Review the Case Study: Carolyn. Then respond to the following questions in your initial post.

Case Study: Carolyn

Carolyn is a 23-year-old Black female graduate student who presents to you for care after being referred by her primary care provider. She has been treated for the last 1 ½ years for major depressive disorder but has not achieved remission with the medications tried so far. According to the records from her PCP, Carolyn was prescribed sertraline 100 mg daily, then bupropion was added and titrated up to 150 mg day, and while Carolyn does report some improvement in depressive mood, she never reached goal. She has also tried some nutraceutical therapies such as St. John’s wort. In the last few months, she has become more withdrawn, and this last semester she did not go back to school. According to notes from her PCP, it appears she may not be taking care of herself; reportedly Carolyn was always very attentive to her appearance, but she looks unkempt and appears to have lost weight. BMI is not available, but she looks thin.

Today during your evaluation, you note that her affect is quite flat, and she does not offer much during the interview, preferring one-word answers when able. However, when you ask specifically about hallucinations and delusions you learn that over the last year or so she has become convinced that there are communist operatives monitoring her life and infiltrating her home and electronic devices. She is afraid to use her computer or her phone, and she is sure that in her last live class at school, one of the communist spies was posing as the teacher. She believes they are trying to frame her as a spy so she can be extradited to prison in Russia.

At this point the diagnosis remains unclear, but she clearly needs management of her delusions. Consider the antipsychotic options available to you and assume that Carolyn has access to adequate resources so you can choose the best medication for her needs.

Initial Post

Please respond to the following:

• Choose a medication for Carolyn and support your option over two-three others available.
• What are some cultural considerations that will influence your choice?
• What are the most important points of patient education you must highlight for Carolyn as she starts her medication?