Montgomery- Asberg Depression Rating Scale (MADRS)

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 “routine” medical work-up to rule out an organic basis for his depression. He has no other health issues except for some occasional back pain and “stiff” shoulders which he attributes to his current work as a laborer in a warehouse. the “Montgomery- Asberg Depression Rating Scale (MADRS)” and obtained a score of 51 (indicating severe depression). reports that he always felt like an outsider as he was “teased” a lot for being “black” in high school. States that he had few friends, and basically kept to himself. 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 “trouble” at work.

· Decision #1: start Zoloft 25mg orally daily

· Which decision did you select?

· Why did you select this decision? Support your response with evidence and references to the Learning Resources.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

· Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

· Decision #2: Client returns to clinic in four weeks, reports a 25% decrease in symptoms but concerned over the new onset of erectile dysfunction

*add Augmentin Wellbutrin IR 150mg in the morning

· Why did you select this decision? Support y our response with evidence and references to the Learning Resources.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

· Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

· Decision #3: Client returns to clinic in four weeks, Client stated that depressive symptoms have decreased even more and his erectile dysfunction has abated

· Client reports that he has been feeling “jittery” and sometimes “nervous”

*change to Wellbutrin XL 150mg daily

· Why did you select this decision? Support your response with evidence and references to the Learning Resources.

· What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

· Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Explain how ethical considerations might impact your treatment plan and communication with clients.

Conclusion

References

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

3 or more credible outside sources

APA

Level 1 heading