Your Perfect Assignment is Just a Click Away

We Write Custom Academic Papers

100% Original, Plagiarism Free, Customized to your instructions!


Journal Entry

Journal Entry

Journal Entry





Diagnosis to Consider and Codes

Major Depressive Disorder, recurrent moderate F33.1

Generalized anxiety disorder 41.1

Rationale for Diagnosis

Major Depressive Disorder, recurrent moderate-The patient meets at least the required five criteria needed for a MDD diagnosis (American Psychiatric Association, 2013). He is in a low mood for a better part of the day (American Psychiatric Association, 2013), most days as he spends the day lying on the couch. He has stopped volunteering at a nursing home, which meets marker number two: a decrease of pleasure in activities (American Psychiatric Association, 2013). He also has both insomnia and hypersomnia because he cannot fall asleep and then spends the day on the couch (American Psychiatric Association, 2013). Next, he has a fatigue in which he believes himself to be moving in slow motion (American Psychiatric Association, 2013). Lastly, he has been having recurrent thoughts regarding death, as he has had a recent diagnosis of prostate cancer, and his father’s current health status (American Psychiatric Association, 2013).

GAD- He meets the criteria for this because he has had anxiety and worry for over six months, he has difficulty controlling the anxiety, and the anxiety is manifested by being fatigued easily, with sleep disturbances, and restlessness when he attempts to fall asleep (American Psychiatric Association, 2013).

Tests and Tools

For MDD, I would use the Hamilton Depression Rating scale or the Patient health Questionnaire. I would also check the T3, T4, CBC, CMP, and A1C of the patient to rule out any external factors. For GAD, I would use the Beck Anxiety Inventory (BAI) or the GAD-7 for measurement of the symptom’s severity.

Differential Diagnosis to Consider

For MDD I would consider Posttraumatic Stress disorder and adjustment disorder (American Psychiatric Association, 2013). I would also consider anxiety disorder due to another medical condition (American Psychiatric Association, 2013).

Treatment Strategy and Rationale

For this patient, I would recommend therapy, to include CBT, and possibly family therapy. Recommendation of these items addresses the depression head on, including the family may be beneficial to the patient’s treatment (Depression, 2020). I would like to trial bupropion with this patient and recommend an increase of activity with alternative approaches like seeking religious counseling (if he is religious). I would also recommend attending a support group for the loss of his wife and the impending death of his father.


With this patient, I would develop a safety plan to put in place in case the patient developed and SI. I would also identify a person close to the patient, who would be willing to listen to the patient in a crisis or would be able to hold possible weapons for the patient. I would also provide crisis line numbers to the patient in the event of a crisis occurring after hours.


Since this patient has trialed Effexor, Prozac, Zoloft, Lexapro and duloxetine, I would trial bupropion for this patient I would titrate up to 300mg per day to see if there has been any improvement in mood and adjust or switch from that point.

Diagnostic Tests

I would use the PHQ depression scale and the HAM and the GAD-7 tests to monitor and track the progression or the digression of the diagnosis.


I would begin with supportive listening and CBT. If after a few sessions, this did not provide any relief, I would adjust my approach to fit the patient’s needs.


This would be most advantageous to the patient because this would empower the patient to understand about depression, giving the patient an opportunity to talk about their experiences and to be a part of their treatment plan (Depression an Information Guide, 2020). If he includes his family, it would also be beneficial to them by learning about the signs and symptoms of depression and what they can do to assist them (Depression an Information Guide, 2020).

Standard Guidelines

For MDD, I would establish a therapeutic alliance, complete a psychiatric assessment, evaluate the patient’s safety, establish an appropriate treatment setting, coordinate and collaborate with other providers (Practice Guideline for the Treatment of Patients with Major Depressive Disorder, 2020). I would continue to monitor and adjust treatments as necessary to his psychiatric status and integrate measurements such as the PHQ (Practice Guideline for the Treatment of Patients with Major Depressive Disorder, 2020). I would also provide education to both the patient and with approval, the patient’s family (Practice Guideline for the Treatment of Patients with Major Depressive Disorder, 2020).

Clinical Note: Is depression a normal part of aging?

Some would consider depression to be a normal part of aging. However, that is a common misconception because people become more susceptible to sadness and anxiety (CDC, 2020). This increased risk may be from chronic health conditions, misdiagnosis, and undertreatment of symptoms (CDC, 2020). Being able to accurately identify and treat depression in an aging person needs to be a fundamental part of a PMHNP’s repertoire. Knowing the signs and the symptoms in an aging patient is key to identifying and accurately diagnosing depression.


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

Depression an Information Guide (2020). [Ebook]. Retrieved from /media/files/guides-and-publications/depression-guide-en.pdf

Depression is Not a Normal Part of Growing Older | Healthy Aging | CDC. (2020). Retrieved 28 October 2020, from

Depression | NAMI: National Alliance on Mental Illness. (2020). Retrieved 28 October 2020, from

Gautam, S., Jain, A., Gautam, M., Vahia, V. N., & Grover, S. (2017). Clinical Practice Guidelines for the management of Depression. Indian journal of psychiatry, 59(Suppl 1), S34–S50.

Practice Guideline for the Treatment of Patients with Major Depressive Disorder. (2020). [Ebook]. Retrieved from df

Order Solution Now

Our Service Charter

1. Professional & Expert Writers: Writers Hero only hires the best. Our writers are specially selected and recruited, after which they undergo further training to perfect their skills for specialization purposes. Moreover, our writers are holders of masters and Ph.D. degrees. They have impressive academic records, besides being native English speakers.

2. Top Quality Papers: Our customers are always guaranteed papers that exceed their expectations. All our writers have +5 years of experience. This implies that all papers are written by individuals who are experts in their fields. In addition, the quality team reviews all the papers before sending them to the customers.

3. Plagiarism-Free Papers: All papers provided by Writers Hero are written from scratch. Appropriate referencing and citation of key information are followed. Plagiarism checkers are used by the Quality assurance team and our editors just to double-check that there are no instances of plagiarism.

4. Timely Delivery: Time wasted is equivalent to a failed dedication and commitment. Writers Hero is known for timely delivery of any pending customer orders. Customers are well informed of the progress of their papers to ensure they keep track of what the writer is providing before the final draft is sent for grading.

5. Affordable Prices: Our prices are fairly structured to fit all groups. Any customer willing to place their assignments with us can do so at very affordable prices. In addition, our customers enjoy regular discounts and bonuses.

6. 24/7 Customer Support: At Writers Hero, we have put in place a team of experts who answer all customer inquiries promptly. The best part is the ever-availability of the team. Customers can make inquiries anytime.