psychological report of a follow up for patient diagnosed with depression

How long should you follow-up after a depression diagnosis?

Follow-up should be completed within one to three weeks after an initial depression diagnosis to assess adherence to treatment (whether counseling, medication or self-management) and side effects of medication, if relevant, Dr. Remus said.

What is the follow-up visit schedule for patients with depressive disorder?

Patients diagnosed with depressive disorder and started on a personalized treatment plan were scheduled for a follow-up visit in 4 to 6 weeks.

How is situationally related depression evaluated in therapy?

exhibiting depression that was situationally related participated in a six-week program of therapy. The BDI, Rathus Assertiveness Schedule, Personality Data Form, and four tape- recorded scenes were used as outcome measures. Clients were evaluated after six weeks

What are the outcome measures for depression treatment?

Improvement, and the Quality of Life in Depression Scale were used as outcome measures. Safety was assessed through laboratory tests, discontinuation rates, vital signs, and adverse events rates.

How do you assess a patient for depression?

Patient Health Questionnaire (PHQ-9) The Patient Health Questionnaire (PHQ) is a self-report measure designed to screen depressive symptoms. It takes one to five minutes to complete and roughly the same amount of time for a clinician to review the responses. The PHQ-9 is available in multiple languages.

How often should you follow-up for depression?

Through the first year following a depression diagnosis, regular follow-up visits and use of the PHQ-9 at least once a month are recommended, until the patient's symptoms have improved for a period of one year.

What must be included for a diagnosis of depression?

Fatigue or loss of energy almost every day. Feelings of hopelessness or worthlessness or excessive guilt almost every day. Problems with concentration or making decisions almost every day. Recurring thoughts of death or suicide, suicide plan, or suicide attempt.

What questions can you ask the patient to screen for depression?

“These various screens may include questions about motivation, fatigue, sleep patterns, suicidality, or hopelessness. They may also ask about frequency and duration,” adds Shadick. “In most cases, a depression symptom must be present most days of the week for at least two weeks to be significant."

What is a positive depression screening?

Positive depression screenings were defined as a score of ≥3 on the PHQ-2 or a score of ≥10 on the PHQ-9. Interventions made in response to positive depression screenings documented in the EHR were recorded.

When should you increase SSRI?

You'll have regular meetings with your doctor when you first start taking SSRIs and you should let them know if you haven't noticed any improvement after 4 to 6 weeks. They may recommend increasing your dose or trying an alternative antidepressant.

What is the gold standard assessment for depression?

The Patient Health Questionnaire (PHQ-9) has rapidly become the national and international gold standard measurement tool in major depression. Every treatment guideline around the world recommends use of measurement-based care.

How do you write a DSM-5 diagnosis?

DSM-5 does state that there is no axial framework for presenting results. DSM-5 does insist that the principal diagnosis be listed first, and suggests that in most cases the qualifying phrase “(principal diagnosis)” or “(reason for visit)” should be added afterwards.

What are the 5 characteristics of depression?

Despite a huge range of symptoms here are five of the most common characteristics that the majority of people with depression experience:Low mood/low interest in activities enjoyed previously: ... Trouble concentrating: ... Changes in appetite or sleep: ... Feeling hopeless/worthless: ... Thoughts of suicide:

What questions should I ask a mental health patient?

Here's a brief list of questions your psychiatrist might ask during your first appointment.What brings you in today? Maybe you're having trouble sleeping, or you're struggling with addiction. ... When did you first notice your symptoms? ... What have you tried so far? ... Does anyone in your family have a psychiatric history?

What questions should I ask about mental health?

Mental health questionsWhat is mental health? ... What do I do if the support doesn't help? ... Can you prevent mental health problems? ... Are there cures for mental health problems? ... What causes mental health problems? ... What do I do if I'm worried about my mental health? ... How do I know if I'm unwell?More items...

What questions do doctors ask about mental health?

Questions to ask your doctorWhat type of mental health problem might I have?Why can't I get over this problem on my own?How do you treat this type of problem?Will counseling or psychotherapy help?Are there medicines that could help?How long will treatment take?What can I do at home to help myself?More items...•

How long does it take to follow up on depression?

Follow-up should be completed within one to three weeks after an initial depression diagnosis to assess adherence to treatment (whether counseling, medication or self-management) and side effects of medication, if relevant, Dr. Remus said. This can be done by support staff like a care manager, she said. Suicide risk should also be assessed at this time, as this “risk sometimes increases as patients respond to treatment and become more energetic,” she added.

What is depression care team?

A depression care team is then activated for follow-up, including a psychiatric nurse practitioner who can titrate or change medications if needed. The team members provide regular feedback to the physicians about patients.

What is the PHQ-9 score?

The PHQ-9 is quick, easy to score and available in several languages, noted Dr. Gutnick. A value of 0 through 3 is assigned to each question based on how often a patient reports having experienced the symptoms described (such as tiredness or poor appetite) in the past two weeks.

