Management Of Major Depressive Episode With Psychotic Features In Elderly Patients: A Case Study

Reflection on the communication technique

Effective communication in patient centric care is crucial for providing competent patient centric care (inpatient interview, 2018). In the video of the Inpatient Interview” I have observed a few techniques of nursing for interviewing Mrs B. (inpatient interview, 2018). I have observed the due to mental condition the communication of the patient was impaired and therefore nurse for assessing necessary data involved her in conversation by giving her recognition. The recognition acknowledges a patient’s behavior and highlights an overt compliment, which provides the patient with a sense of comfort. I have observed that the nurse showing active listening skills while communicating with the patient. According to Kaiser et al. (2015), the verbal cues of nurses encourage the patient to continue talking and highlight the interest of nurse. I have observed the clarification and summarizing skills while interviewing the patient. These are a useful technique for nursing which made the patient feel wanted and worthy. In my opinion, the techniques were demonstrated well since the patient complimented the nurse that he is nice which in turn indicate that the patient was comfortable in the interview with the nurse. Moreover, environment is crucial for interviewing patient and interviewer ensured that the environment was pleasant without any distraction, which enabled interviewer to obtain necessary data through communication.

Psychotic depression or major depressive disorder with psychotic features is a serious illness in which a person suffers from a combination of the depression of mood along with psychosis (Siu et al., 2016). Wagner et al. (2013), stated major depressive disorder characterized, the loss of contact with the reality manifesting itself as the nihilistic type, delusions with false belief, false perception, hallucination, suicidal attempt more commonly for elder patient (Australian commission on safety and quality of the health care,  2018). Mrs. B has the false belief that she is going to die and strong wish of death resulted in probable feeling of unworthiness. These symptoms often regarded as the major depressive disorder where patient often have a period of increase depressed mood and tearfulness, social isolation, sleeping too much, sense of worthlessness (Greenberg et al., 2015). These delusions and hallucinations seem real to the patient and consequently, it implants a tendency of self-harm. Therefore, the patient with the major depressive disorder with psychotic features needs immediate clinical attention in order to prevent self-harm and provide quality of life.

Acutely mentally ill patient present their beliefs and convictions in such a way that challenges the normal social interaction (Gartlehner et al., 2015). Therefore, strategic interpersonal communication skills are crucial for caring mentally ill patient, which involves active listening, identification and problem solving approach. As observed in this case study, Mrs. B was suffering from the major depressive disorder with psychotic features with false beliefs and delusions, which resulted in the loss of appetite and hopelessness. In this context, in order to solve issues nurses can show the expression of empathy through the activity of reflective listening where she will feel comfortable. The communication skills also involve the development of discrepancy between the goals of the patient and their current behavior and beliefs(Bashshur et al., 2016). Further communication involves body orientation, maintaining, eye contact, use of open question, use of short sentence, slow pace of speech and attention. Moreover, response based spontaneous approach without being judgmental to the patient while providing care provide security to the patient with cognitive impairment. This will help her to overcome her delusions and false belief of dying and this, in turn, help her to cope up with the current depression (Bashshur et al., 2016). The nurses can show compassion and respect to the patient by avoiding any argument and direct conformations since she vulnerable in nature due to the mental illness (Carrión et al., 2015). The patient is made to feel they are capable of achieving the change and therefore avoiding any confrontation will provide her a sense of comfort, which in turn enhance her healing process.

Features of a major depressive episode with psychotic features

Appetite loss and weight changes are common but variable diagnosis marker in major depressive disorder. In many cases, some depressed patients manifested with the increases of the appetite while other exhibit loss of appetite (Carrión et al., 2015). According to Ngandu et al. (2015), many of the brain regions are implicated in the appetite response to the food during the episode of depression. In this case study, Mrs. B was suffering from a reoccurrence of the major depressive disorder with psychotic features with false beliefs and delusions which resulted in the loss of appetite due to discontinuing the antidepressant and antipsychotic medications (Carrión et al., 2015). In such cases, the effective nursing intervention will be persuasion for consuming meals in order to prevent physical weakness and supervision of her consumption adequate diet. It also involves adequate fluid intake if the patient refuses to eat adequate food containing proteins, zinc, selenium, calcium, chromium and other trace elements can prevent against depression and improve depression symptoms (Bashshur et al., 2016). Adding vitamins, Omega 3 supplements in form of tablets in diet as these are effective mood elevator and reducing malnutrition .Other nursing interventions can be engaging her in leisure activities such as walking, gardening, listening to music, and reflective listen, engagement in social activities, exercises, and motivational session (Gartlehner et al., 2015). These sessions will boost the self-esteem of the patient, provide her with a sense of worthiness and increase her food intake. Moreover, electro exclusive therapy is proved to be effective and safe to cure depression and loss of appetite (Gartlehner et al., 2015).

