Week 10 ihuman

Diagnosis, Differentials, and Coding

The 17-year-old female patient presents with symptoms of fatigue, unintended 25–30-pound weight gain throughout one year, academic deterioration, irritability, abdominal and gluteal striae, and acanthosis nigricans at the base of the neck. She also presents with excessive fatigability despite having enough sleep, loss of pleasure in activity, and persistent unhappiness following a break-up with a boy. Her Patient Health Questionnaire-9 (PHQ-9) of 19 confirms moderate to severe depression. The differential diagnoses considered, given presenting symptoms and investigation, include Depressive Disorder (F32.9), Hypothyroidism (E03.9), Type 2 Diabetes Mellitus (E11.9), and Pregnancy (Z32.02): Week 10 ihuman.

Depressive Disorder (F32.9) was confirmed to be the first rank of consideration in view of significant emotional distress, anhedonia, excessive tearfulness, and fatigability, as indicated by Chand and Arif (2023). The PHQ-9 tool for severity of depression is a validated tool, and a reading over 15 is an indicator for intervention.

The hypothyroidism (E03.9) consideration is ruled out given a TSH level of 1.43, in a range of 0.35-4.94, as noted by Chaker et al. (2022). Hypothyroidism can present with fatigability, weight gain, and depression, but a normal TSH level excludes it.

The consideration of Type 2 diabetes mellitus (E11.9) arises given that acanthosis nigricans is an insulin marker for resistance and that she has a family history of diabetes mellitus. Yet, a level of 4.8% for hemoglobin A1C, in a range of 4.0-5.6%, excludes diabetes, according to Goyal et al. (2023). She doesn’t have a case for diagnosing diabetes, but lifestyle modifications must be advised to avert the development of a metabolic disorder.

Pregnancy (Z32.02) was eliminated with a negative human chorionic gonadotropin (HCG) test, excluding pregnancy-related etiologies for weight gain and fatigue.

Medications

The pharmacologic therapy for this patient consists of an antidepressant and a selective serotonin reuptake inhibitor (SSRI), such as 10 mg orally daily of fluoxetine. Fluoxetine is approved for use in adolescents with depression and is effective in treating severe and moderately severe depressive phases. Research by Sohel et al. (2022) identifies that fluoxetine lessens depressive symptoms in adolescents when taken alone and in combination with cognitive-behavioral therapy (CBT).

Notably, education for the patient consists of explaining side effects, such as nausea, headache, dizziness, and heightened risk for suicidal ideation in adolescents, particularly during early therapy phases. Stressed must be placed in compliance with medication and titrating dosages over some time to both the patient and her family.

Over-the-counter interventions include 3 mg of melatonin at bedtime, with sleep disturbances being common in depression. However, behavioral sleep hygiene interventions must first be addressed, starting with sleep aids through pharmacologic therapy.

Management Plan

The nonpharmacologic intervention consists of cognitive-behavioral therapy (CBT), which is the first-line psychotherapy for depression in adolescents. According to Sp et al. (2020), CBT involves altering maladaptive thinking and strengthening healthy emotionality. Referral for a week-by-week therapy session with a qualified mental health practitioner must be performed in an attempt to rehabilitate her emotionally.

Subsequently, addressing Social Determinants of Health (SDOH) is critical, and one of the patient’s emotional distress stems from a break-up in a relationship in the past. Teenagers have profound psychological repercussions following interpersonal discord, and these can manifest in terms of depressive symptoms, according to Cheung et al. (2024).

School life must be considered for whether academic performance exacerbates depressive symptoms. There must also be family encouragement for support, and a supportive family environment is linked with positive depression in adolescents. Depression psychoeducation must be shared with family and caregiver providers for proper care at home.

An evidence-based tool, such as an Adverse Childhood Experiences (ACE) survey, must be completed to assess for any psychosocial factors contributing to mental health outcomes. If high ACE scores are identified, trauma-sensitive care interventions must be incorporated into care planning.

Patient Education

Extensive patient education must be conducted for both current encounters and future health assessments. Patients and families must receive education about depression’s chronicity, its treatment, and therapy compliance value. There must also be a discussion about processed food consumption, metabolic risk, and association with mood disorders.

Xiong et al.’s (2024) studies indicate that highly processed foods and high sugar intake have a high risk for depressive symptoms. Nutrition guidance must, therefore, target reduced processed foods and increased mental and metabolic wellness-supporting foods.

In addition, suicide risk education must include warning signs and intervention for a crisis, such as 988 Suicide & Crisis Lifeline. As part of the patient’s background in terms of having experienced emotional distress following a break-up, healthy coping techniques such as journaling, mindfulness, and planned activity must be encouraged.

