Mental health- anxiety and depression
Anxiety and depression
Screening tools for anxiety and depression are used to diagnose, monitor, and check the condition’s severity. Anxiety has several screening tools, which include Generalized Anxiety Disorder Questionnaire IV (GADQ IV), Hospital Anxiety and Depression Scale (HADS), Generalized Anxiety Disorder IV, Hamilton Anxiety Ranging Scale (HARS) and Generalized Anxiety Disorder-7 (GAD-7). Depression’s screening tools are the Primary Care Evaluation of Mental Disorders (PRIME-MD), Geriatric Depression Scale (GDS), Cornell Scale for Depression in Dementia (CSDD) and Patient Health Questionnaire-9 (PHQ-9). GDS and GAD-7 are appropriate for screening KF for depression and anxiety, respectively.
GDS is appropriate for the elderly, just like in our case, where KF is 50 years old. GDS contains yes or no questions asked to the patient, with each question scoring a point for yes as an answer. It takes 10-20 minutes to administer them (Esser et al., 2018). The results obtained here will help the physician to determine the severity of the depression in the patient. GAD-7 is used to assess the severity of anxiety in a patient. It is a questionnaire that consists of 7 questions that ask for the severity of symptoms for the past two weeks and takes 1-2 minutes (El-Den et al., .2018).
Geriatric Depression Scale (GDS)
Patients name: KF
| Yes | No | SCORE | |
| 1. Are you satisfied with your life? | 0 | 1 | 0 |
| 2. Have you dropped many of your activities and interests? | 1 | 0 | 1 |
| 3. Do you feel that your life is empty? | 1 | 0 | 0 |
| 4. Do you often get bored? | 1 | 0 | 1 |
| 5. Are you in good spirits most of the time? | 0 | 1 | 1 |
| 6. Are you afraid something bad is going to happen to you? | 1 | 0 | 0 |
| 7. Do you feel happy most of the time? | 0 | 1 | 1 |
| 8. Do you often feel helpless? | 1 | 0 | 1 |
| 9. Do you prefer to stay at home, rather than going out and doing new things? | 1 | 0 | 1 |
| 10. Do you feel you have more problems with memory than most? | 1 | 0 | 0 |
| 11. Do you feel it’s wonderful to be alive? | 0 | 1 | 1 |
| 12. Do you feel pretty worthless the way you are now? | 1 | 0 | 1 |
| 13. Do you feel full of energy? | 0 | 1 | 1 |
| 14. Do you feel your situation is hopeless? | 1 | 0 | 1 |
| 15. Do you think that people are better off than you are? | 1 | 0 | 0 |
| TOTAL SCORE | 10 | ||
Interpretation: KF scored 10 out of 15. shows that KJ is moderate to severely depressed.
Generalized Anxiety Disorder 7
| How often have you been bothered by the following over the past two weeks | Not at all | Several days | More than half the days | Nearly every day |
| 1. Feeling nervous, anxious, or on edge? | 0 | |||
| 2. Not being able to stop or control worrying? | 0 | |||
| 3. Worry too much about different things? | 0 | |||
| 4. Trouble relaxing? | 3 | |||
| 5. Being easily annoyed or irritable | 0 | |||
| 6. Feeling afraid as if something awful might happen | 0 | |||
| 7. Being so restless that it is hard to sit still | 0 | |||
| SCORE | 0 | 0 | 0 | 3 |
| TOTAL SCORE | 3 | |||
Interpretation: KF scored 3. his means she has no anxiety disorder.
Evaluation and treatment
The signs and symptoms presented by KF could suggest a mental disorder. The differential diagnosis for this case could be bipolar disorder, anxiety and depression. However, the results obtained from the screening tolls we used above show that KF has moderate depression without an anxiety disorder. Treating depression requires combination therapy, which includes administering medication, psychotherapy, and interpersonal therapy. Lack of appetite, lack of sleep and mass wasting are also treated separately. Appetite stimulants and corticosteroids are given for lack of appetite and sleeping pills to enable them to get enough sleep.
Medication
Moderate depression is treated using selective serotonin reuptake inhibitors (SSRIs) such as sertraline, fluoxetine, or paroxetine. Sertraline inhibits presynaptic serotonin reuptake with little effect on dopamine and norepinephrine. It is given orally. Initially, the dosage is 50mg PO qDay. Later on, the dose can be adjusted by the addition of 25mg but should not exceed 200mg qDay. Fluoxetine inhibits serotonin reuptake at the presynaptic terminal without any effect on dopamine and norepinephrine reuptake. It is given orally. Initially, the dosage is 20mg PO qDay. Later on, the dose can be adjusted by the addition of 20mg per day but should not exceed 80mg qDay. Paroxetine is a serotonin reuptake inhibitor at the neuron with little effect on dopamine and norepinephrine reuptake. It is given orally. Initially, the dosage is 20mg PO qDay. Later on, the dose can be adjusted by the addition of 10mg but should not exceed 50mg qDay. Side effects of this drug are diarrhea, insomnia, nausea and headache. When taking the medication, observation will be evident in 2-6 weeks.
References
El-Den, S., Chen, T. F., Gan, Y. L., Wong, E., & O’Reilly, C. L. (2018). The psychometric properties of depression screening tools in primary healthcare settings: A systematic review. Journal of Affective Disorders, 225, 503-522.
Esser, P., Hartung, T. J., Friedrich, M., Johansen, C., Wittchen, H. U., Faller, H., … & Wegscheider, K. (2018). The Generalized Anxiety Disorder Screener (GAD‐7) and the anxiety module of the Hospital and Depression Scale (HADS‐A) as screening tools for generalized anxiety disorder among cancer patients. Psycho‐oncology, 27(6), 1509-1516.
Goldstein, C. M., Gathright, E. C., Gunstad, J., Dolansky, M. A., Redle, J. D., Josephson, R., … & Hughes, J. W. (2017). Depressive symptoms moderate the relationship between medication regimen complexity and objectively measured medication adherence in adults with heart failure. Journal of behavioral medicine, 40(4), 602-611.