What is the PHQ-9?

If a patient answers yes to either question, the patient should then be directed to complete the PHQ-9, a screener that was developed for use in primary care and has been validated for diagnostic assessment and follow-up of outcomes in racial and ethnically diverse populations. The PHQ-9, as well as instructions on scoring and other material, is available from the MacArthur Initiative on Primary Care and Depression.

What is the patient's background?

They moved here to stay with family members but had to be evicted because the house was sold. She has a 10-year-old daughter and 7-year-old twins (a boy and a girl). She got married 11 years ago and presently seeking employment with Safeway supermarket. She has an upcoming interview next week. She is of the Catholic faith , but only occasionally attends church. She and her family have had some difficulties with their church of choice. At one point, the pastor accused her husband of theft of his laptop computer and a credit card; even though, it was later shed to light that one of the young people in the church had been the culprit and no apology was ever given to her husband. Again, both couples were assisting their pastor on a yard sale, the proceeds from the yard sales were stolen, including some discount cards, the patient husband was accursed again, but the thief was later discovered. Still the church never apologizes for the false accusation.

What is the prevalence of major depressive disorder?

The lifetime prevalence of the major depressive disorder in the United States is about 16% (Amanda et al. 2009). The study endorsed at least two current symptoms of depression found that current major depressive disorder was present in 66% cases. The annual prevalence rate is up to 25% in the patient with the chronic medical illness. Risk factors are multifactorial and include genetics, medical, social and environmental factors. Initial patient presentation of major depression can be a variety of physical symptoms including a headache, musculoskeletal pain, abdominal/pelvic pain, mood symptoms and cognitive changes. Depression is highly recurrent. In a study conducted by Bentley, Pagalilauan & Simpson (2014), of 200 patients who have recovered from an episode of major depressive disorder, 64% experienced at least one additional of major depression with the risk of recurrence in the first month after recovery. A history of the most predictive factor for additional episodes of major depressive disorder and each increase the risk of experiencing another by 16%.

What is the history of present illness?

The history of present illness supports a determination of the Major depressive disorder. The DSM-V criteria were met in the above patient demography. Further discussion will be presented in the differential diagnosis section. Patient exhibit some anxiety, as she mentioned of being anxious and stress. The patient goes into panic attack due to inability to pay her bills, and husband is also jobless. Other support measures will be further. Treatment measures will address depression and anxiety, and the family situation will be considered. Folk, J. (2017, April 25).

How old was the patient when she started walking?

The patient was born by a healthy pregnancy, reported by the best of her ability. She started walking without assistance at 12 months old. Patient has no evidence of developmental delays or issue from birth. The patient was born in the southern part of the country; patient has past young adulthood still her mental health problems are affecting her ability to secure a job, which is a primary developmental focus. Functional impairment is common in depression; this may persist more than symptoms. It needs to be assessed. (Culpepper, 2016)

How many people have anxiety disorders?

Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States age 18 and older, or 18.1% of the population every year. Anxiety disorders are highly treatable, yet only 36.9% of those suffering receive treatment. Folk, J. (2017, April 25).

Why does a patient go into panic attack?

The patient goes into panic attack due to inability to pay her bills, and husband is also jobless. Other support measures will be further. Treatment measures will address depression and anxiety, and the family situation will be considered.

Which endocrine disorders are most likely to cause mood changes?

Endocrine Disorders: Endocrinology disorders involving the hypothalamic pituitary adrenal axis or thyroid are especially likely to produce changes in mood. These include Addison disease, Cushing syndrome, hyperthyroidism, hypothyroidism, and hyperparathyroidism. The endocrine disorder must be rule out because the patient has hypothyroidism. However, her recent thyroid tests were regular. The symptoms the patient is exhibiting that may be related to the hypothyroid problem include fatigue, difficulty taking a deep breath, poor memory, and weight change (Sadock, Sadock, & Ruiz, 2015).

How long does it take to follow up on a depression treatment plan?

Patients diagnosed with depressive disorder and started on a personalized treatment plan were scheduled for a follow-up visit in 4 to 6 weeks. Of the patients (n = 236) diagnosed with a depressive disorder and administered MBC, 59.7% (n = 141) received pharmacological treatment, 8.1% (n = 19) received nonpharmacological treatment, 31.3% (n = 74) were recommended for symptomatic monitoring and rescreening at next follow-up appointment, and 2 patients had no follow-up indicated. Patients diagnosed with depression and started on a treatment plan were followed for 14 weeks. A CONSORT (Consolidated Standards of Reporting Trials) flow diagram of the progress through treatment and follow-up is shown in Figure 2.

What is the largest randomized clinical trial of depression?

