Case Study Scenario:
Rick is a 72-year-old man previously diagnosed with depressive disorder. He was brought to the emergency room by his wife after he cut his hands with a hacksaw, sustaining damage to various structures and needing surgical intervention. His wife describes that she was going back to work after an extended leave to care for her husband after a recent hospital admission and that this was his first day home by himself. Her son came to check on Mr. Rick and found him on the floor bleeding profusely and called the ambulance.
Mr. Rick retired as an electrician about 8 years ago. Over the past 5 years, his wife describes an increasing indifference to events. For example, when their basement was flooded due to a water leak, Mr. Rick opened the door to the basement, saw the water, and closed the door, saying nothing. This was uncharacteristic of him in the context of his job and training. His wife tells you that the first symptom noted was “not caring about things,” which could be interpreted as apathy. She notes that the reason he retired early was that he could not keep up with the requirements of his job.
There has been an apparent functional decline. While he is independent in all his activities of daily living, other than cooking, he is dependent on most instrumental activities of daily living. His most recent MoCA score was 16 out of 30. Several comorbid medical conditions are of concern, including hypertension, type 2 diabetes mellitus, and obstructive sleep apnea.
He was assessed for depressed mood by a psychiatrist and started on escitalopram 10 mg daily 1 year ago. There was a mild improvement, but after a few months, he attempted suicide through an overdose. He was admitted to the inpatient psychiatric ward. During that admission, he used shoelaces to tie a ligature around his neck and to the bedroom furniture in an attempt to end his life.
His mood improved over the following few weeks, and he was discharged home with support, including a mental health nurse visiting once a week. His wife had stayed with him at home during the past month, and he was distressed when she left him, even for short periods. He was often tearful even when she was home, and he felt things would never get better. The current episode of self-harm happened on the day she returned to work.
Use the SOAP note template to complete the documentation with the information provided.
· Formulate appropriate diagnoses and design a treatment plan.
· Explain what further information you will explore to aid in accurate diagnosis.
· What treatment management is recommended for this patient with self-harm