Depression disorder
Depression disorder
Trigger 1
Ramla a 40-year-old, nurse describes experiencing headaches for the last 3 months.
She indicates that they feel like tightness around her head. They are present most of the time, worse when she awakens, better during the day, and intensify at night. Trauma, fever, neurologic and visual disturbances are not reported. She was told that is a form of tension headache.
When asked about her problems, Ramla begins to weep. Since separating from her husband with the intent to divorce, a few months ago, she had been doing well, but she is now feels low mood state; upon his recent marriage. She is often tearful when alone, has stopped taking walks, and has lost interest in pleasurable things, such as dining and reading.
She has low energy and motivation, but she is still able to work and explains that work takes her mind off her problems. She has no suicidal thoughts, but does not have happy thoughts.
Trigger 2
Ramla admits having trouble sleeping but denies excessive daytime sleepiness.
General examination was normal apart of looking deeply sad, tearful and withdrawn. Her Epworth sleepiness scale score is 8. The patient us diagnosed as depression disorder.
Trigger 3
Ramla knows that she is depressed but wants reassurance about her headaches. She steadily refuses to take any antidepressants because she has heard that they all cause weight gain. She agrees, however, to take something to help her sleep. Sleep hygiene measures are reviewed and reinforced, and she is prescribed eszopiclone (3 mg at bed night).
Trigger 4
In the next visit, one week after, Ramla states that she is sleeping much better and gets up with her alarm clock. She feels a bit tired when she first gets up, but this quickly dissipates after her shower. On the other hand, Ramla still feels quite low. She is prescribed fluoxetin (20-mg tablets), and told to take half a tablet initially in the morning and then to be increased to 1 full tablet. Her visit one-month later shows her to be noticeably improved.
She has more energy, and feels brighter.
Objectives:
1- Anatomical & physiological basis of mood.
2- Mood changes: history taken & manefistations.
3- Assessment of suicid.
4- Headache: history taken.
5- Sleeping disorders: types, relation to mood disturbances.
6- Depression: definition, types, pathophysiology, clinical features.
7- Epworth sleeping scale.
8- Anxiety.
9- sleep-hygiene measures.
10- Eszopiclone: pharmacology, side effects.
11 Anti-depressant.
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Originally Posted by johosh
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