Miami Dade College Health Case Study

Alejandro Escobar-Vega Case Study

You are still seeing Alejandro Escobar-Vega, a 34-year-old Hispanic man. He attended your group therapy sessions last year, and you saw him for individual therapy. You diagnosed him with DSM-5-TR F33.1 Major Depressive Disorder, recurrent, moderate; and placed him on Trazodone 50 mg by mouth at bedtime as needed for sleep and Lorazepam 0.5 mg by mouth 3 times daily for anxiety and agitation, initially. Subsequently, he began taking 100 mg Quetiapine (Seroquel) and 100 mg Lamotrigine (Lamictal).

He was admitted to the hospital for attempted suicide for the third time last week, when he ingested a hundred 100 mg Quetiapine (Seroquel) and a hundred 100 mg Lamotrigine (Lamictal) pills. He spent last week in the intensive care unit and is now in a medical unit where he is undergoing medical stabilization. Given the number of pills he ingested, it is likely he was not regularly taking his medications and was stockpiling them.

During your session, he says, “I just didn’t want to live any longer. I am a failure. I am not good for Daniella or my family. I can’t even kill myself right. Why am I here? I am sleeping terrible. I lay awake at night, and my mind is going and going and going. I can’t get my mind to shut off. I keep thinking about all the ways I have failed my family, thinking what a terrible father I am, what a terrible husband, Dad, and son I am. I don’t even have the energy or desire to get out of bed in the morning. I feel worse in the morning…I feel completely worthless.” He cannot recall the exact sequence of events or exactly what happened when he took the overdose.

Alejandro’s physical exam and lab results have all been normal, including a normal thyroid function and normal vitamin D levels.

Mental Status Exam

Appearance: unkempt, unshaven, front of shirt stained with food, cooperative with interview, poor eye contact

Speech: normal in rate, volume, and monotonal

Psychomotor activity: retarded

• Mood: depressed, somewhat angry
• Affect: mood congruent
• Thoughts: linear, logical, goal directed
• Thought content: excessive guilt, suicidal ideation, no homicidal ideation
• Perceptual disturbances: none observed
• He’s awake, alert, oriented to person, place, time
• Cognitive functioning: grossly intact, impaired short-term memory, follows directions
• Insight: limited
• Judgement: limited
• You know from past interaction that his mother was diagnosed with an anxiety disorder and his cousin Luis died from suicide 18 months ago. He has a wife, Daniella (Dani), and a 16-year-old son, Dario.
• Alejandro Questions
• From your perspective as Alejandro’s answer the following questions. 

1.  What screening tool(s) would you use during this interview?

2. Would you keep the same diagnosis? Are there any symptoms that would make you consider a different diagnosis? On what evidence and symptoms do you base your diagnosis?

3.What medication change(s) would you prescribe for Alejandro and why? Please note the medication(s), initial dose, and dosing schedule.

a- Fill out a prescription (PDF) See attachment) for one medication. Print the template, fill it out, and scan it or take a photo. Attach the image to your post.

b- Identify whether your decision is FDA-approved or off-label; if off-label, explain why you chose this medication.

5- How will you educate and inform Alejandro about how this medication will work, side effects, and risks/black box warning(s) with this medication.