Psych NP Case Studies - Episode 2: 36 Year old Depressed Female
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Hey guys this is a follow up of the patient from Psych NP Case Studies: Episode 1 where we did an initial assessment. Please make sure to watch that video as this will be a series following this patient throughout a series of events. Link below!
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@AnthonyHinesnusn 4 жыл бұрын
Great case study and recommendations!!...I would also include melatonin as an option and provide sleep hygiene education. I agree that many patients underestimate the importance of therapy and solely believe medication will solve their problem. Both are equally important.
@clearfieldwiffleball6601 6 ай бұрын
Too early to increase. Watchful waiting. Do the therapy. MI, psychoeducation, establish sleep hygiene, and maybe some solutions focused therapy, focus on positives and solutions rather than problems. Labs obviously should be obtained. Sleep apnea? Sleep is worse on SSRI, thinking maybe headed towards mixed features. Monitor very closely. Add hydroxyzine 25 mg prn qhs. 50 is too much to start with. Maybe even 10mg. Lexapro- keep same at 10 and revisit in 2-3 weeks. Ensure safety.
@michellewhitacre9318 2 жыл бұрын
We could add vistaril 50 mg for sleep/anxiety. Evidence based practice would be to increase the lexapro for maximum efficacy up to 20 mg. If we cannot get buy in from the patient to continue lexapro then I would not add vistaril but instead I'd change it to remeron 15 mg po q hs to help with depression, anxiety, and insomnia with little to no sexual s/e. Nursing interventions would include counseling her on good sleep hygiene, proper nutrition and exercise. Encourage her to get out and walk even if she does not want to. Follow up in 1 month.
@broham89 Жыл бұрын
I second the remeron to help with the depressive and anxiety symptoms along with it sedating properties at lower doses. Ramelteon would be my drug of choice for sleep d/o as it is cleaner and a melatonin-derivative
@shedydee4962 4 жыл бұрын
Great series...please do more. Now I'm opinion, I would not increase medications just yet. I would treat insomnia with melatonin and really work on theapist aquisition.
@jazzyj2243 4 жыл бұрын
Definitely like these case studies. I was initially thinking mirtazepine may benefit for her, so long as weight is not an issue, and she eats healthy. Mirtazepine dosed at night can help with sleep without polypharmacy. Also, seems she meets criteria for MDD, as opposed to adjustment disorder. Perhaps her primary is MDD and secondary adjustment d/o? Not that it truly matters since both are treated the same :). Thanks again for thought provoking case, hope to see more of these.
@alexiskironde7413 4 жыл бұрын
THANK YOU ALWAYS-ALEXIS KIRONDE
@alexiskironde7413 4 жыл бұрын
I AM ALWAYS LOVING-ALEXIS KIRONDE
@caroldelville6753 2 жыл бұрын
I love these cases, but it would really help if you made some edits in your closed caption. For example instead of GAD7 the CC reads JD7. For those of us that need CC it would be a tremendous help
@alexiskironde7413 4 жыл бұрын
LOVE YOU ALWAYS-ALEXIS KIRONDE
@DithsHauteSpot 4 жыл бұрын
Isn’t 20mg the max dose for lexapro?
@lesandres23 4 жыл бұрын
In Psychiatry is about the art...Example: Guidelines can reccomend a medication for twice a day...let's say "Lithium". However, the patient have compliant issues or works 12 hour shifts and can't take it b.i.d... What I do is consult a PharmD. They can say if you can play around it.
@shedydee4962 4 жыл бұрын
@@lesandres23 good point. Need a Pharm D on hand.
@pennwoman 2 жыл бұрын
I’ve found with dosing that it can always go over typical ranges. Rapid metabolizers will have higher doses.