NR 603 Week 1 Discussion_Complexity and Clinical Decision-Making Case Discussion-Alma Garcia

Complexity and Clinical Decision-Making: Alma Garcia Case Discussion Applica琀椀on of Course Knowledge The case of Alma Garcia, a 23-year-old Hispanic female, illustrates the nuanced challenge of differentiating emotional responses to grief from clinically significant mood disorders. Alma presents with persistent sadness, fatigue, reduced appetite, difficulty sleeping, and feelings of being overwhelmed following a spontaneous abortion at seven weeks gestation. Her affect is flat, grooming is poor, and she reports limited social support due to cultural stigma around discussing emotional pain. These symptoms align most closely with Major Depressive Disorder (MDD) but overlap with features of Adjustment Disorder (AD) and Generalized Anxiety Disorder (GAD). In Major Depressive Disorder, the hallmark presentation includes a persistently depressed mood or loss of interest in pleasurable activities (anhedonia) lasting at least two weeks, accompanied by additional symptoms such as changes in appetite, fatigue, poor concentration, sleep disturbances, and psychomotor slowing (American Psychiatric Association [APA], 2022). Alma meets these diagnostic criteria, as evidenced by her PHQ-9 score of 12, which reflects moderate depression. Adjustment Disorder, in contrast, represents a maladaptive emotional or behavioral response to an identifiable stressor that occurs within three months of the event and typically resolves within six months once the stressor is removed or the person adapts. While Alma’s miscarriage is a clear trigger, her persistent functional impairment, diminished energy, and loss of motivation extend beyond what would be expected in a normal adjustment process. Generalized Anxiety Disorder (GAD) is characterized by excessive and uncontrollable worry occurring more days than not for at least six months, accompanied by symptoms such as restlessness, fatigue, irritability, muscle tension, and sleep disturbance (National Institute for Health and Care Excellence [NICE], 2022). Alma’s GAD-7 score of 8 indicates mild anxiety; however, her dominant symptoms—sadness, hopelessness, and anhedonia— suggest depression as the primary diagnosis rather than an anxiety disorder. Diagnos琀椀c Criteria and Screening Tools According to the DSM-5-TR (APA, 2022), a diagnosis of Major Depressive Disorder requires at least five of nine key symptoms during the same two-week period, representing a change from previous functioning. Alma meets the following criteria: depressed mood, diminished interest or pleasure in activities, fatigue or loss of energy nearly every day, insomnia or hypersomnia, diminished ability to concentrate, and decreased appetite. Validated screening tools support these findings: - PHQ-9: Score of 12 indicates moderate depression. - GAD-7: Score of 8 reveals mild anxiety symptoms. American Psychological Association. (2019). Clinical practice guideline for the treatment of depression across three age cohorts. https://www.apa.org/depression-guideline Cabassa, L. J., Lara, M., S Pincay, I. M. (2022). Cultural adaptation of mental health interventions for Latino populations: A review of the evidence. Journal of Behavioral Health Services S Research, 49(2), 120–135. National Institute for Health and Care Excellence (NICE). (2022). Depression in adults: Treatment and management (NG222). https://www.nice.org.uk/guidance/ng222 World Health Organization (WHO). (2023). Integrating mental health services into primary care. WHO Press.