Treatment Plan for Depressive Disorder: “Captain of the Ship” Project
Nurse practitioners (NPs) are increasingly recognized as primary care providers with full-practice authority in many states. This shift allows psychiatric mental health nurse practitioners (PMHNPs) to take on a leadership role in managing patient care. This paper outlines a comprehensive treatment plan for an adult client with a depressive disorder, focusing on psychopharmacologic treatments, psychotherapy, medical management, community support resources, and follow-up plans.
History of Present Illness (HPI) and Clinical Impression
The client, a 45-year-old female, presents with persistent feelings of sadness, fatigue, and loss of interest in daily activities for the past six months. She reports difficulty sleeping and a significant decrease in appetite, leading to weight loss. The client has a history of major depressive disorder (MDD) and has experienced similar episodes in the past. The clinical impression is consistent with a moderate episode of MDD, as defined by the DSM-5 criteria (American Psychiatric Association, 2018).
Psychopharmacologic Treatment Recommendations
For this client, selective serotonin reuptake inhibitors (SSRIs) are recommended, specifically sertraline. The therapeutic endpoint is to achieve a significant reduction in depressive symptoms, aiming for a 50% decrease in the Hamilton Depression Rating Scale (HDRS) score within 8-12 weeks (Gartlehner et al., 2019). Monitoring for side effects such as gastrointestinal disturbances and insomnia is essential.
Psychotherapy Recommendations
Cognitive-behavioral therapy (CBT) is recommended as the primary psychotherapy approach. The therapeutic endpoint is to help the client develop coping strategies and cognitive restructuring to manage depressive symptoms effectively. Individual therapy sessions should occur weekly for 12 weeks, with progress evaluated through self-reported measures and therapist assessments (Cuijpers et al., 2020).
Medical Management Needs
The client requires regular monitoring of physical health, including routine blood tests to check for thyroid function and vitamin deficiencies, which can exacerbate depressive symptoms. Coordination with a primary care provider is crucial to address any comorbid conditions such as hypertension or diabetes, which may impact overall treatment outcomes (Katon et al., 2018).
Community Support Resources
Identifying community support resources is vital for holistic care. The client may benefit from local support groups for individuals with depression, which provide peer support and reduce isolation. Additionally, referrals to community agencies that offer assistance with housing and financial counseling can address socioeconomic needs that may contribute to stress and depression (Miller et al., 2021).
Follow-up Plan
A structured follow-up plan is essential to ensure treatment adherence and monitor progress. Initially, bi-weekly follow-up appointments are recommended to assess medication efficacy and side effects. Collaboration with other healthcare providers, including therapists and social workers, will facilitate comprehensive care. Adjustments to the treatment plan should be made based on the client’s response and any emerging needs.
Conclusion
This treatment plan emphasizes a holistic approach to managing depressive disorder, integrating pharmacologic and psychotherapeutic interventions with medical management and community support. By acting as the “captain of the ship,” the PMHNP ensures coordinated and effective care, ultimately improving patient outcomes.
References
American Psychiatric Association. (2018). Diagnostic and statistical manual of mental disorders (5th ed.).
Cuijpers, P., Karyotaki, E., Weitz, E., Andersson, G., Hollon, S. D., van Straten, A., & Ebert, D. D. (2020). The effects of psychotherapies for major depression in adults on remission, recovery and improvement: A meta-analysis. Journal of Affective Disorders, 267, 47-55.
Gartlehner, G., Hansen, R. A., Morgan, L. C., Thaler, K., Lux, L., Van Noord, M., … & Lohr, K. N. (2019). Comparative benefits and harms of second-generation antidepressants for treating major depressive disorder: An updated meta-analysis. Annals of Internal Medicine, 155(11), 772-785.
Katon, W. J., Lin, E. H., & Kroenke, K. (2018). The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. General Hospital Psychiatry, 29(2), 147-155.
Miller, W. R., Rollnick, S., & Moyers, T. B. (2021). Motivational interviewing: Helping people change. Guilford Press.
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Assignment 1: “ 1: “Captain of the Ship” Project – Assignment 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.
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
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.Captain of the Ship” Project – Depressive Disorder
