The presenting problem in Kel’s case is depression. The patient has a severe case of depressive mood since she acknowledges feeling sad, hopeless, and lacking the energy to for anything. She has always been energetic and optimistic about her future (such as cruising), but that is all gone nowadays. She has lost interest in things that gave her pleasure before. She has other presenting symptoms, such as worthlessness, severe weight loss due to lack of interest in eating and not feeling hungry, constant fatigue even after sleeping for long hours, indecisiveness, and disorganized thinking.
Primary and Differential Diagnosis using the DSM-5 and ICD 10 Codes
The primary diagnosis in Kel’s case is due to the presenting symptoms. The criteria for diagnosis fit an ICD-10 code of F32.9. The differential diagnosis in the case is bipolar disorder under the same diagnostic criteria. According to Dubovsky et al. (2021), the criteria for diagnosis based on ICD-5 considers the presence of symptoms and the period. The doctor should confirm the presence of at least five of the symptoms for about two weeks or more. One of the presenting symptoms should be either a depressed mood or a lack of pleasure or interest. Among the symptoms that the doctor considered include persistent depressed mood, reduced interest in the things the client used to enjoy considerable weight loss, slowed down thoughts and lack of energy, fatigue, feeling worthless and inappropriately guilty, indecisiveness or problems concentrating, and death thoughts.
The patient does not suffer bipolar since she does not have episodes of mania or hypomania. In bipolar disorder, the symptoms depend on whether it is a type I or II. In Bipolar I, the patient has manic-depressive episodes, while in II, there are more minor episodes of manic and depressive moods. The patient could also have a cyclothymic disorder, an alternate feeling of depression and hypomania. Although Kel has episodes of depression, she does not have mania, hence, failing to meet the criteria for bipolar.
The client has severe symptoms of depression and will need a treatment plan that includes three elements: pharmacological, non-pharmacological, or psychiatric therapy and patient education. The patient will get a selective serotonin reuptake inhibitor (SSRI). The drug is a commonly utilized first-line treatment for depressive disorder. The drug’s use is controlled by the National Institute for Health and Care Excellence (NICE) guidelines (Molenaar et al., 2018). The drug works by diminishing depressive feelings by hindering serotonin reuptake, thus, stabilizing the patient’s mood. The second element of the treatment plan is psychiatric therapy, such as cognitive-behavioral therapy. The patient will be given an opportunity to speak out and uncover the underlying causes of the depression. Confronting the cause of the problem is an effective way of addressing the presenting problem (Ólason et al., 2018). Finally, patient education will include self-help and management strategies that the patient can use to reduce depression, such as physical exercise, meditation, enough sleep, and a proper diet.
Appropriate Screening Instruments for Suicidal Ideation
Some of the tools that can be used to screen for suicide ideation include Patient Health Questionnaire 2 (PHQ2), originally designed to screen for depression but currently being used for suicide risk or ideation; Suicide Behaviors Questionnaire-Revised (SBQ-R),
The Suicide Behaviors Questionnaire-Revised (SBQ-R), Patient Health Questionnaire (PHQ9), Emergency Medicine Network’s EDSAFE Patient Safety Screener, and Suicide Behaviors Questionnaire-Revised (SBQ-R).
Dubovsky, S. L., Ghosh, B. M., Serotte, J. C., & Cranwell, V. (2021). Psychotic depression: diagnosis, differential diagnosis, and treatment. Psychotherapy and Psychosomatics, 90(3), 160-177. doi: 10.1159/000511348
Molenaar, N. M., Kamperman, A. M., Boyce, P., & Bergink, V. (2018). Guidelines on treatment of perinatal depression with antidepressants: An international review. Australian & New Zealand Journal of Psychiatry, 52(4), 320-327. doi: 10.1177/0004867418762057
Ólason, M., Andrason, R. H., Jónsdóttir, I. H., Kristbergsdóttir, H., & Jensen, M. P. (2018). Cognitive behavioral therapy for depression and anxiety in an interdisciplinary rehabilitation program for chronic pain: a randomized controlled trial with a 3-year follow-up. International Journal of Behavioral Medicine, 25(1), 55-66. doi: 10.1007/s12529-017-9690-z.