Depression is a common but destructive disease that destabilizes the mental and physical well being of the patient (Greenberg et al., 2015). As observed in this case study, Mrs. B was experiencing the reoccurrence of major depressive disorder with the psychotic features and behavioral disturbance. She was exhibiting the disturbed sleeping pattern which is another symptoms of major depressive disorder. In such cases, in order to assist her to sleep, increase of sleeping hygiene with a combination of the psychotherapy along and antidepressant prove to be effective in managing the sleeping patient. According to Gartlehner et al. (2015)., electro exclusive therapy is proved effective and safe therapy if the patient has dementia and coexistence depression (Paul & Paul, 2017). However, the mental health worker must monitor the effectiveness of the therapy. Cognitive behavioral therapy is also effective for eliminating the negative thoughts of the patient and replace with the positive thoughts (Carrión et al., 2015). It will manage the behavioral issue of the patient and improve the sleeping pattern. Warm shower before sleeping , limited napping during the day is effective for good sleeping pattern. Other novel treatment of choice can be exercise, yoga, meditation, relaxations techniques, music, and light therapy during sleep is effective for reducing depression (Gartlehner et al., 2015).

References

Australian commission on safety and quality of the health care,  (2018). REDUCING INAPPROPRIATE USE OF ANTIPSYCHOTICS in people with behavioural and psychological symptoms of dementia (BPSD). Retrieved from :www.safetyandquality.gov.au and cognitivecare.gov.au

Bashshur, R. L., Shannon, G. W., Bashshur, N., & Yellowlees, P. M. (2016). The empirical evidence for telemedicine interventions in mental disorders. Telemedicine and e-Health, 22(2), 87-113.

Carrión, S., Cabré, M., Monteis, R., Roca, M., Palomera, E., Serra-Prat, M., … & Clavé, P. (2015). Oropharyngeal dysphagia is a prevalent risk factor for malnutrition in a cohort of older patients admitted with an acute disease to a general hospital. Clinical nutrition, 34(3), 436-442.

Gartlehner, G., Gaynes, B. N., Amick, H. R., Asher, G., Morgan, L. C., Coker-Schwimmer, E., … & Bann, C. (2015). Nonpharmacological versus pharmacological treatments for adult patients with major depressive disorder.

Greenberg, P. E., Fournier, A. A., Sisitsky, T., Pike, C. T., & Kessler, R. C. (2015). The economic burden of adults with major depressive disorder in the United States (2005 and 2010). The Journal of clinical psychiatry, 76(2), 155-162.

inpatient interview. (2018). Retrieved from https://download.www21.filehosting.org/4cf415270d653d49dd45a2b84bdf3924/mrs%20b%20video.mp4 

Kaiser, R. H., Andrews-Hanna, J. R., Wager, T. D., & Pizzagalli, D. A. (2015). Large-scale network dysfunction in major depressive disorder: a meta-analysis of resting-state functional connectivity. JAMA psychiatry, 72(6), 603-611.

Ngandu, T., Lehtisalo, J., Solomon, A., Levälahti, E., Ahtiluoto, S., Antikainen, R., … & Lindström, J. (2015). A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. The Lancet, 385(9984), 2255-2263.

Paul, S., & Paul, D. (2017). Cognitive-behavioral therapy. In Social Work Theory and Methods (pp. 78-93). Routledge.

Siu, A. L., Bibbins-Domingo, K., Grossman, D. C., Baumann, L. C., Davidson, K. W., Ebell, M., … & Krist, A. H. (2016). Screening for depression in adults: US Preventive Services Task Force recommendation statement. Jama, 315(4), 380-387.

Wagner, G. S., McClintock, S. M., Rosenquist, P. B., & McCall,W. V. (2013).  Major Depressive Disorder with Psychotic Features May Lead to MisDiagnosis of Dementia: A Case Report and Review of the Literature. Journal of Psychiatric Practice, 17(6), 432–438. doi:10.1097/01.pra.0000407968.57475.ab.