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Assignment 8.2: Case Study: Mr. Rodriguez 

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Author’s Name

Date
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Assignment 8.2: Case Study: Mr. Rodriguez

The diagnosis of depression alongside chronic pain, more so back pain as evident in the

case of Mr. Rodriguez, paints the picture of a vicious cycle that points to the interrelationship

between the two. While the latter could cause the former, the former could also lead to the latter.

In this patient's case, the back pain has been in existence for the last 30 years, long before the

death of his wife; thus, the underlying condition worsening his depression is the back pain.

Consequently, treating Mr. Rodriguez would require emphasizing chronic back pain even though

depression treatment is also necessary. Therefore as his psychiatric mental health nurse

(PMHNs), my response to Mr. Rodriguez would help him understand the connection between his

persistent chronic back pain and the recent diagnosis of depression. In so doing, Mr. Rodriguez

would be able to see how his back pain has contributed to the worsening of the symptoms of

depression and how the resulting depression also worsens his feelings of pain.

Based on this patient’s medical history, I would diagnose him for somatic symptom

disorders (SSD) and persistent depressive disorder (dysthymia). Notably, since DSM-5

eliminated pain-specific disorder, all pain disorders are now integrated under somatic symptom

disorder and related disorders, thus the reason for recommending this diagnosis. According to

DSM-5, an SSD diagnosis would be recommended if the individual presents symptoms that

cause significant distress or impairment in their social, occupational, or other critical areas of

their life, thus interfering with their daily functioning (Xiong et al., 2017). In chronic pain, such

pain would warrant SSD diagnosis if the pain is predominant and has persisted for at least 3 to 6

months. On the other hand, dysthymia diagnosis would be recommended on this patient if his

depressive condition lasted for at least two years alongside the criteria listed under DSM-5.
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In screening for the possibility of dysthymia, I would use the Beck Depression Inventory

(BDI) to assess the behavioral manifestations and severity of his depression. Some of the

questions I would ask include: (1) “During the past month or recent weeks, have you often felt

bothered by your state of hopelessness, depression, or experiences of feeling down?” and (2)

“During the past one or two months, have you often been disturbed by your tendency of having

diminished interest or pleasure in participating in activities or doing things?”(Parker & Malhi,

2019). On the hand, somatic symptom disorder (SSD) would require a physical exam as well as

other laboratory to rule out other diseases that may present similar symptoms. Some of the

questions I would ask during SSD examination include: (1) “During the past six months, have

you been experiencing distressing pain or fatigue that is problematic to your daily life”, 2

(During the past six months, have you been having persistent and excessive thoughts about your

condition’s seriousness, leading to increased anxiety?), and 3 (have you been on antidepressants

for the past six months?) According to the symptoms exhibited by Mr. Rodriguez, he is at risk of

dysthymia and pain disorder contained under somatic symptom disorders classification.

Since this patient’s chronic pain and depression occur in a vicious cycle, a tricyclic

antidepressant such as Duloxetine. This drug is a selective serotonin and norepinephrine reuptake

inhibitor antidepressant (SSNRI) whose brand name is Cymbalta, Drizalma Sprinkle, Irenka and

is available in capsule form, to be consumed in 20mg; 30mg, 40mg; or 60mg depending on the

patient’s condition and response to medication (Matheson & Hainer, 2017). For an adult such as

Mr. Rodriguez, his initial dosage would be an oral 30mg once per day for at least one to two

weeks. Afterward, a maintenance dosage of 30mg to 60mg once per day will be administered

once his depressive symptoms positively respond to the drug. In the case of his sleep disorder, I

would recommend Temazepam (Restoril) and not diazepam. Temazepam (Restoril) would not
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only help him fall asleep but also help him remain asleep. A starting dosage of 7.5mg could be

taken a few minutes before retiring to bed and progressively increased to 15mg if the initial

7.5mg is not effective (Yasmin Begum et al., 2021). Additionally, basic sleep hygiene tips such

as avoiding caffeine, regular physical exercise, maintaining a regular sleep schedule, and

eliminating noise from his sleeping environment could also be implemented to increase the

impact of Temazepam (Restoril) in inducing and maintaining sleep.

Finally, in addition to medications such as Temazepam (Restoril) and Duloxetine, talk

therapies such as dialectical behavioral therapy (DBT), humanistic therapy, cognitive-behavioral

therapy (CBT), and psychodynamic therapy could be applied in helping Mr. Rodriguez deal with

negative, depressive thoughts and feelings (Ellyn Vohnoutka & Silvestro, 2021). As a result, the

therapies would help mold positive changes by eliminating negative habits. Second, I would also

recommend pain rehabilitation programs. Mayo Clinic’s comprehensive Pain Rehabilitation

Center would be resourceful since it has a team of psychiatric and medical professionals

specializing in is mental disorders.

 
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References

Ellyn Vohnoutka, B. S. N., & Silvestro, S. (2021). Types of therapy: what works for different

issues?. Therapy.

Matheson, E. M., & Hainer, B. L. (2017). Insomnia: pharmacologic therapy. American family

physician, 96(1), 29-35.

Parker, G., & Malhi, G. S. (2019). Persistent depression: should such a DSM-5 diagnostic

category persist?. The Canadian Journal of Psychiatry, 64(3), 177-179.

Xiong, N., Zhang, Y., Wei, J., Leonhart, R., Fritzsche, K., Mewes, R., ... & Schaefert, R. (2017).

Operationalization of diagnostic criteria of DSM-5 somatic symptom disorders. BMC

psychiatry, 17(1), 1-10.

Yasmin Begum, M., Alqahtani, A., Ghazwani, M., Alhamood, N. A., Hani, U., Jajala, A., &

Rahamathulla, M. (2021). Development of Duloxetine Hydrochloride Tablets for

Delayed and Complete Release Using Eudragit L 100. International Journal of Polymer

Science, 2021.