Free Essay. Assessing and Treating Adult and Geriatric Clients With Mood Disorders

The client, who is a Hispanic man is aged 32 years. He migrated to the US together with his father from Mexico. His mother had died earlier while he was in school. Due to the referral from his primary care provider, the client present to PMHNP's office. The aim was to rule out any depression emanating from an organic basis without significant medical problems. Earlier on, the client had indicated the signs of loneliness, insomnia decrease in interest when it comes to unusual activities isolation, a fluctuating weight of 15 pounds within two months, and poor concentration. According to the report from the mental status exam, the client indicated alertness, clear speech, oriented 3, minimal eye contact, and constricted effects which indicates some improvement in the course of the interview process's client did not show any positive results of hallucinations, paranoid thinking, or delusions. The Montgomery -Asberg Depression rating scale indicated a score of 51, meaning he had severe depression.

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First Decision

I selected Zoloft 25mg as the pharmacologic anti-depression for the treatment. The choice of the aged was based on the symptoms that the client had presented. I felt that the client's situation coincided with the medication that I chose. According to Stahl (2013), the primary targets symptoms of sertraline include insomnia depression mood and low body energy. The report from the client has shown some of these symptoms. Therefore, I have opted to start that kind of medication on the client.

There are multiple beneficial effects on the client that the agent I selected can produce. There is, therefore, a high hope that the medication will improve the exhibited symptoms of a typical depression which has been indicated in the client's test results. These problems had caused the client to decrease his interest levels and increased his weight by 15 pounds in two months.

Upon the application of the agent. I expect the client to show a significant reduction of the symptoms by at least 30%. Muijsers & Noble (2002) argue that a daily dosage of 50mg is recommended when treating adults. Based on that study, I came to understand that my dosage of 25mg was so much below the required standards. I could not expect my decision could have a large margin or difference with the standard requirement before. Therefore, I did not expect a significant large decrease in the client's symptoms upon applying the medication to him because of that margin. It is also clear that antidepressants, for example, selective serotonin rebuke inhibitors leads to a common side effect of sexual dysfunction. However, there was a clear indication of a notable effect when it came to erectile dysfunction, the effect was due to the initial application of 25 mg daily dosage, which was very low initially.

Second Decision

I have opted to continue with the same medication in addition to offering counseling services to the client even though the client had few concerns regarding the issues of dysfunction. The current dosage has indicated significantly good results to the client, making me select this option for the second time. Therefore, even though there are some side effects experienced by the client, there is a need for a phase of adaption is required because of the untended reactions.

It is, therefore, necessary that I offer counseling services to the client due to the possible side effect that might arise from the medication. Such an effect might include sexual dysfunction on the side of the client. I will also guide him on the importance of not discontinuing the medication abruptly.

My decision to offer counsel to the client was driven by the hope that the counseling sessions would be highly effective when it comes to instilling confidence in the client. The client was expected to believe that the side effect of the dosage is just temporary and he should not give up on taking the medication just as prescribed. Hggins et al., (2010) assets that the management course of anti-depressant related to sexual dysfunction is treated just like a wait and see kind of treatment. Therefore, my hope was that through continuing therapy, and enough tolerance on the side of the client, he would eventually experience efficacy in the initial treatment phase but experience better results and adaption to the therapy afterward. I expected that the client would inform me of better results eventually if he opts to continue with the provided treatment option.

However, it was sad that the client decided to discontinue the medication abruptly when I offered the counseling session on him. According to him, the reason for discontinuing the medication included the dysfunction of sexual activities plus the worsening self-esteem he experienced. The depressed symptoms that the client was experiencing already contributed to these actions because he said that was the only option for him.

Third Decision

Once the client opted to discontinue the medication, I have now decided to opt for Wellbutrin XL. The purpose of Selective-Serotonin Reuptake inhibitors (SSRIs) is to increase serotonin availability. Instead, I just decided to utilize Serotonin-norepinephrine reuptake inhibitor (SNRI) so that it can act quickly on other receptors and neurotransmitters to ensure that sexual dysfunction risk is decreased. Thus, efficacy from a double-blind randomized study made me select Wellbutrin XL. The results had indicated that a single daily Bupropion (XL) could be the most appropriate when it comes to the treatment of depression while decreasing the side effects of sexual dysfunction.

