A Psychopathological Analysis Of Patients With Depression - Essay Example

A Psychopathological Analysis Of Patients With Depression With regards to the first case study concerning Isabella Morales, it is concluded from the available evidence and testimony that she suffers from clinical depression. She matches the symptoms and timeframes required. Her specific issues are put into appropriate context within the expected challenges of the disorder, and recommendations for greater activity are given as a treatment regimen. In the first case study, involving 15-year-old Isabella Morales, there is little doubt that she suffers from clinical depression. The particulars of her circumstances and symptoms are highly indicative of this diagnosis. Depression itself can manifest in a variety of pathologies that inform attempts to define the condition. It can refer to a dysphoric mood, a true clinical disorder, in addition to a spectrum of other symptoms. Individually, the manifestations of depression can readily appear in a variety of medical contexts, and an individual case of sleep irregularity, fatigue, or loss of appetite may not in and of itself warrant psychiatric intervention. Cardiac diseases, such as congestive heart failure could produce certain depressive symptoms. (Brosse, 2002) Brosse, in addition to the DSM-IV describe a series of five symptoms that must be present for at least 2 weeks, and each must coexist within the same 2 week period. Furthermore, clinical distress must exist that impairs social behavior, occupation (or education in the case of Isabella). The symptoms should not be directly attributable to a specific habit of substance abuse or prescription drug medication. There must not be an identifiable medical condition that replicates enough of these symptoms so that five cannot be attributed to the patient's psychological state alone. While the symptoms must coincide for at least 2 weeks, the total duration of the crisis must persist for longer than 2 months. The specific symptoms are as follows: 1.) Depressed Mood, emptiness and inability to feel pleasure. Children and adolescents can experience irritability. 2.) Decrease in interest or pleasure in most activities, including actions and hobbies the patient used to enjoy. This lack of interest persists for the majority of the patient's observed time. 3.) Observation of weight loss, persisting over time with no apparent change in diet or exercise. 4.) Observation of Weight gain, without apparent behavioral changes, of at least 5% in one month. (Brosse, 2002) 5.) Sleep disturbances daily, or nearly every day. The disturbances can include either insomnia or hypersomnia. 6.) Daily fatigue or enervation. 7.) Observable retardation, or excessive psychomotor activity that is noticeable to others. 8.) Inappropriate guilt, or feelings of worthlessness persisting daily, as described by patient, or noticed by others. 9.) Decreased concentration or indecisiveness persisting daily. 10.) Suicidal impulses or unfocused suicidal ideation. May or may not be accompanied by a committed suicide plan. Based on the description, Isabella can easily be said to have at least five of the described symptoms. These criteria are essentially the same as the standards arrived at independently by various other psychiatric professional organizations. Specifically the International Classification of Diseases, (WHO, 1992) and Research Diagnostic Criteria. (Spitzer et al. 1978) AXIS-V Global Assessment of Functioning - GAF SCALE - In accordance with the Diagnostic and Statistical Manual of Mental Disorders, (APA, 2000) An assessment of the overall functionality of the patient, Isabella should range between 50 to 41 on the GAF scale. This is a judgment based on the degree of interference her symptoms exert in terms of her social and academic pursuits. The severity of her symptoms and subsequent decline of academic performance, do indicate a disturbed individual - but her rating should not be below 41 due to her as yet failure to actually attempt suicide with demonstrably lethal intent. She does demonstrate signs of aggression, "little things bother her". She also displays preoccupations with suicide, but does not at present follow through. Her rating should not be higher than 50, due to the fact that her dysfunction is apparent to anyone involved continuously in her life, in several venues. At home, she has sleeping irregularities, and at school her grades on the decline, with only variable/sporadic difficulties there should not be an intersect of symptoms across all social venues. Isabella also displays physical manifestations of inner turmoil, in the forms of headaches and loss of appetite. AXIS IV: In terms of real-world stressors not dependent on psychopathology, but contributing to it, Isabella has sexual abuse issues. A male tenant abused her when she was ten years of age. Furthermore, her parents are divorced and she has lived nearly half her life with an absent father. Confirming the existence of issues involving sex is the report of an acute onset of symptoms when Isabella engaged in sexual intercourse for the first time with her boyfriend. AXIS-III: With respect to contributing medical issues a symptom that should receive more attention would be her apparent weight loss. If in fact Isabella does eat steadily, and has not changed her eating or exercise habits then persistent weight loss could reflect an underlying medical concern that may both contribute to, or result from the actual depression. A consultation is advisable to rule out a purely phychological factor. AXIS-II: There appears little likelihood that a severe, underlying developmental/neurological disorder is present, not in an organic sense. Isabella did once display high functionality and a rich social life. In the absence of a diagnosed brain injury, the highest probability is that her decline is due to depression without neurocellular