The Patient Health Questionnaire (PHQ-9)
|Over the last two weeks how often have youbeen bothered by any of the following problems||Not at all||Several days||More than half the days||Nearly every day|
|1||Little pleasure in doing things||0||1||2||3|
|2||Feeling down, depressed or hopeless||0||1||2||3|
|3||Trouble falling asleep, staying asleep or sleep too much||0||1||2||3|
|4||Feeling tired or having little energy||0||1||2||3|
|6||Feeling bad about yourself – that you are a failure or have let yourself or your family down||0||1||2||3|
|7||Trouble concentrating on things, such as reading the newspaper or watching television||0||1||2||3|
|8||Moving or speaking slowly. Or, the opposite-being so fidgety or restless that you have been moving around a lot more than usual||0||1||2||3|
|9||Thoughts that you would be better off dead or hurting yourself in some way||0||1||2||3|
|Column Totals + 4 + 21|
|10.||Add Totals Together 25 |
When you have problems, how difficult do they make it for you to do your work, take care of things at home, or get along with other people?
Not difficult at all Somewhat difficult Very difficult Extremely difficult x.
Depression is the most prevalent mental disorder in the current society. It is a medical condition affecting mood and leading to the inability to function properly. Occasional mood swings are a normal part of life in every individual especially when upsetting events occur. However, when the feeling of hopelessness becomes persistent it may be a sign of depression. Occasionally, mood disorders occur due to medication or a medical condition.
The doctor must determine the cause of the depressed mood before commencing treatment. Several therapy options are available with high-reliability rates. The condition can be treated with minimal chance of relapse. Depression can be diagnosed through a laboratory test or an assessment test. A doctor will determine the tests to be done after interviewing the patient. One credible assessment instrument is The Patient Health Questionnaire (PHQ-9) which is a criteria-based diagnostic tool for determining the severity of depression in patients. The cause of depression is critical in developing a reliable treatment option.
The patient, Nancy, is a 56-year-old African American woman suffering from depression. She recently lost her son and became isolated by confining herself into the house and stopping her trips to work. She ceased normal personal hygiene and daily cleaning in her home and minimized communication with others. Nancy’s ex-husband noticed the changes in her moods and admitted her in a hospital for treatment. Conventional treatment was not yielding positive results which necessitated the doctors to perform electroconvulsive therapy treatment. She improved from her symptoms but needed to continue with outpatient treatment.
On arrival to the hospital, Nancy took a self-assessment PHQ-9 test. Nancy scored 3 in questions one and two. She also scored 3 in questions 4, 6, 7, 8 and 9. She scored 2 in questions 3 and 5. The assessment gave a score of 25 which confirms that Nancy has severe depression. The doctors began the treatment procedure immediately because of her acute symptoms.
- Occupations: Activity of daily living (ADLs) and Instrumental activity of daily living (IADL’s), home establishment and management, social participation. Grooming and showering need stand-by assistance with verbal cues.
- Client Factors: emotion regulation (flat affect), cognitive processing.
- Performance skills: producing speech, organization, and social interactions with others.
- Performance patterns: routines, habits, light housekeeping.
- Context and environment: personal (unemployed), no desire to communicate with others or partake in social activities.
- Occupations: feeding independently, toileting with no assistance and preparing microwave dinners.
- Client Factors: visual intact, independent ambulatory movement.
- Performance Skills: Nancy is still able to follow simple step directions and navigating around her home.
- Performance patterns: (all impaired)
- Context and Environment: (all impaired).
Nancy exhibited limitations of violation, habituation, and performance capacity. She was showing signs of having no drive or ambition to perform her normal activities or duties. In addition, she decided to stop going to work and spends most of her time in the house. Nancy limited her social skills and her daily living activities to a bare minimum. Considering that Nancy believed in tidiness and cleanness, she currently lives a life of filth and hoarding. The patient has difficulty performing daily tasks and her hygiene has decreased. Despite the limitations, Nancy was a cooperative patient and responded well to electroconvulsive treatment (ECT) despite the temporary memory loss side effects. She renewed her interests in traveling, gardening, cooking and reading.
The primary goal in treating Nancy’s major depressive disorder (MDD) is to ensure complete relief from all the symptoms. Nancy achieved partial remission and was able to go back to work. Full remission can be achieved through counseling which would improve her social interactions. Furthermore, it is critical to discuss treatment goals with Nancy as the counseling sessions progress (Seidler et al., 2018). Discussions can necessitate a change in treatment options. Behaviorally oriented psychotherapy can help with improving physical health behaviors, and organizing the home and social interactions (Kraus et al., 2020). The psychotherapy sessions will improve her score on cognitive skills.
- Major depressive disorder;
- Nancy’s depression is an active problem that requires immediate treatment;
- The evidence is a depressed mood;
- Details are:
- Little pleasure in doing things;
- Feeling down, depressed or hopeless;
- Sleeping too much;
- Feeling like a failure for letting her son die;
- Trouble concentrating on things, such as reading the newspaper or watching television;
- Moving or speaking slowly;
- Thoughts that she would be better off dead.