I was confident that the choice of Wellbutrin XL will result in better results for the client compared to sertraline drugs. The improvements had earlier been noted in various symptoms on the client. The study by Lee & Park, (2017) had already indicated that those getting treated with sertraline have more side effects like sexual dysfunction in the course of the duration compared to the patients taking Bupropion. The medication was also capable of treating atypical depression as well as sleep disturbance, depressed mood without leading to sexual dysfunction compared to the earlier dosage.

More so, the switch of medication, according to me, could lead to positive outcomes and medical administration situation compliance decreased signs of depression and a decrease in sexual dysfunction. More, I expected a change to Wellbutrin XL would be more effective but would result in increased insomnia. However, according to the guidelines, there was a need to add SSRI before switching the classes of drugs. Once I had a review of the results, I am also convinced that the drug would be the most appropriate to the client. The study by Cates (n.d) asserts that the switching of antidepressants to the ones why lower effects of sexual dysfunction in an appropriate manner can easily contribute to the best results; with Bupropion being the best option to consider.

Ethical Considerations

Studies have already indicated that the Hispanic community is the largest minority in the USA. However, the group receives the inadequate quality of care, a situation that leads to inequalities when it comes to recognizing, managing and treatment of major depressions. The government has to address these racial and ethnic health disparities that the population experiences. The studies by Beeker et al., (2017) have already indicated that the continuance of under-recognition of depression in the Hispanic community is probably due to language variances, somatic appearances medical literacy barriers and cultural distress. However, health professionals have to respect the ethics and morals of the clients and ensure each client is handled with respect, love, and fairness. The client should always understand the probability of language disparities, illiteracy to various disease processes and understanding. The health care professional should always educate the client about any health problem and the respective medication. More so, the healthcare provider should offer the best treatment to the client, and also understand that the client's autonomy might remain intact regardless of the decisions that the health profession thinks that their clients have to consider.

Conclusion

The healthcare provider must acknowledge the ethnicity of the clients. They should consider the probability of any barriers when it comes to learning and language barriers and the role these issues play when offering the medication to the client. The case study analyzed in this week listed the pharmacologic agents that health providers can select for the provision of the best treatment to the client based on the signs and symptoms of Major Depression Disorder. The ethical considerations were also discussed about specific ethical challenges when it comes to the Hispanic community. It included the major information that one has to consider when handling an adult and geriatric population.

References

Cates, M. E. (n.d.). Antidepressant-Induced Sexual Dysfunction and Its Management. AISD [Compatibility Mode]. 3(25), 525-8. HYPERLINK "https://cdn.ymaws.com/www.aparx.org/resource/resmgr/CEs/Antidepressant-Induced_Sexua.pdf" https://cdn.ymaws.com/www.aparx.org/resource/resmgr/CEs/Antidepressant-Induced_Sexua.pdf

Higgins, A., Nash, M., & Lynch, A. M. (2010). Antidepressant-associated sexual dysfunction: Impact, effects, and treatment. Drug, healthcare and patient safety, 2, 141-50. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108697/

Muijsers, R. B. R., Plosker, G. L., & Noble, S. (2002). Sertraline: a review of its use in the

Management of major depressive disorder in elderly patients. Drugs & Aging, 19(5), 377-392. https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=12093324&site=eds-live&scope=site

Stahl, S. M. (2013). Stahl's essential psychopharmacology: Neuroscientific basis and practical Applications. (4th ed.). New York, NY: Cambridge University Press. http://bucket.daz.cat/9781107025981.pdf

Lee, S., & Park, Y. (2017). Variation in Major Depressive Disorder Onset by Place of Origin Among U.S. Latinos. The Psychiatric Quarterly, 88(3), 653-663. https://doi-org.ezp.waldenulibrary.org/10.1007/s11126-016-9484-5Beeker, T., Schlaepfer, T. E., & Coenen, V. A. (2017). Autonomy in Depressive Patients

Undergoing DBS-Treatment: Informed Consent, Freedom of Will and DBS' Potential to Restore It. Frontiers in integrative neuroscience, 11, 11. doi:10.3389/fnint.2017.00011