Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs.
Case: An elderly widow who just lost her spouse.
Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications:
Metformin 500mg BID
Januvia 100mg daily
Losartan 100mg daily
HCTZ 25mg daily
Sertraline 100mg daily
Current weight: 88 kg
Current height: 64 inches
Temp: 98.6 degrees F
BP: 132/86
Full Answer Section
Diagnosis:
Based on the assessment findings, the patient may be diagnosed with major depressive disorder and insomnia disorder. Major depressive disorder is a common mental health condition that is characterized by persistent feelings of sadness and loss of interest in activities that were once enjoyable. Insomnia disorder is a sleep disorder that is characterized by difficulty falling asleep, staying asleep, or waking up too early.
Treatment:
The treatment plan for the patient's insomnia and depression will be individualized based on her assessment findings. However, some common treatment approaches include:
- Psychotherapy: Psychotherapy, also known as talk therapy, can be helpful for patients with insomnia and depression. Psychotherapy can help patients to understand and manage their emotions, to develop coping skills, and to make lifestyle changes that can improve their sleep and mood.
- Medication: Medication may also be prescribed to treat the patient's insomnia and depression. Some common medications used to treat these conditions include antidepressants, sleeping pills, and anti-anxiety medications.
- Lifestyle changes: Lifestyle changes, such as regular exercise, a healthy diet, and good sleep hygiene, can also be helpful for patients with insomnia and depression.
Specific therapy approaches for the case study excerpt:
Given the patient's age and medical history, the following therapy approaches may be particularly beneficial:
- Cognitive-behavioral therapy (CBT): CBT is a type of psychotherapy that is focused on changing unhelpful thoughts and behaviors. CBT can be helpful for patients with insomnia and depression by helping them to identify and challenge negative thoughts, to develop coping skills, and to make lifestyle changes that can improve their sleep and mood.
- Interpersonal therapy (IPT): IPT is a type of psychotherapy that is focused on improving relationships. IPT can be helpful for patients with depression by helping them to identify and resolve interpersonal problems that may be contributing to their depression.
- Light therapy: Light therapy is a treatment that involves exposing the patient to bright light. Light therapy can be helpful for patients with insomnia by helping to regulate their circadian rhythm.
Conclusion:
The patient's insomnia and depression are likely related to her recent bereavement. However, there may also be other factors contributing to her symptoms, such as her medical history and lifestyle. A thorough assessment will be necessary to identify the underlying causes of her insomnia and depression and to develop a treatment plan that is right for her.
It is important to note that the patient is at increased risk for suicide due to her age, depression, and recent bereavement. The healthcare provider should carefully assess the patient's suicide risk and should provide appropriate support and resources.