Chronic Illness – A 28-Year-old Female Presents to the Facility Complaining of Weight gain, Increased Sleeping, and Fatigue

Chronic Illness – A 28-year-old Female Presents to the Facility Complaining of Weight gain, Increased Sleeping, and Fatigue

The patient is a 28-year-old female who presents to the facility complaining of weight gain, increased sleeping, and fatigue. Her medical history shows that she has been suffering from depression on and off since the age of 17 years. She has never had any medical problems apart from depression. Despite being aware of her condition with depression, she has never taken any medication to manage the condition.

Differential diagnoses include depression, sleep-related disorders, central nervous system diseases such as multiple sclerosis, drug-related conditions such as the use of central nervous system depressants and abuse of cocaine, and endocrine disorders such as hypothyroidism, Cushing syndrome, and hyperthyroidism. The patient’s evaluation includes the patient’s history, physical assessment, measuring of vital signs, and laboratory tests. Essentially, a thyroid-stimulating hormone test is conducted to rule out hypothyroidism and hyperthyroidism, while toxicology screening and blood alcohol level are done to rule out substance abuse (Pirahanchi et al., 2022). HBA1c level, fasting plasma glucose test, or a random plasma glucose test is done to rule out diabetes (Goyal & Jialal, 2022). A cosyntropin stimulation test is done to rule out Addison’s disease. Laboratory tests include complete blood cell count, vitamin B12, liver function traits, arterial blood gas, and electrolytes.

The patient’s current weight and height are used to determine her BMI. If the BMI shows that the patient is overweight or obese, the patient’s treatment plan focuses on weight loss. Dietary and lifestyle adjustments are recommended to prevent unintended weight gain and ensure weight loss. The patient’s sleep hygiene is assessed to determine the causes of increased sleeping. Notably, the patient has a history of depression without treatment since the age of 17; therefore, her treatment plan should include the management of depression. The treatment plan includes psychotherapy and pharmacological therapy (Chand & Arif, 2022). Pharmacological therapy includes the prescription of atypical antidepressants such as bupropion, tricyclic antidepressants such as amitriptyline, selective serotonin reuptake inhibitors such as fluoxetine, monoamine oxidase inhibitors such as selegiline, serotonin dopamine activity modulators such as aripiprazole and serotonin/norepinephrine reuptake inhibitors such as duloxetine (Chand & Arif, 2022). Any other underlying disorders are also treated.

References

Chand, S. P., & Arif, H. (2022). Depression. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430847/.

Goyal, R., & Jialal, I. (2022). Diabetes Mellitus Type 2. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK513253/.

Pirahanchi, Y., Toro, F., &bJialal, I. (2022). Physiology, Thyroid Stimulating Hormone. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499850/.

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A 28-year-old female presents with complaints of fatigue, increased sleeping, and weight gain. She states she has had depression off and on since she was 17. She denies any other health problems and has never taken any prescription medication, including anything for depression.

What are your differentials? What laboratory tests could you perform? What would be your treatment plan?

Length: A minimum of 250 words, not including references
Citations: At least one high-level scholarly reference in APA from within the last 5 years
EXAMPLE;
The patient presents with recurrent episodes of depression for the past 11 years. She is currently not taking any medications despite a history of chronic depression. The patient denies any diagnosed medical condition. Today, she is complaining of “fatigue, increased sleeping, and weight gain.” After listening to the patient’s current symptoms, I would like to ask her if she has had any “cold intolerance, puffiness, decreased sweating, dry skin, voice changes, hair loss, constipation, muscle cramps, sleep disturbances, menstrual cycle abnormalities, painless thyroid enlargement, or galactorrhea” (Patil et al., 2022, p. 4). Since the patient is complaining of weight gain, depression, and fatigue, it is reasonable to assess for additional symptoms related to hypothyroidism (Patil et al., 2022).
I would also inquire about the patient’s last physical and mental health examinations. It might shed light on previously identified issues or abnormal laboratories. Fatigue and weight gain are also linked to sleep (Domino et al., 2022). I want to find out the quantity and quality of the patient’s sleep every night. Sleep can also be altered due to drug and alcohol abuse (Cash & Glass, 2017). To ensure that treatment is not harmful, I would also ask the patient if she is sexually active. Menstrual cycle disruption or abnormal bleeding may be related to hypothyroidism or pregnancy (Cash & Glass, 2017).
The differentials for this patient include “hypothyroidism, iron deficiency anemia, sleep apnea, chronic fatigue syndrome, and depression” (Patil et al., 2022, p. 7). Diagnostic studies for this patient will include physical examination, PHQ-9 (depression), urine drug screen, ferritin, “TSH (and free T4 if indicated), FLP, CK, hepatic enzymes, CBC with differential, A1C, CMP, BUN, creatinine, uric acid” (Patil et al., 2022, p. 5). Both non-pharmacological and pharmacological interventions will depend on the results of the diagnostics performed.
If the patient’s scores are indicative of depression, I will discuss the results with the patient. With the patient’s permission, I would refer them to a specialist for psychotherapy (Domino et al., 2022). If pharmacotherapy for depression is necessary, I would start the patient on sertraline 50 mg by mouth daily (Ferri, 2020). The patient would require a 2-week follow-up and education that symptom resolution may take several weeks (Ferri, 2020). If there is a history of sleep apnea, a sleep study test will be ordered. If the patient needed additional iron, I would start her on ferrous sulfate 325 mg by mouth TID (Domino et al., 2022).
Presuming diagnostic tests revealed hypothyroidism, the patient would require “levothyroxine at 1.6 mcg/kg/day” (Patil et al., 2022, 6). Selective serotonin reuptake inhibitors would also help the patient if the diagnosis pointed to chronic fatigue syndrome (Sapra & Bhandari, 2021). Additional interventions for chronic fatigue syndrome include “cognitive behavioral therapy, NSAIDs, and tricyclic antidepressants” (Sapra & Bhandari, 2021, p. 10).

Follow-up care would include a 1-2 week follow-up for lab result interpretation, as well as continued monitoring to assess for medication/treatment tolerance. If conditions requiring lab work were identified, the patient would also be asked to return in 3 months for new labs.