, particularly while spending time with close friends in support groups at a local church helping others cope with the death of loved ones.
Billy, 27 years old, was brought to the psychiatry emergency department for suicidal ideation and auditory hallucinations. He admitted to being depressed because of his recent divorce and job loss. He had not been taking his medications regularly. He reported being so depressed that he had taken a pair of scissors and cut holes in his jeans.
Nursing case presentation. The student chooses the case of Mrs. Chiang, who is a 42-year-old Taiwanese woman suffering from terminal cancer. She was diagnosed with breast cancer in 2010 and has become increasingly depressed since starting chemotherapy. Her husband feels that her depression is worse than the pain from her treatment or the fear of death. He brought Mrs. Chiang to the clinic for a consultation to help improve her mood and performance status.
In the case of Ms. Coronado, she fits all of the criteria for major depressive disorder except for losing interest in activities that are normally pleasurable. Ms. Coronado was unable to work or do things she used to enjoy, such as watching television or walking her dog.
John is a 60 year-old Caucasian male, retired from his job as an Air Force officer after 20 years of service. Since his retirement, he finds little pleasure in the activities he used to enjoy. He has lost interest in his favorite pastimes—fishing, hunting, and riding his Harley Davidson with his friends. John has also had trouble sleeping, and wakes up tired even though he sleeps for 10 hours a night. Over the past 2 weeks he has been irritable and impatient with his wife and three children. He feels guilty about being this way, but not so guilty that it stops him from berating them on a regular basis. John also has noticed that his mood improves when they go out to eat or when they have family parties at their house. However, these binge eating episodes are followed by guilt, weight gain, and major financial issues when the credit cards get maxed out in record time.</p>
A PMHNP student is reviewing his notes from his clinical experience over the past week to prepare his first required case presentation on a patient suffering a major depressive episode. Which of the following patients best represents the DSM-5 criteria for major depressive episode?