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Case Study 22 Depression: Drug-Nutrient Interaction

Case Study 22 Depression: Drug-Nutrient Interaction . By Kayla Zerman. What is depression?.

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Case Study 22 Depression: Drug-Nutrient Interaction

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  1. Case Study 22 Depression: Drug-Nutrient Interaction By Kayla Zerman

  2. What is depression? Depression is a mental state or chronic mental disorder characterized by feelings of sadness, loneliness, despair, low self-esteem, and self-reproach; accompanying signs with depression are psychomotor retardation (or less frequently agitation), withdrawal from social contact, and vegetative states such as loss of appetite and insomnia.

  3. Meet my client: • Name: IvannaGeitl • DOB: 9/17 • Age: 20 • Sex: Female • Education: International college student (junior year) • Occupation: Student • Hours of work: varies • Household members: Lives with roommates- Erika age 20, Veronica age 21, and Carol age 21- in excellent health. At home in Germany, she lives with her mother (age 45), father (age 50), and grandmother (age 70) • Ethnic Background: German • Religious Affiliation: Lutheran

  4. Chief Complaint: “All I want to do is sleep. I haven’t been able to eat- I don’t feel hungry. I can hardly make myself go to classes. And when I go, I can’t concentrate on what the professors are saying. My roommates tell me that I’ve been really moody. I’m so lonely being here in the U.S. without my family. But I wouldn’t want them to see how poorly I’m doing in school. It’s just hopeless– I’ll never meet their expectations. Maybe it be better for everyone– me, my roommates, and my family– if I just wasn’t around.”

  5. Patient History Ms. Geitl is a 20 year old female university student from Germany. She seeks medical attention at the urging of her roommates, who report that her mood has become increasingly depressed over the past two semesters. She has become withdrawn and moody– a significant change in her affect since first coming to the U.S. to attend college. She is otherwise a healthy young woman. Ms. Geitl reports a 5 pound weight loss in the past 3 months. She takes birth control pills for contraception and regulation of menses. Her mother has been treated for depression with St. John’s wort by the family physician for the past 10 years. Dx: depression; Mother suggested she should start taking St. John’s wort as well.

  6. What is St. John’s wort? St John’s wort (hypericumperforatum) is a perennial herb with a yellow flower that has been used to treat nervous conditions since ancient Greek times. Today, it is a popular herbal remedy for mild depression. The plant has many chemical compounds, some of which are believed to help depression by preventing nerve cells in the brain from reabsorbing the chemical messenger serotonin, or by reducing levels of a protein involved in the body’s immune system functioning.

  7. Side Effects of St. John’s • Dry mouth • Dizziness • Gastrointestinal symptoms • Increased sensitivity to sunlight • Fatigue

  8. Regulation of St. John’s wort in the United States In the United States, St. John’s worts is classified as a dietary supplement by the U.S. Food and Drug Administration, which is a regulatory agency of the federal government. The FDA’s requirements for testing and obtaining approval to sell dietary supplements are less strict than its requirements for drugs. Unlike drugs, herbal products can be sold without requiring studies on dosage, safety, or effectiveness. This is because the strength and quality of herbal products are often unpredictable; products can differ in content not only from brand to brand, but from batch to batch.

  9. Nutrition History Usual Dietary Intake: Breakfast: Black Coffee (2 cups) Lunch: She doesn’t have time for lunch she says PM Snack: Low-fat frozen yogurt- approx. ½ cup of chocolate or strawberry Dinner: (usually with roommates– they take turns cooking 3” square Stouffer’s Lasagna – eats only ½ 1 cup steamed broccoli (plain only with salt and pepper 1 breadstick Diet cola soft drink HS Snack: air-popped popcorn sprayed with butter-flavored Pam Diet cola soft drink

  10. 24-Hour recall Breakfast: 1 cup of Black Coffee 1 slice dry whole wheat toast Lunch: 2 cups chicken and noodle soup 2 saltine crackers ½ cup strawberry gelatin 1-12 oz can of Diet Cola Dinner: 2 peach halves 1 cup cottage cheese (low fat) 1 cup black coffee

  11. Ms. Geitl’s Energy Needs Harris-Benedict Equation: Women: REE (kcal)=655+9.56 wt. (kg)+1.85 ht. (cm)-4.68 (age) REE (kcal)= 655 + 9.56(72.96kg) + 1.85 (180.34cm) -4.68 (20) = 1,592 kcals (1,500-1,600 kcals per day) TEE= 1.5 x 1,592 kcals = 2,388 kcals/day (2,300-2,400 kcals/day)

  12. Ms. Geitl’s Therapy Plan • Zoloft, 50 mg qd • Referral to house psychologist for counseling • Nutrition consult re: poor eating habits

  13. Patient-Generated Subjective Global Assessment (PG-SGA) Ms. Geitl’s score: SGA Rating Select one:

  14. Triage Nutritional Intervention based off of PG-SGA score • Additive Score of 4-8 • Requires the intervention of the dietician, working in conjunction with the nurse or physician as indicated by the symptom check-off for pharmacological management

  15. Nutrition Intervention (con’t) • Along with the triage nutritional intervention, I would advise Ms. Geitl to come talk to me or another dietician about working on a diet plan that allows her to eat healthy and get the extra calories and nutrients she has been lacking. • To do this, I’d start by having Ms. Geitl increase her caloric intake each and every day so that way she isn’t just trying to increase her caloric intake all at once to the amount of calories she should be taking in each and everyday.

  16. Monitoring and Evaluation To monitor Ms. Geitl we will take her weight and ask for a 24-hour recall before every session we have with her to see if she is getting the right amount of calories in her diet and to see if she maintaining/gaining weight. Also, we will have her meet with a counselor to help her talk about why she is depressed and hopefully get her to become less depressed in the future.

  17. References • "Definition: 'Depression'" Depression. MediLexicon, n.d. Web. 25 Nov. 2012. http://www.medilexicon.com/medicaldictionary.php?t=23823 • Nelms, Marcia Nahikian. Nutrition Therapy and Pathophysiology. Belmont, CA: Wadsworth, Cengage Learning, 2011. A67-A70. Print. • Stanfield, Peggy, and Y. H. Hui. Nutrition and Diet Therapy: Self-instructional Approaches. Sudbury, MA: Jones and Bartlett, 2010. 198-99. Print. • "St. John's Wort." TheFreeDictionary.com. Medical Dictionary, n.d. Web. 25 Nov. 2012. • <http://medical-dictionary.thefreedictionary.com/St. John%27s wort>.

  18. Questions?

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