He has not been sleeping well, which he attributes to recent stress.

Oct 9, 2022

Learning Goal: I’m working on a health & medical multi-part question and need an explanation and answer to help me learn.
THEME OF THE WEEK: BRINGING IT TOGETHER, ASSESS, DIAGNOSE, AND TREAT
You are working in a behavioral health outpatient setting and your next patient to see complains of depression. He is a 29 year old who tells you that he has a long standing history of depression. The patient recently lost their job of many years and he has been struggling more with depression. He does not feel like he has much of a support system left now. He denies SI or HI. He had been taking over the counter St. Johns wort and prescription escitalopram, which was working well prior to recent events. Since his recent misfortunes, he has tried to increase his doses on his own, which he doesn’t feel has helped much. He does have a history of anxiety and was recently prescribed bupropion. He has noted some palpitations which he attributed to his anxiety. He has not been sleeping well, which he attributes to recent stress. He notes a mild HA over the past few days and did take a dose of sumatriptan yesterday with no improvement. He denies any injury to his head. Today he reports he has had some increased anxiety to the point he feels nauseated and his arms/hands are shaking. He did have 2 episodes of vomiting prior to arrival and multiple episodes of diarrhea. He has been experiencing sweating all day today. He feels his symptoms are getting worse.
On physical exam you find he is diaphoretic. He seems somewhat anxious/agitated. He does have some fine motor tremors and slightly dilated pupils. He has no unilateral weakness or facial asymmetry. Strength is equal but has some generalized rigidity. His reflexes on his upper extremity are normal but hyperreflexia on examination of his patellar reflexes. ECG, and head CT are unremarkable.
Vitals: Temp-38.1, Pulse-107, RR-20, BP-137/87, O2-97%
Write in paragraph form your diagnosis. Include what supports this diagnosis and write your full treatment plan. Address one issue relating to social, cultural, ethical, or economic factors that may need consideration in your pharmacologic management. This discussion should be building on all five weeks of learning assessment, diagnosis, and treatment.
Submission Instructions:
Your initial post should be at least 500 words, formatted, and cited in current APA style with support from at least 2 academic sources.
You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts.
All replies must be constructive and use literature where possible. They must be at least 100 words and supported by at least one source.
Please post your initial response by 23:59 Thursday, and comment on the posts of two classmates by 23:59 Sunday.
You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.

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