The largest prospective randomized clinical trial of depression, the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) supported screening for and treating depression in primary care.28-34This landmark trial was implemented over 5 years, across 41 primary care and specialty sites, included 4041 adults, 18 to 75 years of age, and represented a broad range of socioeconomic and ethnic groups.29,34,35The STAR*D trial found depression treated in primary care produced quality outcomes on par with specialty care.28,30,36The results of this study are widely published and provide guidance and clinical implications for managing patients with moderate depressive disorder in primary care.30-32,35,36,37However, despite increased attention to depression screening and treatment from research and national guidelines over 50% of patients in primary care still are unrecognized and undertreated.5,20,38,39The national depression screening rate from 2005 to 2015 was 1.4%, and 2.2% of primary care physician office visits included depression screening for adults, 18 years of age and older.4,14,38,40,41

What is pre-post intervention design?

A pre-post intervention design to improve screening rates and subsequent referrals was used to assess screening effectiveness, clinical outcomes, and satisfaction. The setting was UTSW Department of Family and Community Medicine. The study was reviewed and approved by the Institutional Review Board of UTSW Medical Center with a waiver of the need to obtain informed consent from individual patients.

What percentage of patients with PHQ-2 have a negative screen?

Of patients screened with the PHQ-2 (n = 1145), 18.6% (n = 214) had a negative screen, but had a history of depression or antidepressant medication documented in the EHR, triggering the BPA to advise the nurse to have patient continue screening. Additionally, 7.1% (n = 81) of patients with negative PHQ-2 scores and no history of depression or antidepressant medication were screened with PHQ-9 per physician request.

What is Vitalsign6 for depression?

VitalSign6 included a checklist for diagnosis and decision support to allow tailoring a patient-specific treatment plan. Treatment plan options available to the providers were pharmacological treatment using MBC, behavioral treatment such as psychotherapy with behavioral health providers integrated in the clinic, exercise plans, continue symptomatic monitoring, referral to a specialist, or no further follow-up. Program functionality supported scheduling follow-up in 4 to 6 weeks to evaluate patient’s progress.

What are the most commonly used depression screening tools?

Efforts to improve depression identification and treatment in primary include increased use of screening tools. The Patient Health Questionnaire (PHQ)–2 and PHQ-9 are the most commonly used adult depression screening tools and demonstrate clinical utility and diagnostic accuracy.5,18,20,23,38,42-44The PHQ-2 was designed to be used as the first step in the screening process and if positive, to be followed with the more comprehensive PHQ-9.20,45The PHQ-2 tool consists of 2 questions about frequency of depressed mood and anhedonia, scoring each as 0 (“not at all”) to 3 (“nearly every day”).45A PHQ-2 score ≥3 was shown to have a sensitivity of 83% and a specificity of 92% for detecting major depression.45,46The PHQ-9 consists of 9-items based on the 9 DSM-5(Diagnostic and Statistical Manual of Mental Disorders, fifth edition) criteria for major depressive disorder.47Scores of 5, 10, 15, and 20 represent mild, moderate, moderately severe, and severe depression respectively.46-48

How common is depression in the US?

The prevalence of at least 1 major depressive episode among US adults aged 18 years or older, was 17.3 million, representing 7.1% of all US adults.1Depression is disabling and costly,2-9with an estimated $210 billion annual medical care and lost productivity cost.3,10Untreated depression causes emotional suffering, reduced productivity, lost wages, impaired relationships, and increased comorbidity risk.3,5,11With the inextricable link between mental and physical health,4,8,12evidence shows depression concomitant with serious chronic diseases.4,6,7

3.Physical and Behavioral Observation

The interviews were conducted twice a week since the 12 of December until the 10th of January; there was one personal meeting with the patient and one with his mother being present weekly. James behaved acceptably, he was never late to the interview, even to those that he attended just by himself.

4.Family Background

James’ parents are divorced for four years; they stay in a friendly relationship. The boy lives with his mother but has weekly meetings with the father, he spends at least one week of the summer vacations with him. Mr. Robert Blake, James’ father, is going to get married for the second time; his fiancée, Ms. Mary Brown, is fourth months pregnant.

5.Summary

James is most likely to be concerned about his relationship with the father after his new marriage, especially considering the fact that Mr. Robert is going to have a second child. The boy is afraid of being unwanted in the new family and ‘replaced’ by the newborn baby.

7.Recommendations

The parents of the boy have to explain the situation and the future development of it to James, he needs to be ensured of being needed and loved by his father in order to feel safe and to overcome the diagnosed issues. In addition, it would be helpful for the boy to spend some time, a week or two, with Mr.

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Jane Copland is a passionate PR manager at ThePensters.com – the community of freelance academic writers. She’s into writing, technology and psychology.

Session Report

Case Summary

History of Present Illness

Background Information

Preliminary Assessment

Informal Assessment

Formal Assessment

Visual Analogue

Diagnosis