*There are multiple parts to be addressed with each question*
Week 3: Psychiatric Disorders and Screening
The purpose of student discussions is to provide the opportunity for application of depression and anxiety screening tools to a selected case patient. Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
1. Explain the purpose of two selected screening tools
2. Interpret the scoring criteria of two selected screening tools
3. Discuss the mechanism of action, side effects and expected onset of action for a selected medication
Anxiety and depression are the most common psychiatric problems you will encounter in your primary care practice.
Review this case study
HPI: BT, 50-year-old Caucasian male presents to office with complaints of “no energy and staying in bed all day.” These symptoms have been present for about 4 months and seem worse in the morning. It is hard to get out of bed and get the day started because he does not feel rested when he gets up in the morning.  BT reports “deep sadness & heartache over the loss of his wife”. States” I really don’t feel like making plans or going out”.  He tries to make plans with family or friends once a week, but it can be really exhausting because everyone asks about how he is handling the loss. Reports he also has difficulty completing projects for work, he cannot stay focused anymore. He reports not eating regularly and has lost some weight. BT has been a widower for 10 months. His wife died unexpectedly, she had an MI. His oldest daughter has a 2-year-old daughter, she asked him to babysit a couple of times, which he thought would help with the loneliness, but the care of his granddaughter seems overwhelming at times. Rest, evening walks, & lifting weights 2 days a week help him feel better. At this time, he does not want to do any activities or exercise, it seems like too much effort to get up and go. He has not tried any medications, prescribed or otherwise. He reports drinking a lot of coffee, but that does not seem to help with his energy levels.
Current medications: Tylenol PM about once a week when he can’t sleep, does not help.
PMH: no major illnesses. Immunizations up to date.  COVID Vaccinated.
SH: widowed, employed part time as a computer programmer. Drinks 1 beer almost every night. No tobacco use, no illicit drug use. Previously married 25 years ago, reports a passive aggressive, abusive relationship that ended in divorce. The judge gave full custody of his children to his ex-wife. The last time he saw his son was10 years ago. He lives in another stated. He sees his daughter 1-2 times a month. He would like to talk to his son but he is concerned the relationship cannot be repaired because he moved out during the divorce.
FH: Parents are alive and well. Has a daughter 20 and a son 18.
CONSTITUTIONAL: reports weight loss of 4-5 pounds, no fever, chills, or weakness reported. Daily fatigue.
HEENT: Eyes: No visual loss, blurred vision, double vision or yellow sclera. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose or sore throat.
CARDIOVASCULAR: No chest pain, chest pressure or chest discomfort. No palpitations or edema.
RESPIRATORY: No shortness of breath, cough or sputum.
GASTROINTESTINAL: Reports decreased appetite for about 4 months. No nausea, vomiting or diarrhea. No abdominal pain or blood.
NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.
GENITOURINARY: no burning on urination.
PSYCHIATRIC: No history of diagnosed depression or anxiety. Reports history feeling very sad and anxious about loss of wife. Sad about not speaking to his son. Did not seek treatment. He started to feel better about the loss of his wife after 6 months, but the grief and depression has returned.
ENDOCRINOLOGIC: No reports of sweating, cold or heat intolerance. No polyuria or polydipsia
ALLERGIES: No history of asthma, hives, eczema, or rhinitis.
Discussion Questions:
1. Research screening tools for depression and anxiety. Choose one screening tool for depression and one screening tool for anxiety that you feel are appropriate to screen BT.
2. Explain in detail why EACH screening tool was chosen. Include the purpose and time frame of each chosen tool.
3. Score BT using both of your chosen screening tools based on the information provided (not all data may be provided, those areas can be scored as not present). Pay close attention to the listed symptom time frame for your chosen assessment tool.  In your response include what questions could be scored, and your chosen score.  Interpret the score according to the screening tool scoring instructions. Assume that any question topics not mentioned are not a concern at this time.
