Case presentation

on
Depression
BY:
Mirza Habeeb
Pharm D-III yr
15122D1007.
 Demographic details
• Name : xxxx
• Age :21 yrs
• Sex: Male
• Unit : MICU
• IP NO : 5107
• DOA :17/7/17
 Reasons for admission
C/O

• Fever since 3 days

• Neck pain since 2 days
• Suicidal attempt before day of admission
• Sleeplessness since 6 months
• Not taking food properly since 6 months
• Loss of weight since 6 months.
• PMHx :No HTN/DM/Asthma .
• PMEDx :Nil .
• FMHx :Nil
• SHx : Mixed diet
Alcoholic ocassionally
Smoker
• General : c/c
• VITAL SIGNS : Temp : 99ºF
BP:120/80 mmHg
PR :80 b/m
• CVS : S1S2 +
• RS : clear
• GIT : NAD
• CNS : plantars ↓↓
• GU : NAD
PROVISIONAL DIAGNOSIS
?DEPRESSION
? ACUTE PSYCHOTIC DISORDER
?? ACUTE ENCEPHALITIS
 Day 1 – Medication
 Inj.Lorazepam 1 ml IV OD
 Tab.Fluoxetine 200mg P/O BD
 Tab.Trihexphenidyl HCl 1 tab P/O BD
 Inj.Pantoprazole 40mg IV OD
 ADVICE :
CBP
Urine analysis
Electrolytes
widal test
P.v/P.f
Progen test
MRI Brain
CSF Analysis
 Laboratory reports
Haemogram:
Hb%: 11.0 gm%
RBC count: 3.8mill/cmm RBS:115mg/dl
WBC: 6000 Blood.urea:24mg/dl
DLC: Sr.Cr.:1.2mg/dl
N-62%
L-32%
M-06%
B-00 %
E-01%
PLT: Adequate
• URINE ANALYSIS
Appearance- sl.opalascent
colour -pale yellow
pH-5.0
epithelial cells:1-2 cells/hpf
pus cells:2-4 cells/hpf
RBC’s:2-4 cells/hpf

Electrolytes:
Na-137mEq/L (136-145)
K-3.7mEq/L(3.5-5)
Cl-99mEq/L (97-111)
CSF Analysis:
CSF fluid:2.7 U/L
colour: colourless
Appearance:clear
Cell count: no cells
Sugar:72mg/dl
Protein:44.3mg/dl

MRI Brain
Mild-moderate dilatation of bilateral ventricles.
Widal test: -ve
P.V/P.F :-ve
Progen test:+ve
FINAL DIAGNOSIS

Depression
+
Typhus fever
 Day wise follow up
Day- 2

Temp:99°F BP:120/110 mmHg

PR: 85b/m

C/O: pt was drowsy

Neck rigidity present
Received reports of progen test
Add: Tab.Doxycyclin 100mg P/O BD
Inj.Neurokind plus
Inj.Ceftriaxone 2g IV BD
 Day-3
Temp: 98.6°F
PR: 90b/min
BP:100/70 mm Hg
C/O: Abnormal behaviour,neck stiffness +
CSF Reports received – Normal
No CNS infection
 Day-4
Temp: N
PR: 82b/m
BP:120/80mmHg
C/O:Altered behaviour , delayed response,neck
stiffness.
MRI reports received & reviewed by Doctor –
Normal
Fever subsided.
SOAP NOTES
 Problem list

• Depression
• Typhus fever
Subjective evidence Objective evidence
• Fever since 3 days • Abnormal behaviour of
• Neck pain since 2 days patient
• Progen test:+ve
• Suicidal attempt before
day of admission
• Sleeplessness since 6
months
• Not taking food
properly since 6 months
• Loss of weight since 6
months.
 ASSESSMENT
Final diagnosis: Based on subjective and objective
evidence, the final diagnosis was made to be
Depression & typhus fever.
Etiology: pt’s depressive condition.
Assessment if therapy is indicated:
Yes, therapy is needed to reduce the symptoms. If
therapy is not indicated, it may lead to severe
complications like death.
Assessment of current therapy
• Inj. Lorazepam
Category : Anti anxiety.
Indications: anxiety
MOA: potentiator of gamma aminobutyric acid receptor-
opening of chloride channels-influx-hyperpolarization
Adverse effects: sedation,fatigue,nausea.
• Fluoxetine:
Category: Selective serotonin reuptake inhibitor
Indication: To treat depression
MOA: Inhibits sodium dependent seotonin transporter
and blocks serotonin reuptake making more serotonin
available to brain
Dose:20-40 mg/day
Adverse effects : drowsiness, headache, diarrhoea
• Tab. Pantaprazole
Category: Proton pump inhibitor
MOA:It acts by binding to H+/K+/ATPase which is
present on the surface of parietal cells that decreases
acid production
Dose:40mg
ADR:GI disturbances
• Tab.Trihexphenidyl HCl:
Category:Anticholinergic
MOA: It inhibits the parasympathetic nervous system &
has relaxing effect on smooth muscles.
Dose: 2-5 mg/day
ADR: rash,dry mouth,constipation.
• Tab. Doxycycline:
Category: Tetracycline
Indication: To treat typhus fever.
MOA: it binds to 30s & 50s ribosomal subunits and
inhibits protein synthesis in bacteria. .
DOSE: 100mg P/O BD
ADR: Anorexia,diarrhoea,dental discoloration.
• Inj.Ceftriaxone:
Category: cephalosporin
Indication:Used to treat bacterial infections
MOA:Inhibits the bacterial cellwall synthesis.
DOSE:1-2g IV
ADR: hypersensitivity,sore throat.
PLANNING
 Goals of therapy
• General goals:
To reduce morbidity and mortality.
To improve patient quality of life.

• Patient specific goals:

To reduce signs and symptoms.
To prevent from further complications.
 Points to patient
• About disease:
You are suffering from Depression
Seek help from family and friends don’t isolate
yourself from social meetings and gatherings
Exercise thrice a week X 20 min
Life style modifications:.
 Avoid alcohol and smoking.
 Reduce stress.
 Try relaxation exercises like yoga.
 Maintain proper hygenic conditions.
 Keep yourself busy with self esteem boosting
activities like meeting up with friends,gardening etc.
THANK YOU