NR 607 Week 4 | Diagnosis &
Management in Psychiatric Mental
Health III Study Questions | Correctly
Answered and Rated A+ | Chamberlain
Harry is a 48-year-old who presents to the outpatient mental health clinic
for an initial evaluation of symptoms of depression. Harry has been
prescribed bupropion XL 300 mg daily by his primary care provider and
has been taking it for the past five years. Harry endorsed that at first, the
medication "worked really well," but states he has been feeling more
down lately and is concerned that the medication is no longer working.
He stated that about eight months ago, he changed to a new position at
work that was "overwhelming." He had no time to participate in his
hobbies, which include reading, racquetball, and golf. He states that
since his promotion, "I have no time to do anything but work, eat, and
sleep, so I tend to eat and sleep a lot more than I used to." Harry states
that his wife of 18 years has become frustrated with him because he has
no energy to participate in raising their children.”
- Correct Answer - -switch to bupropion 150 mg twice daily
-recommend follow-up with a primary provider
-recommend initiating psychotherapy
Rationale: The most appropriate initial treatment for Harry is to switch to
bupropion 150 mg twice daily, recommend follow-up with the primary
provider, and recommend initiating psychotherapy. Because the client
has had gastric bypass surgery, his ability to absorb extended-release
,medications may be impaired. Since the medication initially worked to
control his symptoms, it is reasonable to begin by switching to the same
medication in an immediate release format. Harry should follow up with
his primary provider to obtain a complete physical, including lab work for
possible deficiency of vitamin D or B12. Because of the client's recent
increase in daily stressors, psychotherapy may also be appropriate at
this time.
Bettina is a 24-year-old who presents to the mental health clinic after a
referral from her primary care provider. She endorses symptoms of
depression that began "when I was still in college," including excessive
sleepiness, withdrawal from social activities, the guilt associated with
"leaving my friends hanging," and anhedonia. Bettina states that she
saw a counselor through the college health service, which helped her
symptoms somewhat, but she was unable to continue with counseling
after graduation two years ago. She made an appointment with her
primary care provider to discuss medications for depressive symptoms
and was prescribed citalopram 20 mg daily. After six weeks on the
medication, she did not experience relief of symptoms and returned to
the provider at which time her dose was increased to 40 mg daily. She
had a follow-up appointment with the provider six months later.
- Correct Answer - continue current medications and add aripiprazole 2
mg daily
Rationale: The most appropriate treatment for Bettina is to continue her
current medications and add aripiprazole 2 mg daily. According to the
STAR*D guidelines, the client may choose to remain on the current
medications and add an atypical antipsychotic medication such as
, aripiprazole. Alternatively, the client may choose to discontinue current
medications and start a tricyclic or tetracyclic antidepressant. The client
may also choose to begin therapy. Inpatient admission is not indicated
for this client.
Carlos is a 25-year-old who was admitted to the inpatient psychiatric unit
after a nonfatal suicide attempt. He has a history of major depressive
disorder which was initially diagnosed when he was 22, at which time he
was started on sertraline 50 mg and then increased to sertraline 100 mg.
Carlos attempted suicide approximately four months after beginning the
sertraline. At that time, he was referred for psychotherapy and
prescribed aripiprazole 5 mg in addition to sertraline. Carlos states that
while his symptoms of depression improved after starting the
aripiprazole, they never completely disappeared. He endorses frequent
thoughts of dying but states "Most of the time, they are just thoughts of
not being here anymore- they aren't active thoughts of killing myself."
Carlos states that he attempted suicide by overdosing on his
medications after his girlfriend broke up with him. Currently, he endorses
active suicidal thoughts.
- Correct Answer - prescribe electroconvulsive therapy
Rationale: The most appropriate management strategy for Carlos is
electroconvulsive therapy. Since Carlos is experiencing active suicidal
thoughts, electroconvulsive therapy may be the best treatment option at
this time. Carlos's symptoms have been resistant to multiple
medications; increasing dosages is not the best option, especially since
Carlos attempted to overdose on his medications. Neither a suicide
contract nor one-to-one observations will provide symptom relief.
