The client is a 32-year-old Hispanic American male who came to the United States when he was in high school with his father. His mother died back in Mexico when he was in school. He presents today to the PMHNPs office for an initial appointment for complaints of depression. The client was referred by his PCP after â€œroutineâ€ medical work-up to rule out an organic basis for his depression. He has no other health issues with the exception of some occasional back pain and â€œstiffâ€ shoulders which he attributes to his current work as a laborer in a warehouse.
During todayâ€™s clinical interview, client reports that he always felt like an outsider as he was â€œteasedâ€ a lot for being â€œblackâ€ in high school. States that he had few friends, and basically kept to himself. He describes his home life as â€œgood.â€ Stating â€œDad did what he could for us, there were 8 of us.â€ He also reports a remarkably diminished interest in engaging in usual activities, states that he has gained 15 pounds in the last 2 months. He is also troubled with insomnia which began about 6 months ago, but have been progressively getting worse. He does report poor concentration which he reports is getting in â€œtroubleâ€ at work.
MENTAL STATUS EXAM
The client is alert, oriented to person, place, time, and event. He is casually dressed. Speech is clear, but soft. He does not readily make eye contact, but when he does, it is only for a few moments. He is endorsing feelings of depression. Affect is somewhat constricted, but improves as the clinical interview progresses. He denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment and insight appear grossly intact. He is currently denying suicidal or homicidal ideation. The PMHNP administers the â€œMontgomery- Asberg Depression Rating Scale (MADRS)â€ and obtained a score of 51 (indicating severe depression).
Â§ Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389.
Decision Point One
Select what the PMHNP should do:
Begin zoloft 25 mg orally daily
Begin Effexor XR 37.5 mg orally daily
Begin Phenelzine 15 mg orally TID