4. Identify your next step for evaluation and treatment for BT. Remember to consider both physical and mental health differential diagnoses when answering this question. (3-5 sentences) for each diagnosis. (Make sure to include 2 physical and 2 mental diagnosis)
5. What medication or treatment is appropriate for BT based on his screening score today? Provide the rationale. All medications should include the medication class, mechanism of action of the medication and why this medication is appropriate for BT. Include initial prescribing information and education to include side effects
6. If the medication works as expected, when should BT expect to start feeling better? (efficacy)
Please APA format 7th edition and see below what is and isn’t acceptable as sources.
Expectations for use of Scholarly Sources
This course will emphasize formulating differential diagnoses and clinical treatment plans based on data published in peer-reviewed scholarly journals. While textbooks and course lessons can help give you a framework for organizing your thoughts specific information should come from scholarly sources.
To begin thinking like a provider, you will need to establish a general knowledge base and then interpret and apply newly available information to specific clinical scenarios. To accomplish this, aim for the following criteria:
Scholarly references are:
• Peer-reviewed
• Preferably a Clinical Practice Guideline (CPG)
• Intended for providers (MDs, NPs)
• No more than 5 years old (unless it is a clinical practice guideline’s most recent update)
• U.S. based journal
• Intended for the primary care population
• Directly related to the case or situation that you are writing about (Ex: references for treatment of strep pharyngitis in cancer patients should not be used as rationale for treatment decisions if your patient does not have cancer)
• Must be studies based on human research
References to AVOID using:
• Nursing and Allied Health Journals. Nursing articles tend to be “black and white” in their descriptions of disease and algorithmic in their discussion of possible differential diagnoses. One of the goals of this course is to help everyone start thinking critically as independent care providers. Making decisions which shape the care of patients and direct the efforts of other healthcare team members is a significant responsibility, and as such requires a broader and more detailed knowledge base than is frequently found in standard nursing practice. I want you to draw from sources that emphasize the gray areas of medical practice and get you actively thinking through problems and differentials instead of looking for the “right” answers. For the purposes of this course, the information in peer-reviewed nursing journals will probably be correct but not sufficiently detailed, and it generally good practice to get in the habit of reading and interpreting provider-level journals now as this will help you help your patients in the future.
• Summary Websites. By this I mean disease-specific websites and provider resources such as Medscape, MayoClinic, Up-to-Date, CDC, etc. The information from these sources is probably accurate but not sufficiently detailed as these sources are meant to provide key points to aid diagnosis and treatment decisions, not facilitate scholarly discussion of pathophysiology. They can be useful for outlining your thoughts and self-study, but your discussion posts should come from original publications and not sources which have summarized and distilled peer-reviewed work for you. Many of these websites will cite the original source of the information so feel free to track it back to the original publication and cite the true source. This would be an entirely appropriate use of these resources. EXCEPTION: ICD-10 and CPT codes may be searched and cited from the internet.
• Databases. Databases to search EBM references exist such as Dynamed, EBSCOHOST, CINAHL, Cochrane Library, Medline, etc. While it is appropriate to use this as a starting point for your research, the original publication should be cited and referenced.
• Textbooks. Textbooks provide an overview of key information, but again are not sufficient to facilitate scholarly discussion. You should definitely use the text to establish a knowledge base and give yourself a framework for your discussion posts, but all citations should come from references that are outlined above. I want to see you interpret and apply information to the discussion prompts, not recite the distillation of facts that you can find in the textbook. EXCEPTION: Pathophysiology statement can be referenced using the textbook.
• Quick Reference Apps and Handbooks. These include smartphone apps and handbooks that can be used to quickly formulate a differential or provide arguments for your treatment or testing decisions. Epocrates and Ferri’s Clinical Advisor are good examples of references NOT to use for your EBM arguments. These apps and handbooks are great for clinical practice but not in your didactic work. Part of being a graduate student is being able to review and research. A quick reference guide takes the thinking out of it and you are unable to grasp the “why” we do things. EXCEPTION: Epocrates and other drug reference books are allowed ONLY for the dosing of your medications.