PART ONE Case History Synopsis: A 45 years old patient named Mr. A was referred to psychiatry ward for the first time by his coworkers with the observation of withdrawal from society, loss of appetite and weakness. However the patient himself complains of headache only from more than two years…
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Onset of Illness: Mr. A was referred to psychiatry ward for first time by his coworkers. According to his coworkers he had been seen sitting alone most of time and even when with people around he doesn’t communicate with them and put minimum input in any conversations. His appetite has dropped down drastically in last few months. He himself reported to have normal appetite and sleeping pattern but his nephew and coworkers says his sleep has reduced and sometimes he sleeps too much. His nephew reports that he had been like this from last 3-4 years. And has constant complain of lack of sleep, appetite and has no desire to meet people. His main psychosocial stressors is not having child of his own. The emptiness of not having his own children and not being able to reproduce children has given him an underlying depression and constant feeling of being imperfect due to which his symptoms have become obvious from last few years. From the replies of his RISP test; it shows that his incapability of reproduce children has affected his self-worth and makes him feel his not complete thus he feels uncomfortable to meet people. Symptoms: He complains of Headache and emptiness of thoughts in head from more than 2 years. His other main symptoms are; lack of appetite, Anhedonia, vertigo, aggression, disturbed sleeping pattern (hypersomnia or insomnia), hopelessness, and withdrawal from society and is less talkative. From his symptoms he is diagnosed with Dysthymic disorder as his symptoms are constant from 2 years which makes him fall in criteria of Dysthymia. Other possible revised diagnosis can be Double Depression; Dysthymia with current Major Depressive episode. Multiaxial Evaluation: Axis I 300.4 Dysthymic Disorder Axis II No diagnosis Axis III Sexual Dysfunction /diseases of the genitourinary system Axis IV Problems with primary support group (health issues) Axis V GAF “60” PART TWO Therapeutic Recommendations: There are several types of medications (antidepressants) used to treat depression. Two main popular medications used to treat depression are Selective serotonin reuptake inhibitors (SSRIs) and Serotonin and norepinephrine reuptake inhibitors (SNRIs). SSRIs work by altering the amount of a chemical in the brain called serotonin whereas with SNRIs depression is treated by increasing the availability of the brain chemicals serotonin and norepinephrine. In depression when serotonin level is decreased SSRI medication is given to operate on serotonin; it inhibits (slow or stop) the process of “re-uptake” thus serotonin neurotransmitter is passed normally. So while choosing between SSRI or SNRI, Serotonin is considered as “mood" neurotransmitter and Norepinephrine is believed to be involved with "energy and alertness." Because SNRI's act on norepinephrine, in addition to serotonin, it is considered to be more effective in treating depression. (ehow, 2012) A research on depression suggests that the neurobiology of pain relief is complex in depression; research suggested that serotonergic and noradrenergic projection from brainstem are through spinal pathway; therefore depression may leads to increased perceptions of these symptoms. It is suggested depression and pain are mediated through a common pathway and hence the balance of 5-HT and NE influences the perception and control of painful symptoms. In therapeutic psychological treatment of dysthymia different psychotherapy can be
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