Short term goals and interventions
Short-term goal 1: Nancy will perform meal planning in a group activity for 15 minutes with minimal assistance for four weeks.
Medical necessity: Functional independence would be affected when not receiving this treatment to prepare meals. Solely relying on microwaveable dishes and putting limitations on various foods, could cause nutrition problems and cause issues with food intake or not eating due to a food shortage. Also, having a meal plan would eliminate the stress of trying to find something to eat every night; this also gives a sense of routine to balance out the day-to-day task. Performing this treatment would give her the confidence that she needs to get back to her normal adls of preparing her meals independently, taking trips to the supermarket, or ordering groceries online.
Short-term goal 2: Nancy will perform group therapy sessions, coping with the loss of a loved one for 20 minutes, Journaling her feelings and sharing them with the group for four weeks
Nancy will be able to explain her causes of depression during her group therapy sessions.
Medical necessity: Nancy will keep a journal or diary expressing how the loss of her son made or makes her feel. Keeping the journal will help her differentiate her moods from her feelings. Understanding the relationship between the two emotions will help Nancy deal with them separately. She will share the details of her journal with the group every week. The goal is to reduce the occurrence of depressive mood to less than four times a week
- S: Not interested in many aspects of life. She kept saying “I want to sleep”;
- O: General: Disoriented and anxious:
- Heart- Increased heart rate;
- Lungs- CTA bilaterally;
- Skin- no lesions or rashes;
- A: Major Depressive Disorder, recurrent, with psychotic features;
- P: Electroconvulsive treatment,
- Begin outpatient counseling and behavioral oriented psychotherapy.
Long term goal
Nancy’s long-term goal would include performing all ADLs and IADL’s with Minimal to No assist in 5 weeks, giving her complete independence with grocery shopping, cleaning and grooming.
- S: The patient states that she has been improving with fewer depressive symptoms. She is getting more than enough sleep. She says she achieves 7-8 hours of rest every night. The ECT helped with noticeable side effects. She has a short-term memory loss which she believes will improve. Her depressive mood is improving with decreasing episodes. She has no intentions to kill herself despite her depressive thoughts on the same. She believes the counseling and group sessions will help with full remission.
- O: Vitals: T 98.5, P 83, R 16, BP 121/79:
- General: Oriented and alert to place time and person. Affect is significantly improved with good range of emotional expression.
- Heart- RRR, no murmurs, no gallops;
- Lungs- CTA bilaterally;
- Skin- no lesions or rashes;
- Labs: CBC, lytes, and TSH all within normal limits.
- A: Major Depressive Disorder, non-recurrent, without psychotic features.
- Keeping the journal is helping her differentiate her moods from her feelings. Understanding the relationship between the two emotions is helping Nancy deal with them separately. She shares the details of her journal with her therapist every week. Her anxiety has gone down with a good range of emotions. She is back to her normal day-to-day activities.
- P: Continue outpatient counseling and behavioral-oriented psychotherapy. Follow-up in one week or earlier if any depressive symptoms worsen.
Music therapy is a well-recognized clinical intervention that uses music within a therapeutic process to assist the patient in identifying and dealing with social, cognitive, emotional, or physical concerns (Jonas, 2018). Nancy can use musical therapy to help the recovery process.
Meditation is a practice that involves consciously exerting control over breathing and attending nonjudgmentally sessions. It produces multiple physiological and chemical effects such as decreased heart rate and blood pressure (Jonas, 2018). Meditation will help Nancy develop peace, hence promoting her recovery.
Depression is a serious ailment but can be treated with the proper diagnosis. The PHQ-9 assessment test is one of the tools used to determine the mental condition of a depressed patient. Family history can also guide a doctor to make informed decisions. Mental disorders are hereditary; therefore, an individual coming from a family with a history of depression is likely to develop the illness. Occupational therapy evaluation helps care physicians monitor the progress of patients. It is important to keep patients with a history of depression or depressed ones away from the identified stressors. Clearly stated, short and long-term goals can guide the treatment procedure for a depressed patient. Intervention measures are determined through patient-doctor discussions. Close monitoring is necessary to notice symptoms that might lead to relapse.
Jonas. W. (2018). 8 Evidence-based integrative approaches to treat depression. Psychology Today. Web.
Kraus-Schuman, C. A., Sanchez, M. L., Benson, K. M., & Asghar-Ali, A. A. (2020). Psychotherapy and Cognitive Disorders. Psychotherapy in Later Life, 139.
Seidler, Z. E., Rice, S. M., Oliffe, J. L., Fogarty, A. S., & Dhillon, H. M. (2018). Men in and out of treatment for depression: Strategies for improved engagement. Australian Psychologist, 53(5), 405-415. Web.