CASE STUDY 4 Depression, Anxiety, Substance Use, and Chronic Pain

Ms. R.D. is a 45-year-old female presenting with insomnia, fatigue, chronic low back pain, and mood changes.

History

· PMH: Chronic pain, prior opioid exposure

· Reports alcohol use nightly

· PHQ-9: 17, GAD-7: 15

Student Assignment Requirements

1. Pathophysiology (25%)

· Neurobiology of depression and anxiety

· Substance use impact on CNS

· Pain–mood interaction

2. Mental Health Assessment (35%)

· Diagnostic differentiation

· Suicide risk screening

· Substance use screening

· Safety planning

3. Pharmacology & Integrated Treatment (30%)

· Antidepressant selection and titration

· Avoidance of high-risk medications

· Non-pharmacologic and referral planning

4. APA & Evidence Use (10%)


RUBRIC – CASE STUDY 4 - Mental Health, Substance Use & Chronic Pain (100 Points)

1. Neurobiologic Pathophysiology (25 points)

Level

Description

Excellent (23–25)

Integrates neurobiology of mood disorders, substance use, and pain with strong application to clinical symptoms.

Satisfactory (18–22)

Accurate explanation with limited integration.

Unsatisfactory (13–17)

Partial or unclear explanation.

Poor (1–12)

Incorrect or superficial discussion.

Not Submitted (0)

Section not submitted or missing.


2. Mental Health & Safety Assessment (35 points)

Level

Description

Excellent (33–35)

Comprehensive assessment including diagnostic differentiation, suicide risk, substance use screening, and safety planning.

Satisfactory (26–32)

Assessment is appropriate but lacks depth or clarity in prioritization.

Unsatisfactory (18–25)

Incomplete assessment or missed safety considerations.

Poor (1–17)

Unsafe or inadequate evaluation.

Not Submitted (0)

Section not submitted or missing.


3. Pharmacology & Integrated Care Plan (30 points)

Level

Description

Excellent (28–30)

Evidence-based medication selection with safe prescribing, clear rationale, and integrated non-pharmacologic strategies.

Satisfactory (22–27)

Appropriate plan but lacks optimization or monitoring detail.

Unsatisfactory (16–21)

Limited pharmacologic understanding or justification.

Poor (1–15)

Unsafe or inappropriate treatment decisions.

Not Submitted (0)

Section not submitted or missing.


4. APA & Scholarly Writing (10 points)

(Same descriptors as Case 1)

Submission

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