Follow-Up Instructions

The follow-up schedule entails a re-evaluation in 2-4 weeks for an improvement in symptoms, tolerance to medication, and compliance with therapy. Prompt follow-up after initiation of antidepressants in adolescents is critical in the early detection of adverse effects and in optimizing therapeutic modalities. She will have to be instructed to report early in case of a deterioration in depressive symptoms, ideation for harming oneself, or in case of medication-related side effects such as extreme agitation, insomnia, or gastrointestinal symptoms.

A repeat laboratory workup with a normal TSH and an A1C level is not currently indicated. In case of continued weight gain, a repeat in 6 months with an A1C, a fasting blood sugar, and a lipid profile must be conducted. Re-referral for an endocrinology consultation must be re-evaluated with continued clinical evaluation.

Conclusion

The case highlights a multidimensional therapeutic intervention for depression in adolescents, with consideration for both psychological and metabolic factors. Depressive disorder is the first and most crucial diagnosis, but her high BMI and nutrition demand preventive interventions for minimizing future disease-related complications. Multimodal therapeutic interventions with pharmacotherapy, cognitive-behavioral therapy, lifestyle modifications, and social intervention will go a long way in improving therapeutic improvement in symptoms and overall well-being in terms of long-term compliance with treatment.

References

Chaker, L., Razvi, S., Bensenor, I. M., Azizi, F., Pearce, E. N., & Peeters, R. P. (2022). Hypothyroidism. Nature Reviews. Disease Primers, 8(1), 30. https://doi.org/10.1038/s41572-022-00357-7

Chand, S. P., & Arif, H. (2023). Depression. PubMed; StatPearls Publishing. https://pubmed.ncbi.nlm.nih.gov/28613597/

Cheung, H. N., M. Habibi Asgarabad, Ho, W. S., Zibetti, M. R., Li, Stella, C., & Williams, J. M. (2024). Interpersonal symptoms in adolescence depression across Asian and European regions: a network approach. BMC Psychiatry, 24(1). https://doi.org/10.1186/s12888-024-06161-9

Goyal, R., Jialal, I., & Singhal, M. (2023). Type 2 diabetes. National Center for Biotechnology Information; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK513253/

Sohel, A. J., Shutter, M. C., & Molla, M. (2022). Fluoxetine. PubMed; StatPearls Publishing. https://pubmed.ncbi.nlm.nih.gov/29083803/

Sp, C., Dp, K., & Mr, H. (2020, January 1). Cognitive Behavior Therapy (CBT). PubMed. https://pubmed.ncbi.nlm.nih.gov/29261869/

Xiong, J., Wang, L., Huang, H., Xiong, S., Zhang, S., Fu, Q., Tang, R., & Zhang, Q. (2024). Association of sugar consumption with risk of depression and anxiety: a systematic review and meta-analysis. Frontiers in Nutrition, 11(2). https://doi.org/10.3389/fnut.2024.1472612

ORDER A PLAGIARISM-FREE PAPER HERE

We’ll write everything from scratch

---

Patient is 17 years old female with no significant past medical history, complains of fatigue, unintentional weight gain of 25-30 lbs in a year, decline in school grade, elevated BMI, and irritability. Physical examination reveals striae noted on abdomen and buttocks and acanthosis nigricans at nape of neck. Patient reported tired all the time despite sleeping 6-8 hours per night. Fatigue began roughly 2 months ago.

She reported lost interest in things she used to like do. Patient reported cried daily after breakup last year. Patient reported consumes high calories and fast food two or three times a week and consumes snacks at bedtimes. The family has a medical history of Type 2 diabetes mellitus and obesity.

Test result

• PHQ9 score 19
• Hemoglobin A1C 4.8% (normal 4-5.6, elevated risk 5.7-6.4, diabetes  >6.7)
• HCG negative
• TSH 1.43 (normal 0.35-4.94)

Different diagnosis

1. Depressive Disorder
2. Hypothyroidism
3. Type 2 Diabetes mellitus
4. Pregnancy
   

   Week 10 ihuman

Diagnosis

• Depressive Disorder

1). Diagnosis, Differentials, and Coding: What were the key clinical presentations in this patient that led you to choose these differentials; then how did you rule them out to reach your primary diagnosis? Include ICD 10 codes for each diagnosis.

2). Medications: Ordered (including over the counter) are appropriate, evidenced based, written as a complete prescription, and includes appropriate patient education on side effects.

Management Plan: Nonpharmacological treatment, Social Determinants of Health (SDOH) is addressed and evidenced based screening tool is used.

Patient Education: Comprehensive patient education is included related to current health visit and recommended health screenings.

Follow Up Instructions: are complete and include time to next visit and specific symptoms to prompt a return visit sooner.

Scholarly References and Clinical Practice Guidelines: The assignment includes a minimum of 3 scholarly references that are not older than 5 years. Clinical practice guidelines are included if applicable.