Discuss about the Altered Mood.
The main aim of this presentation is to examine the problems faced by Mrs. Mary by diagnosing her problem, sound understanding of her mental health needs, understanding of her personal recovery, connecting her mental and physical health and its implications in our professional practice. In this case study, the first section of mental health and illness will comprise of the signs and symptoms and diagnosis of depressive disorder. Next section discusses about the personal recovery of the depressive patient and what it meant for Mrs. Mary. Then next part focuses on the nexus between the physical and mental health. The treatment section involves various management aspects as pharmacotherapy, cognitive therapy, etc. At last it discusses about the implication of this case study analysis on our professional practice.
Based on the evaluation of Mary’s case study, it is found that she has recurrent type of major depression. When it is compared with the clinical feature of common depressive patient, Mary is found to have same type of disorder. Mary’s clinical feature was compared with the DSM-IV Criteria – Major Depressive Disorder. A depressed person will always have depressed mood and loss of interest and will not meet daily needs at least for more than 2 weeks (Segal, 2013, p. 12). Similar to this, Mary is always depressed, sits alone and not performing activities of daily living for past one month. There will be impaired functioning in social, educational and occupational aspect. Mary has put sick leave and not going for work. According to DSM- IV criteria, 2010, a depressive patient will experience at least any five of the following specific symptoms almost every day.
The first criterion is that the patient may have mood depression or irritability almost throughout the day, nearly every day with sadness or emptiness and tearful (Lucas, 2010, p. 13). Mary also has depressed mood and always feels despair and is tearful almost throughout the day. The patient may not have interest or pleasure in most of the activities for almost each day. Mary is not eating and dressing by herself. For past one month, she is not bathing and taking care of her personal hygiene measures. There will be change in the weight to 5% or changes in appetite (Segal, 2013, p. 12). Mary is not eating for many days. There may be decreased or increased sleep (Schatzberg, 2015, chapter, 2). Mary has insomnia and awakes in early morning.
The criteria suggest that there will be changes in activity level with psychomotor retardation/ agitation. Mary is not performing her activities of daily living. These persons will experience fatigue and loss of energy. Mary says that she has little or sometimes no energy to get out from the bed. They will feel worthlessness or guilt which is similar to her expression that she cannot manage the next day (Segal, 2013, p. 12). They will have decreased concentration and thinking. Mary sits desperately. Depressive persons will have suicidal thought which is not present in Mary. She meets all the DSM-IV criteria except last criteria which suggest that Mary has major depression. She had depression few years ago and now she has similar symptoms which suggest that she has recurrent major type of depression.
There are various treatment modalities for depression based on their severity. The best treatment option for depression is antidepressant especially selective serotonin reuptake inhibitor (SSRIs) (e.g. citalopram) but causes many side effects as increased suicidal thought, nausea, vomiting, headache, dizziness, increased sweating, etc (Miller, 2014, p. 899- 909). Symptomatic treatment should be given to control these side effects. Sexual dysfunction may occur, for which counseling should be given for both Mary and her husband (Schatzberg, 2015, chapter, 2). If depression is not treated, it will recur within one year whereas if treated only 10% to 30% will recur (Dunner, 2007, p. 214- 223). The maintenance therapy of citalopram for depression on a long term basis showed decreased depressive symptoms (Dunner, 2007, p. 214- 223). Mary has responded to citalopram but she has discontinued it.
In case of severe depression with suicidal risk, electroconvulsive therapy is recommended (Mankad, 2010, p.9- 26). This is not needed for Mary as she dose’nt have suicidal tendencies. ECT should be used as maintenance therapy only for patients with decreased response to drugs and psychotherapy (Dunner, 2007, p. 214- 223). The study of Broek was peer reviewed by Keller in 2007, which suggests that ECT is not needed to be used as a maintenance therapy after remission (Keller, 2007, p. 214- 223).
Various psychotherapies are used for depressive patients as cognitive behavior, inter-personal and cognitive- mindfulness based therapy (beyoundblue, n.d., 27). Cognitive therapy should be given to Mary, which helps to replace the negative thoughts with modified cognitive response (Segal, 2013, p. 12). Behavior therapy as social skill and assertiveness training should be given. Supportive therapy as reassuring, motivating to ventilate their emotions, relaxation therapies, etc should be given. Group therapies that help to mingle with others should be given. But it is very difficult to engage depressive patients in group therapies (Fehr, 2016, p. 12). To overcome this, inter personal relationship should be maintained between the group members. Family therapy is needed for persons with inter personal difficulties. Mary should receive all these therapies to overcome her depressive symptoms. The combination of drugs and psychotherapy showed greater improvements in psychosocial functioning than with separate therapies (Dunner, 2007, p. 214- 223).
