solve following subparts related to case study thanksa .Identify a minimum of twelve clinical manifestations that are consistent with major depression in this patient.b.Is bipolar depression a reasonable alternative diagnosis in this patient?c. Does thyroid disease appear to be a potential contributing cause of depression in this patient? CASE STUDY49MAJOR DEPRESSIVE DISORDERFor the Disease Summary for this case studysee the CD-ROM.PATIENT CASEPatient's Chief Complaints"I don't know how much longer I can go on like this. I've been down in the dumps for yearsand it isn't getting any better. I've lost everyone who has ever meant anything to me. I've disappointed my son to the point that he l never forgive me. I've asked God to help me throughthis, but it seems that He isn't listening. Now my wife is telling me that I have AlzheimerkNothing is fun and I don't believe that life is worth living anymore."History of Present IllnessMr. H.B. is a 75 yo white male who presents to the clinic with the above complaints. He losthis first wife to a stroke 19 years ago after 27 years of a "wonderful marriage." The patientemphatically states thatnow more than ever what a good woman she was" He remarried 2 years after her death. Hissecond and current wife was a former co-worker. "I was lonely and I probably mamried againtoo soon," he admits.He explains that his current wife has been a very difficult person with which to live. Itall began about a year after their marriage when she insisted that he put up a privacy fencebetween their house and the neighbor's house. The patient had been a close friend to hisneighbors for more than 25 years and knew that putting up a fence would cause discord.Soon thereafter, his current wife insisted that the patient no longer visit his elderly father inlaw or sister-in-law from his first marriage even though they had been friends for nearly 50years. "When you married me, you divorced that whole family." she had said Then, on oneoccasion and while the patient was at work, she would not allow his son, his son's wife, andtheir newborn baby into the house to visit. The patient began to feel that he was distancinghimself from family and friends that he had known and loved for many years. He tried toresolve issues between his son and wife, but his wife was closed to any suggestions.The patient began to feel guilty, very much alone, and extremely sad. He began attend-ing church more than usual-on weeknights in addition to Sunday mornings-just to get outof the house. This went on for years. At one time, he visited with the pastor of his church andrelated his unhappiness. Although his pastor was a Catholic priest, he suggested that H. consider a divorce for the benefit of his health. When he confronted his wife with the topic ofdivorce, however, she burst into tears and told him that she would change and be a betterwife to him She changed-for about 6 months-and then reverted to her former means ofmanipulation.Tove of his life and can never be replaced. "I realinewas232 CASE STUDY 49 - MAJOR DEPRESSIVE DISORDER 233Recently, the patient's wife insisted that they sell the house in which the patient had livedfor 46 years and move into an apartment. He totally rejected the idea. "We agreed when weot married that we would live there. If she wants me out of that house, she'l have to carryme out herself," he stated with defiance. When the patient considered divorce as an optionfor a second time, he dismissed it quickly, because he was a devout Catholic and believed thathe would be condemned for that decision. He also decided that "he had made his bed andnow must sleep in it" and continued in his sadness and despair.The patient notes that his memory and ability to make simple decisions have been dete-riorating significantly during the last several months. His wife has told him that he hasbecome so forgetful that he probably has Alzheimer disease and should see a doctor. Tvebeen eating all right and I try to get some exercise every day, but I wake up often now dur-ing the night and am usually up for good by 5 o'clock every morming-then I feel tired by9 AM and throughout the day. I am becoming increasingly depressed. I am ready now to giveup the fight and be with K. (his first wife), I know that she is waiting for me."Past Medical HistoryThe patient has been relatively healthy throughout his 75 years. He has had all of the usualchildhood illnesses, but has no current non-psychiatric adult illnesses and takes no medications. At age 54, he was diagnosed by neurologists with a rare eye disorder characterized bypoor peripheral vision. The doctors had attributed this condition to trauma that he sufferedduring the 1941 attack at Pearl Harbor where he had been stationed as an army cook. Hesustained temporary deafness for six months due to the noise of the bombings He has hadno other incidents of trauma during his lifetime.He has never been treated for any psychiatric illnesses, although he reports a 15-yearhistory of many periods of intense sadness, loneliness, and guilt that have lasted weeks tomonths. He has not had any surgeries performed and there has been no significant travel his-tory. The patient has no dietary restrictions and, although he has no strict exercise program,he walks every day to maintain a healthy weight. His last tetanus booster was six years ago.Family History• Father, died from colon cancer at age 67• Mother, died from influenza epidemic at age 24 (when patient was 2 years old)• No known family history of depression or other mental illness• No biological siblings; one half-brotherSocial History• High school graduate• Married to high school sweetheart for 27 years, then widowed• Currently married to second wife for 17 yearsRetired: 25-year career as a baker; when the company moved to another part of the state.patient tooka job in maintenance where he met his second wife• Attends Catholic mass regularly and has always been very religious• Drinks 1-2 beers several times a week, but denies drinking to intoxication• Has never smoked or used illegal substances• Rarely drinks coffee anymore as it causes Gl distress; often drinks hot tea• He has never driven a motor vehicle due to poor peripheral visionReview of Systems• Feels tired much of the time• No complaints of headache, body aches, dirriness, fainting spells, tinnidischarge, nasal congestion, diarrhea, constipation, change in appetite, skin abnormali-ties, or genitourinary symptomsear pain,

Sadness is a natural part of one's feelings and should be short-lived. But if someone feels intense…

Answered: .Identify a minimum of twelve clinical…

6th Edition

ISBN:9781451194524

Author:Ruth McCall, Cathee M. Tankersley MT(ASCP)

Publisher:Ruth McCall, Cathee M. Tankersley MT(ASCP)

Chapter1: Phlebotomy: Past And Present And The Healthcare Setting

Section: Chapter Questions

Problem 1SRQ