contribution. AXIS-I: Isabella is depressed. Her symptoms are consistent with a major depressive episode. She self-describes as feeling "hopeless", and her sleep difficulties would be consistent. Also suggestive of a depressive episode are feelings of being "worthless", in addition to petty frustrations. ALTERNATIVE POSSIBILITIES: Initially, upon appraisal of the symptoms, a diagnosis of Anhedonia was considered. The disorder does entail depressive symptoms, including poor concentration, and sleep disturbances. (Brennan, 2007) And the disorders are closely related to one another, but not truly identical. But in the case of Isabella, there are a few key differences that make Anhedonia less likely. Anhedonia can be described as a lack of variation in mood, but research indicates that it is more a matter of negative emotions counteracting pleasurable experiences. (Cohen et al. 2009) An inability to experience pleasure (Meehl, 1962) to react properly, or a 'flat' mood. This is not entirely descriptive of Isabella. In her case, a symptom noted by professionals and family members is a sense of irritability, aggression towards petty disappointments. Cohen (2009), and Meehl, (1962) also associated anhedonia with schizophrenia, which does not appear to be the case in this instance. Furthermore, her case expressly states that these symptoms had been extant for five months, then worsened after sex with her boyfriend. Anhedonia would lessen her sex drive in the first place. (Brennan, 2007) She does display many consistent symptoms, but her psychopathology is not entirely explained by anhedonia alone. A Depressive episode could account for her slackening performance and behavioral abnormalities. ETIOLOGY The root of Isabella's disorder is likely an outgrowth of the sexual abuse she suffered years earlier. A contributing factor is likely the loss of her father at a young age. The symptoms had been in evidence for five months prior, but sexual intercourse likely triggered a crises that worsened her condition to a full Depressive episode. RECOMMENDATIONS While pharmaceutical/psychiatric intervention is always a possibility, and may in fact be advisable, there can be other treatment options either in place of, or to supplement anti-depressants. Researchers have discovered that a regimen of physical exercise can prove useful as a novel approach for the treatment of depressive disorders, in cases without a bi-polar diagnosis. (Brosse, 2002), (Martinson, 1990) While drugs may seem an attractive option, this particular patient’s age creates more diverse treatment opportunities. Her youth would permit greater physical activity than would be advisable in older patients. Furthermore, there is some evidence that exercise may prove superior to a purely drug-dependent approach with respect to symptom relapse. Drug-treated patients exhibit a 30% chance of relapse for depression symptoms, which is 21% greater than the relapse rate for exercise-based treatment plans. This risk of relapse can be reduced in half if the exercise continues over a six-month period. (Babyak, et al. 2000) Some questions still exist concerning the exact quantification of the benefits derived, and more follow-up is needed on patient populations to determine the long-term improvements that may be derived from exercise in this regard. (Lawlor & Hopker, 2001) More studies with periods of post-experimental follow-up greater than six months should provide more refined analytical tools for the implementation of exercise in this way. In the case of Isabella, she once enjoyed a variety of activities and social pursuits; regardless of the raw statistics of the benefits of exercise, she should be encouraged to pick up her old activities. After-school extracurricular activities should be encouraged and physically strenuous actions might prove beneficial. But in any event, if she can be helped towards a renewed personal investment in the friends and activities she once enjoyed, it is reasonable to suppose that the engagement will improve her overall psychopathological condition. REFERENCES American Psychiatric Association. 2000. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) ISBN-10: 0890420254 | ISBN-13: 978-0890420256 | Edition: 4th Babyak, M., Blumenthal, J.A., Herman, S., et al. 2000. Exercise treatment for major depression: maintenance of therapeutic benefit at 10 months. Psychosom Med 2000; 62 (5): 633-8. Brosse, A.L., Sheets, E.S., Lett, H.S., Blumenthal, J.A. 2002. Exercise and the Treatment of Clinical Depression in Adults. Recent Findings and Future Directions. Sports Med 2002; 32 (12): 741-760. 0112-1642/02/0012-0741/$25.00/0. Brennan, C. 2007. netdoctor.com. Conditions and treatments. Anhedonia. http://www.netdoctor.co.uk/special_reports/depression/anhedonia.htm. Accessed: 3/26/2012. Cohen, S.A., St-Hillaire, A., Aakre, J.M., Docherty, N.M. 2009. Understanding Anhedonia in Schizophrenia through Lexical Analysis of Natural Speech. Cognition & Emotion Volume 23, Issue 3, 2009. pages 569-586. DOI:10.1080/02699930802044651. Lawlor, D.A., Hopker, S.W. 2001. The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomised controlled trials. BMJ 2001; 322 (7289): 763-7. Martinsen. E,W. 1990. Benefits of exercise for the treatment of depression. Sports Med 1990; 9: 380-9. Meehl, P. E. (1962). Schizotaxia, schizotypy, schizophrenia. American Psychologist, 17(12), 827 - 838 Psyweb.com 2012. Depression Resources and Information. DSM IV Criteria. Psychopathology 2002;35:72-75 (DOI: 10.1159/000065122) http://www.psyweb.com/DSM_IV/jsp/dsm_iv.jsp. Accessed: 3/26/2012. Spitzer, R.L., Endicott, J., Robins, E. 1978. Research diagnostic criteria: rationale and reliability. Arch Gen Psychiatry 1978; 35 (6): 773-82. World Health Organization. 1992. ICD-10 classification of mental and behavioural disorders: clinical description and diagnostic guidelines. Geneva: World Health Organization. Read More