Posted: September 7th, 2024

Week 2: Captain of the Ship Project – Depressive Disorder

Week 2: Captain of the Ship Project – Depressive Disorder

Student Name
College of Nursing-PMHNP, Walden University
NRNP 6670: Psychiatric Mental Health Nurse Practitioner Role II: Adults and Older Adults

Week 2: Captain of the Ship Project – Depressive Disorder
HPI and Clinical Impression
The patient I experienced in the practicum environment was major depressive disorder. The patient was a black female aged 28. She had a history of drug abuse and prostitution. She was seeking to quit prostitution and find a new job. She lives in the neighborhood with her mother and brother. The two are jobless and rely on her for daily bread. Her medical history is unremarkable. The client has no child and is not married. She broke up with her boyfriend when he found her promiscuous character. She regrets losing a special person in her life. She wishes to raise a family with a faithful husband.
She experienced the loss of pleasure in daily activities, weight loss, trouble falling asleep, suicidal thoughts, feeling worthless, feeling restless and agitated, and fatigue. The patient has a history of depression but did not adhere to the treatment plan. She did not take all the drugs or attend all the counseling sessions.
The patient has experienced a depressive mood for over two weeks. She started experiencing the symptoms after two of her colleagues died in a car accident. Another friend died after a client brutally abused her. Several of her colleagues died last year during the pandemic, while others suffer from sexually transmitted infections. She fears that she will end up in the same fate of death, sexual harassment, or sexually transmitted infections.
The patient has never been to a hospital to test for sexually transmitted infections. She was influenced by the cousin to join prostitution in a local club. She feels worthless and wasted. She believes the job has stripped her of her dignity and ability to focus on her goals. The patient is a college graduate of nutrition. She graduated two years ago with a second-class upper degree.
The clinical impression shows that the client is not feeling well. She looks depressed and not in touch with the medical interview. Her mind seems disturbed, and her face is pale. She cannot imagine dying of a sexually transmitted disease or in the hands of an abusive client. The patient is at risk of going back to the prostitution job. Going to the local club may expose her to drifting to the old habits. She needs counseling to alleviate the negative and suicidal thoughts.
Psychopharmacologic Treatments
Psychopharmacologic treatment for major depressive disorder involves selective serotonin reuptake inhibitors. Antidepressants are effective in treating depressive disorders. One of the best medications is sertraline (Zoloft) which has few side effects and is highly effective (Hasin et al., 2018). The 28-year-old patient should start with a 5mg dose tablet daily during bedtime. The patient should take the drug for two weeks and report back to the clinic for further assessment. The assessment is necessary to determine whether increasing the dose to 10mg tablet daily is necessary (Hasin et al., 2018). The patient needs to report to the clinic immediately they experience any side effects. Antidepressants are important to relieve symptoms of depression. The medication is the first line of treatment for major depressive disorder. It helps relieve the depression.
Psychotherapy Choices
An individual psychotherapeutic approach to the treatment of the major depressive disorder is important. Cognitive behavior therapy is an effective approach since it involves brief sessions that explore the issues causing depression (Kohler‐Forsberg et al., 2019). Patients with depression experience distorted thoughts about their current life and future. For example, patients may become hopeless since they believe they will die or something worse will happen to them (Kohler‐Forsberg et al., 2019). Talking therapy is effective in the treatment of depressive disorders.
The patient will attend at least 10-12 sessions, each comprising 20 minutes. The psychotherapist will allow the patient to share their experiences. Sharing will help the patient express her frustrations and beliefs about life (Kohler‐Forsberg et al., 2019). The sharing will open the client’s eyes to visualize the need to embrace a positive mindset. Another benefit is that it will change the irrational thoughts of the patient about the future. Talk therapy will help the client to develop hope for the future.
Medical Management Needs
The medical management needs will involve a mental examination to determine the severity of the depression. The patient will require a psychiatrist’s referral to carry out additional tests (Cipriani et al., 2018). Another medical need is to refer the client to a gynecologist for further tests. The tests will be used to determine the risk of infection with a sexually transmitted disease. Diagnosing the disease early is crucial since the treatment is easy and effective (Cipriani et al., 2018). The medical management will involve educating the patient to take all medications. Adhering to the treatment plan will enhance the recovery process.
Community Support Resources
Community resources are necessary to support the patient during and after recovery. One of the needs of the patient is a job opportunity or a source of income. The patient lives with an ailing mother and unemployed brother. Connecting the patient to job agencies and organizations that support former prostitutes will be effective (Farb et al., 2018). Helping the patient to find a job will help them to generate income to support the family. Another benefit is keeping off the company of friends who drag her to prostitution. It is important to connect the patient to organizations supporting former prostitutes. Attending their meetings will enhance the recovery process and their ability to build up her life again. Housing support is necessary to ensure the patient has house rent, food, and other necessities (Farb et al., 2018). A comprehensive approach to patient care improves chances of positive results and recovery.
Plan for Follow-Up
Follow-up is necessary to ensure the client is not going back to the old habit. One of the follow-ups is visiting the healthcare facility after one week of taking the medication. After the first clinic, the client should visit the facility every two weeks for further assessment (Ebert et al., 2019). Another follow-up is to ensure the patient has the necessary support from the former prostitute organizations. Finding a reputable job is necessary to ensure she has income to support the family. The follow-up will allow the healthcare worker to review the progress and determine if some treatment plan changes are necessary.
Collaboration with other healthcare workers such as psychiatrists, counselors, nurses, and gynecologist is crucial. For example, the gynecologist report will indicate if the patient is at risk of sexually transmitted diseases. If the patient has a sexually transmitted infection, she should get immediate treatment (Ebert et al., 2019). Counselors should have the report from the healthcare workers to address all the problems. Ongoing support is necessary to ensure a quick recovery.

References
Cipriani, A., Furukawa, T. A., Salanti, G., Chaimani, A., Atkinson, L. Z., Ogawa, Y., … & Geddes, J. R. (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Focus, 16(4), 420-429.
Ebert, D. D., Buntrock, C., Mortier, P., Auerbach, R., Weisel, K. K., Kessler, R. C., … & Bruffaerts, R. (2019). Prediction of major depressive disorder onset in college students. Depression and anxiety, 36(4), 294-304.
Farb, N., Anderson, A., Ravindran, A., Hawley, L., Irving, J., Mancuso, E., … & Segal, Z. V. (2018). Prevention of relapse/recurrence in major depressive disorder with either mindfulness-based cognitive therapy or cognitive therapy. Journal of consulting and clinical psychology, 86(2), 200.
Hasin, D. S., Sarvet, A. L., Meyers, J. L., Saha, T. D., Ruan, W. J., Stohl, M., & Grant, B. F. (2018). Epidemiology of adult DSM-5 major depressive disorder and its specifiers in the United States. JAMA psychiatry, 75(4), 336-346.
Kohler‐Forsberg, O., N. Lydholm, C., Hjorthøj, C., Nordentoft, M., Mors, O., & Benros, M. E. (2019). Efficacy of anti‐inflammatory treatment on major depressive disorder or depressive symptoms: meta‐analysis of clinical trials. Acta Psychiatrica Scandinavica, 139(5), 404-419.

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