It is said that, ‘the sound mind in the sound body’. Both physical and mental health is like two sides of a coin. They are highly interdependent with each others as well as inter related. If the physical health alters, it affects the mental health and if mental health alters, then it acts vice versa (Thibodea, 2013, p. 947- 948). Mary’s case shows that there is evidence of nexus between physical and mental health. Mary has moments of despair and is tearful. This shows that her mental health has affected her thought and made her to cry. She always feels that she has no or less energy to work and get out of her bed. This indicates that Mary’s depression has affected her thinking adversely. Kolappa (2013) found that persons having mental illness may develop physical illness and vice versa. Depression is not just having low mood but it a very serious condition as it impacts on physical and mental health (beyondblue, n.d., p. 9)
Collingwood in 2016 has found that persons having depression often manifests with some physical disorder and vice versa and other physical health conditions affect the well-being of the individuals. She does not eat properly due to lack of motivation which suggests that depression has affected her personal hygienic activities. She is not dressing herself due to the impact of depression on her activities of daily living. Mary’s family identified her recurrence of depression only by the changes in her physical activity and mood. She is also not willing to work which suggests that mental health even affects her social health and communication skills. She feels worthless and hopeless with insomnia which suggests that her mental health has affected her physical health. Ultimately physical and mental health affects the quality of life adversely (Ekkekakis, 2013, p. 230). Even mental health is influenced by individual behaviors, environmental and social factors (WHO, 2012, p. 4-5)
Based on the patient’s evaluation, it was identified that Mary requires an antidepressant therapy especially SSRIs. There are certain side effects which have to be monitored carefully which is main need for Mary (Miller, 2014, p. 899- 909). The side effects should be controlled by cognitive- behavior therapy and individual and family counseling to avoid discontinuation of medication. Even low dose of buprenorphine could be given to reduce depressive symptoms and suicidal ideation (Panksepp, 2014, p. 383–393). In the past, Mary had depression for 5 weeks and was on citalopram but she discontinued as she felt that she doesn’t require this medication which has recurred symptoms. For the patients, who encounter remission with no symptoms or with one or two symptoms, maintenance therapy has to be given to reduce the chance of getting relapse (Dunner, Keller & Thase, 2007, p. 214- 223). Patients with residual symptoms of depression are found to have more severe depressive illness with increased symptoms of relapse, suicidal attempt and decreased social involvement as compared to asymptomatic patients (Dunner, Keller & Thase, 2007, p. 214- 223). Similarly Mary has relapse of her symptoms and so citalopram has to be continued as maintenance therapy.
Psychotherapies as cognitive-behavioral, family and group therapy should be given. The next most important need is to control her feelings on herself. Cognitive therapy should be given to modify her behavioral features and to make her feel worth. Sexual counseling should be given to the patient and her husband. Current researches suggest that safe administration of opioids could be used for depressive patient (Elman, 2013, p. 1-27). Family therapy should be given by involving her husband, children, parents, friends and other relatives and help her to chat with them which motivates her to manage herself care needs by herself. Supportive therapy, group therapy should be given.
Studying psychological health of a person is much needed for health care professionals as physical health is directly affected by their mental health. Nearly 1 in every 5 women has depression at some point of life (Australian Bureau of Statistics, 2008). So this case study will definitely help in caring a woman with depression. Mary has typical depressive symptoms and gives a clear picture of depression to medical persons. This helps to know the criteria for depression that helps to diagnose the case of depression (DSM criteria IV, 2010). It gives way to medical persons to distinguish the clinical features to provide prompt treatment. It also helps to provide care with tool kits provided by the Government of South Australia in 2015.
This case study helps the professional person to understand the impact of medication on depressive patients and adverse effects caused by SSRIs. This suggests methods to overcome these side effects by giving psychotherapies. e- therapy is newer form of treatment (Beyoundblue, n.d., p. 30). The case of Mary guides us to involve family members in the therapy. Australian Bureau of Statistics (2008) states that both anxiety disorder and depression are most common psychiatric disorder in Australia and at least one million people experience depression every year. Therefore learning depression will help the health care professionals to give required care to such patient.
The relationship between physical and mental health with evidence will motivate the health care persons to have a great concern towards both physical and mental health. This case study helps us to identify the needs of the depressive patients and about various therapies as pharmacological, cognitive behavior therapy and inter personal therapy (Beyoundblue, n.d., p. 12). This helps to understand that if untreated, depression will cause negative effects that affect their job as like Mary (Beyoundblue, n.d., p. 16). The evidence from the studies will help to practice accordingly. This will also motivate the medical persons to conduct further research in depressive patients. Thus this case study will promote knowledge, attitude and skill in the care of mentally ill patients.
Conclusion
This case study was to evaluate Mary with major type of depression. This covers the mental health problem, DSM criteria for diagnosing depression, nexus between physical and mental health, and personal recovery of Mary and treatment modalities. This discusses about various treatment options as pharmacotherapy, cognitive therapy, behavioral therapy, group therapy, ECT, family therapy, counseling, etc. This gives the need for these therapies for a depressive patient. This clearly discusses about the SSRI drugs with great advantage for depressive patients. Yet there are certain side effects of using the drugs and this case study discusses this and methods to overcome this. The implications for its use in professional practice were discussed. This case study serves as a better mode to understand various aspects of depressive patients.
Reference
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DSM- IV, 2010, ‘Diagnostic Criteria for Major Depressive Disorder and Depressive Episodes’ , from American psychiatry association
Dunner, Keller & Thase, 2007, ‘Preventing Recurrent Depression: Long-Term Treatment for Major Depressive Disorder’, Prim Care Companion J Clin Psychiatry, 9(3): 214–223. doi. PMCID: PMC1911177
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