Case Study N.Y.
When N.Y. 20, came in for an evaluation with her family, her main complaint was that she could not retain information and was worried about starting school and her performance in college. Her family noticed that she was also very tired, slept a lot and did not seem to follow through on her goals. She complained of very low energy and increased appetite, and was concerned about the weight that she gained and could not lose. She felt sad and worried most of the time- especially about her starting school again and not feeling up for it.
N.Y. was never seen by a psychiatrist before and was not aware of any mental illness running in her family. She had been a good student in her country of origin, came to United States when she was in 9th grade and once here, her academic performance gradually deteriorated. She found that she needed more time to accomplish her tasks; she was easily distracted in class, and seemed that she worked twice as hard as her peers to achieve the same results.
During the first meeting with her-it became clear that based on the clinical history and the self-reported questionnaires that she was suffering from significant depression and anxiety symptoms. At the same time, while her concentration could have been impaired by the presence of an affective disorder, I considered the presence of a comorbid ADHD. At the same time, her lethargy, decreased energy and mental cloudiness could have been explained by an atypical form of depression but I was also concerned about the possible comorbidity with a thyroid deficiency, vitamins deficiencies, or anemia.
I created a customized treatment plan and discussed the plan with N.Y. and her family and decided to start the treatment for the most obvious complaint, the low depressed mood, and test for ADHD when the mood was better through a Continuous Performance test. At the same time, I recommended we run a set of lab tests to address possible biological causes of her symptoms.
The laboratory results confirmed my clinical suspicions by showing signs of microcytic anemia, and significant deficits in Vitamin D, B12, and folate, with an increased homocysteine level that is a marker for a generalized inflammatory state.
The Continuous Performance Test (CPT) test for ADHD showed that she was having a lot of difficulties with maintaining attention, and increased distractibility.
Integrative Psychiatric Treatment For N.Y.
We created a customized Integrative psychiatric treatment program which began to help N.Y. see improvements. N.Y. showed significant improvements on a combination of a medication (an SSRI) for her depressive symptoms and anxiety, Strattera (for ADHD) and targeted supplementation including Vitamin B12, Vitamin D, folate(Vitamin B9), and B-Complex. She was also referred for further testing and follow up with her primary care physician for her microcytic anemia. I also recommended that she start exercising by going for a walk regularly, at least 25 minutes a day at a fast pace. To help her lose the extra weight she wanted to lose we talked about her trying a low-glycemic index diet.
It is possible that with an improved regimen of regular exercise, improved nutrition and supplementation with the appropriate vitamins she might be able to get off the antidepressant in about 6 months. At that time- we plan on repeating the CPT test to assess her ability to concentrate on and off medication, and decide if further treatment is necessary.
Integrative treatment in Psychiatry is becoming more and more popular and effective because it provides a more comprehensive analysis of the potential factors that may influence an individual’s health and mental health. It also provides a more customized plan of treatment that incorporates the interplay of body, mind and spirit and therefore can be much more effective than traditional medicine which takes a narrower view.
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