Management in Psychiatric Mental
Health III Study Questions | Correctly
Answered and Rated A+ | Chamberlain
Harry is a 48-year-old who presents to the outpatient mental health clinic
for an initial evaluation of symptoms of depression. Harry has been
prescribed bupropion XL 300 mg daily by his primary care provider and
has been taking it for the past five years. Harry endorsed that at first, the
medication "worked really well," but states he has been feeling more
down lately and is concerned that the medication is no longer working.
He stated that about eight months ago, he changed to a new position at
work that was "overwhelming." He had no time to participate in his
hobbies, which include reading, racquetball, and golf. He states that
since his promotion, "I have no time to do anything but work, eat, and
sleep, so I tend to eat and sleep a lot more than I used to." Harry states
that his wife of 18 years has become frustrated with him because he has
no energy to participate in raising their children.”
- Correct Answer - -switch to bupropion 150 mg twice daily
-recommend follow-up with a primary provider
-recommend initiating psychotherapy
Rationale: The most appropriate initial treatment for Harry is to switch to
bupropion 150 mg twice daily, recommend follow-up with the primary
provider, and recommend initiating psychotherapy. Because the client
has had gastric bypass surgery, his ability to absorb extended-release
,medications may be impaired. Since the medication initially worked to
control his symptoms, it is reasonable to begin by switching to the same
medication in an immediate release format. Harry should follow up with
his primary provider to obtain a complete physical, including lab work for
possible deficiency of vitamin D or B12. Because of the client's recent
increase in daily stressors, psychotherapy may also be appropriate at
this time.
Bettina is a 24-year-old who presents to the mental health clinic after a
referral from her primary care provider. She endorses symptoms of
depression that began "when I was still in college," including excessive
sleepiness, withdrawal from social activities, the guilt associated with
"leaving my friends hanging," and anhedonia. Bettina states that she
saw a counselor through the college health service, which helped her
symptoms somewhat, but she was unable to continue with counseling
after graduation two years ago. She made an appointment with her
primary care provider to discuss medications for depressive symptoms
and was prescribed citalopram 20 mg daily. After six weeks on the
medication, she did not experience relief of symptoms and returned to
the provider at which time her dose was increased to 40 mg daily. She
had a follow-up appointment with the provider six months later.
- Correct Answer - continue current medications and add aripiprazole 2
mg daily
Rationale: The most appropriate treatment for Bettina is to continue her
current medications and add aripiprazole 2 mg daily. According to the
STAR*D guidelines, the client may choose to remain on the current
medications and add an atypical antipsychotic medication such as
, aripiprazole. Alternatively, the client may choose to discontinue current
medications and start a tricyclic or tetracyclic antidepressant. The client
may also choose to begin therapy. Inpatient admission is not indicated
for this client.
Carlos is a 25-year-old who was admitted to the inpatient psychiatric unit
after a nonfatal suicide attempt. He has a history of major depressive
disorder which was initially diagnosed when he was 22, at which time he
was started on sertraline 50 mg and then increased to sertraline 100 mg.
Carlos attempted suicide approximately four months after beginning the
sertraline. At that time, he was referred for psychotherapy and
prescribed aripiprazole 5 mg in addition to sertraline. Carlos states that
while his symptoms of depression improved after starting the
aripiprazole, they never completely disappeared. He endorses frequent
thoughts of dying but states "Most of the time, they are just thoughts of
not being here anymore- they aren't active thoughts of killing myself."
Carlos states that he attempted suicide by overdosing on his
medications after his girlfriend broke up with him. Currently, he endorses
active suicidal thoughts.
- Correct Answer - prescribe electroconvulsive therapy
Rationale: The most appropriate management strategy for Carlos is
electroconvulsive therapy. Since Carlos is experiencing active suicidal
thoughts, electroconvulsive therapy may be the best treatment option at
this time. Carlos's symptoms have been resistant to multiple
medications; increasing dosages is not the best option, especially since
Carlos attempted to overdose on his medications. Neither a suicide
contract nor one-to-one observations will provide symptom relief.
