Depressive Disorders

The National Institutes of Mental Health acknowledges that depression is one of the most common mental disorders in the United States. It is associated with significant disability, fiscal impact, and considerable personal suffering. It may have significant impact on the individual, their family, and their social network. The PMHNP must be capable of providing comprehensive care for depressive disorders, including both psychotherapy and psychopharmacologic approaches.

This week, you will become “captain of the ship” as you take full responsibility for a client with a depressive disorder. You will recommend psychopharmacologic treatment and psychotherapy, identify medical management needs and community support, and recommend follow-up plans. You will also explore how to obtain a DEA license and the responsibilities for safe prescribing and prescription monitoring.

                                               “Captain of the Ship” – Depressive Disorder

As nurse practitioners strive to achieve full-autonomous practice across the country, it should be noted that many states grant this ability to practice independently to psychiatric mental health nurse practitioners. To that end, you will be engaging in projects this semester that assume that you are practicing in a state that allows full-practice authority for NPs, meaning that the PMHNP may be the “captain of the ship” concerning caring for a patient population. The “captain of the ship” is the one who makes referrals to specialists, coordinates care for their patients/clients, and is responsible and accountable for patient/client outcomes overall. This is a decided change from a few decades ago when physicians were the “captain of the ship” and NPs played a peripheral role.

In this Assignment, you will become the “captain of the ship” as you provide treatment recommendations and identify medical management, community support resources, and follow-up plans for a client with a depression disorder.

                                              Learning Objectives

Students will:

· Recommend psychopharmacologic treatments based on therapeutic endpoints 

  for clients with depression disorders

· Recommend psychotherapy based on therapeutic endpoints for clients with 

  depression disorders

· Identify medical management needs for clients with depression disorders

· Identify community support resources for clients with depression disorders

· Recommend follow-up plans for clients with depression disorders

                                                        Assignment (Project)

To prepare for this Assignment:

• Select an adult or older adult client with a depressive disorder you have seen in your practicum.

In 3–4 pages, write a treatment plan for your client in which you do the following:

• Describe the HPI and clinical impression for the client. Recommend psychopharmacologic  treatments and describe specific and therapeutic endpoints for your psychopharmacologic agent. (This should relate to HPI and clinical impression.)
• Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for      your choices.
• Identify medical management needs, including primary care needs, specific to this client.
• Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client. Recommend a plan for follow-up intensity and frequency and collaboration with other providers including PCP or medical provider

                                                               Tip for the Assignment

This week assignment, you will ‘captain the ship’ you are the provider and writing the diagnostic work-up and treatment plan for a patient with DEPRESSIVE DISORDER. You will develop plans for a patient that you have worked with in your practicum. 

A few comments about the ‘Captain of the Ship’ assignment. The spirit of the assignment is that you are directing the client’s care, not simply writing a paper about depressive disorder. When you are the team leader, it’s important to provide authoritative direction for other providers. In your treatment plan, it’s good to outline your collaboration with client’s other providers. Later in the quarter, you will have another opportunity to complete ‘Captain of the Ship’ project.

I have attached an excellent example of a different Captain of the Ship project with this assignment and. Note that this assignment is on depressive disorder, not on Obsessive Compulsive.

                                                              Learning Resources

Required Readings

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.

• Chapter 8, “Mood Disorders” (pp. 347–386)

Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications.

• Chapter 12, “Psychotherapy of Mood Disorders”
• Chapter 14, “Pharmacological and Somatic Treatments for      Major Depressive Disorder”

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

o Major Depressive Disorder

o Persistent Depressive Disorder (dysthymia)

o Premenstrual Dysphoric Disorder

o Substance/Medication-Induced Depressive Disorder

o Depressive Disorder Due to Another Medical Condition

o Other Specified Depressive Disorder

o Unspecified Depressive Disorder

Stahl, S. M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press.

Grieve, S. M., Korgaonkar, M. S., Koslow, S. H., Gordon, E., Williams, L. M. (2013). Widespread reductions in gray matter volume in depression. NeuroImage: Clinical, 3, 332-339. doi:10.1016/j.nicl.2013.08.016

Lach, H. W., Chang, Y-P., & Edwards, D. (2010). Can older adults with dementia accurately report depression using brief forms? Reliability and validity of the Geriatric Depression Scale. Journal of Gerontological Nursing, 36(5), 30–37. doi:10.3928/00989134-20100303-01

Steffens, D. C., McQuoid, D. R., & Potter, G. G. (2014). Amnestic mild cognitive impairment and incident dementia and Alzheimer’s disease in geriatric depression. International Psychogeriatrics, 26(12), 2029–2036. doi:10.1017/S1041610214001446

Drug Enforcement Administration. (n.d.). Drug schedules. Retrieved June 14, 2016, from https://www.dea.gov/druginfo/ds.shtml 

                                                            Required Media

Hagen, B. (Producer). (n.d.-b). Managing depression [Video file]. Mill Valley, CA: Psychotherapy.net.

                                                        Optional Resources

Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications.

• Chapter 15, “Brain Stimulation Treatments for Mood      Disorders”

Ahern, E., & Semkovska, M. (2017). Cognitive functioning in the first-episode of major depressive disorder: A systematic review and meta-analysis. Neuropsychology, 31(1), 52–72. doi:10.1037/neu0000319

Anderson, N. D., Damianakis, T., Kröger, E., Wagner, L. M., Dawson, D. R., Binns, M. A., . . . Cook, S. L. (2014). The benefits associated with volunteering among seniors: A critical review and recommendations for future research. Psychological Bulletin, 140(6), 1505–1533. doi:10.1037/a0037610

Inoue, J., Hoshino, R., Nojima, H., Ishida, W., & Okamoto, N. (2016). Additional donepezil treatment for patients with geriatric depression who exhibit cognitive deficit during treatment for depression. Psychogeriatrics, 16(1), 54–61. doi:10.1111/psyg.12121

Sachs-Ericsson, N., Corsentino, E., Moxley, J., Hames, J. L., Rushing, N. C., Sawyer, K., . . . Steffens, D. C. (2013). A longitudinal study of differences in late- and early-onset geriatric depression: Depressive symptoms and psychosocial, cognitive, and neurological functioning. Aging & Mental Health, 17(1), 1–11. doi:10.1080/13607863.2012.717253

Shallcross, A. J., Gross, J. J., Visvanathan, P. D., Kumar, N., Palfrey, A., Ford, B. Q., . . . Mauss, I. B. (2015). Relapse prevention in major depressive disorder: Mindfulness-based cognitive therapy versus an active control condition. Journal of Consulting and Clinical Psychology, 83(5), 964–975. doi:10.1037/ccp0000050

Wanklyn, S. G., Pukay-Martin, N. D., Belus, J. M., St. Cyr, K., Girard, T. A., & Monson, C. M. (2016). Trauma types as differential predictors of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and their comorbidity. Canadian Journal of Behavioural Science / Revue Canadienne Des Sciences Du Comportement, 48(4), 296–305. doi:10.1037/cbs0000056