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PS5.1-2,PS6.1 | Mood Disorders — Assignment
CLINICAL SCENARIO
You are the medical officer at a primary health centre. A 38-year-old schoolteacher, Mrs Kavitha R., presents with a 4-week history of depressed mood, loss of interest in her work, insomnia, poor appetite, fatigue, and feelings of worthlessness. She has no past psychiatric history and denies suicidal ideation. She is married, lives with her family, and has not missed work yet, though her performance has declined. Physical examination and basic labs are normal. You must construct a comprehensive, evidence-based management plan and a clear referral decision framework.
Instructions
Using the clinical vignette above, write a structured management plan that addresses all sections below. Your response must be grounded in ICD-11/DSM-5 diagnostic criteria, current Indian evidence-based guidelines, and the MHCA 2017 where relevant. All drug choices must be justified with reasons. Use clear clinical reasoning — not a list of facts — throughout.
Length: 600-900 words
What to Submit
1. Diagnosis and Severity Assessment
Establish the diagnosis using ICD-11 or DSM-5 criteria. Specify the minimum symptom count and duration required. Classify severity (mild/moderate/severe) and justify your classification using Mrs Kavitha's symptoms. What additional history would you gather to complete your assessment (e.g., suicidality, past episodes, family history, psychosocial stressors)?
2. First-Line Management Plan (Stepped-Care Step 1–2)
Describe your non-pharmacological and pharmacological management plan. Which SSRI would you choose, at what starting dose, and why? What psychoeducation will you provide to the patient and her family? How will you structure your follow-up schedule in the first 8 weeks? What are the key counselling points about the antidepressant (onset of action, adherence, side effects, duration of therapy after remission)?
3. Red-Flag Monitoring and Escalation Triggers
List at least five specific red-flag signs or clinical developments that would prompt you to escalate or urgently refer Mrs Kavitha to a psychiatrist. For each red flag, explain WHY it exceeds primary-care scope. At least one red flag must relate to pharmacotherapy safety (drug interaction, adverse effect, or toxicity). Include the MHCA 2017 consideration if any involuntary referral scenario arises.
4. If Initial Treatment Fails — Stepped-Care Step 3
Mrs Kavitha returns at 8 weeks with only partial improvement (she is sleeping better, but mood and anhedonia persist). What is your next clinical decision — dose optimisation, switch, or refer? Justify your choice with the evidence-based algorithm. What would constitute 'treatment failure' requiring specialist referral at this point?
Grading Rubric — Mood Disorders Assignment Rubric
| Criterion | Points | Full-marks descriptor |
|---|---|---|
| Diagnostic accuracy and severity classification using ICD-11/DSM-5 | 10 pts | Correctly names the diagnosis (MDE/MDD), cites the exact ICD-11 or DSM-5 symptom and duration criteria, accurately classifies severity with clear justification linked to the vignette, and identifies additional history required (suicidality screen, past episodes, family history, stressors). |
| Quality and appropriateness of stepped-care management plan | 10 pts | Chooses an SSRI (names a specific agent and dose), justifies the choice with reasons (first-line, safety profile, tolerability), provides comprehensive psychoeducation (onset, adherence, side effects, duration), and outlines a structured follow-up schedule at 2, 4, and 8 weeks. Non-pharmacological measures (lifestyle, psychosocial support) are included. |
| Identification of red flags and escalation triggers | 10 pts | Lists ≥5 specific red flags with individual clinical explanations for each (e.g., suicidal ideation with plan → crisis referral; psychotic features → antipsychotic required beyond primary care; failure of two SSRI trials → specialist augmentation; SSRI + serotonergic drug → serotonin syndrome risk). Includes a pharmacotherapy safety red flag. References MHCA 2017 in an involuntary referral scenario. |
| Stepped-care escalation reasoning and treatment failure decision | 10 pts | Correctly identifies partial response at 8 weeks and applies the evidence-based algorithm: dose optimisation first → if no improvement after optimised dose trial → referral. Clearly defines 'treatment failure' (e.g., failure of two adequate SSRI trials). Reasoning is explicit, sequential, and evidence-linked. |
| Clinical reasoning clarity, integration, and professionalism | 10 pts | Responses integrate findings across all four sections into a coherent clinical narrative. Writing is precise, professional, and clinically mature. No factual errors. Word count within 600–900 word guidance. |
PEER REVIEW
Read your peer's management plan carefully. Using the rubric criteria as your guide, provide specific, constructive feedback on: (1) whether the diagnosis and severity classification are justified with correct criteria; (2) whether the SSRI choice, dose, and psychoeducation are evidence-based; (3) whether the red flags are clinically specific and each has a reason beyond primary-care scope; (4) whether the stepped-care escalation at week 8 follows the correct evidence-based sequence. Identify one strength and one area for improvement in each section. Your feedback should help your peer understand HOW to improve, not just WHAT is missing.