CASE STUDY DISCUSSION
Summarize the clinical case.
A 28-year-old woman has presented with the following symptoms: persistent headaches, exhaustion, problems sleeping, a lack of interest in activities, difficulty focusing, frequent weeping outbursts, a loss of appetite, and a 10-pound weight loss over the previous month. She takes ibuprofen for migraines and has no substantial medical or mental health history. Both drinking and drug use are something she says she never does. They have been married for two years and have two children.
Create a list of the patient’s problems and prioritize them
Headaches (dull, aching, and generalized)
Fatigue and poor sleep quality
Lack of interest in usual activities
Loss of appetite and weight loss
Worried about “something bad” and “losing” her children
Which diagnosis should be considered? What is your rationale for the diagnosis?
- Depression: The patient’s symptoms of “fatigue, lack of interest in usual activities, difficulty concentrating, and frequent crying spells, and weight loss could be consistent with depression” (Mullen, 2018). Depression is a common and treatable mental health condition that can cause various physical, emotional, and behavioural symptoms (Mullen, 2018).
- What differential diagnosis should be considered?
- Chronic fatigue syndrome: The patient’s symptoms of fatigue, poor sleep quality, difficulty concentrating, and lack of energy could be consistent with chronic fatigue syndrome, a condition that causes persistent fatigue that is not relieved by rest.
- Tension headache: As mentioned earlier, the patient’s headache symptoms could be consistent with a tension headache, a common type of headache that is characterized by diffuse, aching pain in the head and neck.
- Migraine headache: The patient’s headache symptoms could also be consistent with a migraine headache, a type of headache that is characterized by intense, pulsing pain, often on one side of the head, and is often accompanied by other symptoms such as sensitivity to light, sound, and smell.
What test or screening tools should be considered to help identify the correct diagnosis?
Medical history and physical examination
CBC
PHQ-9
What treatment would you prescribe, and what is the rationale (consider psychopharmacology, diagnostics tests, referrals, psychotherapy, psychoeducation)
Psychopharmacology: these include SSRIs or SNRIs to improve mood and reduce symptoms of depression.
Psychotherapy: CBT or IPT to help the patient identify and manage negative thought patterns, build coping skills, and address any underlying psychological or emotional issues contributing to their symptoms (National Institute of Mental Health 2018).
- Psychoeducation: educate the patient about depression, chronic fatigue syndrome, tension headaches, and migraines, as well as strategies for managing symptoms and improving overall well-being.
What standard guidelines would you use to assess or treat this patient?
- The Patient Health Questionnaire (PHQ-9) is a commonly used tool for screening for depression and can help the healthcare provider to assess the severity of the patient’s symptoms and determine if further evaluation or treatment is necessary (Shadrina, et al., 2018).
References
- Mullen, S. (2018). Major depressive disorder in children and adolescents. Mental Health Clinician, 8(6), 275-283.Major depressive disorder in children and adolescents | Mental Health Clinician (allenpress.com)
National Institute of Mental Health (2018) “Depression” [online] Available at: https://www.nimh.nih.gov/health/topics/depression/index.shtml#part_145397
Shadrina, M., Bondarenko, E.A., & Slominsky, P.A. (2018) “Genetics Factors in Major Depression Disease” [online] Front Psychiatry. 2018; 334(9) Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6065213/
