Major Depression with Psychotic Features - Research Paper Example

Running Head: MAJOR DEPRESSION WITH PSYCHOTIC FEATURES Major Depression with Psychotic Features BY YOU YOUR SCHOOL INFO HERE HERE Major depression with psychotic features is characterized by symptoms including persistent low mood, lack of self-esteem and anhedonia. Concurrently, an individual suffering from this mental disorder maintains symptoms of psychotic behavior inclusive of, but not limited to, hallucinations and deluded cognitive distortions. Common treatment options for this disease include electroconvulsive therapy, a blend of antipsychotic and antidepressant drugs, or cognitive behavioral therapy. Based on research findings, a blend of Olazapine and Fluoxetine are the most viable treatment options as CBT is too simplistic of a treatment plan for this complex disease and electroconvulsive therapy maintains potential long-term health problems for those who have been exposed to this treatment ideology. Introduction Major depression with psychotic features, also characterized as depressive psychosis, is a severe mental disorder in which the afflicted experiences unrelenting low mood, diminished self-esteem and loss of satisfaction related to activities that were previously considered pleasurable (Gelder, 2005). Concurrently, the individual suffering from depressive psychosis loses touch with reality, sustaining such symptoms as hallucinations, delusions or even catatonia (Murray, Buttner & Price, 2012). Common symptoms associated with this illness include hearing voices that criticize the victim of the disease or even false beliefs about one’s body, such as maintaining a strong conviction that the individual has cancer. Major depression with psychotic features is very difficult to effectively treat as those afflicted by this disorder have a very large risk of relapse and can even lead to suicidal thoughts (Hales & Yudofsky, 2003). Potential Treatment Options Psychotic depression requires immediate treatment due to its complexities and severity of symptoms impacting the patient. The most common treatment methodology is the administration of atypical anti-psychotic drugs. Antipsychotics work by obstructing dopamine receptors in the brain. Dopamine influences motivation, cognition and sexual gratification in humans and where there is an imbalance, an excess of dopamine, it can lead to severe psychotic behaviors. Common antipsychotics that have been known to be effective in treatment include a blend of Olanzapine and Fluoxetine, two second-generation antipsychotic drugs that regulate serotonin production and decrease dopamine levels (Rothschild, Williamson, Tohen, Schatzberg, Andersen, van Campen, Sanger & Tollefson, 2004). Excess dopamine is often found in schizophrenic patients which is the rationale for why Olanzapine maintains the ability to regulate psychotic symptoms, whilst Fluoxetine regulates the hormone that is influential in regulating mood. The domain of psychology prefers the utilization of cognitive behavioral therapy (CBT) as a means of treating depressive psychosis. CBT is a psycho-therapeutic intervention which addresses maladjustment in emotional competence in an effort to change dysfunctional cognitive responses and thinking using systematic approaches to alter a variety of negative thought patterns. CBT consists of different face-to-face meetings with a counselor and the afflicted patient, usually 15 different total interventions, occurring once weekly. The counselor will often use a strategy known as cognitive rehearsal, whereby the patient is asked to recall a specific situation which caused frustration or stress. The patient and trained psychotherapist identify historical situations that have influenced mood disorders to identify potential, more effective solutions to alter negative thinking and replace these dysfunctional cognitions to more positive thought processes. The therapy also assists in identifying effective coping mechanisms that will work for the specific individual, which serves to reduce the prevalence of self-defeating thoughts that drive negative behavioral responses (Hoffman, Sawyer & Fang, 2010). Yet another potential treatment option is the use of electroconvulsive therapy. This treatment methodology consists of inducing seizures in the patient through the use of electric stimulation, a process also referred to as electroshock. This radical treatment is considered to be a last resort for treatment options after other, more traditional treatment options have been tested and found unsuccessful in aiding those suffering from depressive psychosis. It is believed, based on empirical data, that introducing electric current into the brain will essentially restart the central nervous system resulting in more balanced anatomical functioning (Shorter, 2007). Historically, this method of treating depressive psychosis has been criticized for causing brain damage to patients which explains the outcome of altered mood and perception. Today, in contemporary treatment practice, electroconvulsive therapy is usually administered to an anesthetized patient to spare them the emotional and physical disturbances of being exposed to electrical current whilst awake. In 2012, neuroscientists working with the National Institute of Mental Health found that major depression was rather instantly and effectively treated using the drug Ketamine, a drug that managed to relieve depression symptoms in only a matter of hours rather than in a period of months as with other treatment options (Zarate, Brutsche, Ibrahim, Franco-Chaves, Diazgranados, Cravchik, Selter, Marquardt, Liberty & Luckenbaugh, 2012). Ketamine, prior to being administered as an effective treatment option for major depression, was used as an anesthetic in humans and animals. Ketamine, in high doses, creates a trance-like condition in the patient and creates amnesia-like impact on memory and cognitive functioning. Preferred Treatment Methodology As indicated by the research, electroconvulsive therapy has been criticized for creating long-term brain damage. Even though this option is still being used to treat depressive psychosis, the rationale for changing mood and behaviors using electroshock methodology cannot be supported with reliable empirical data. Electroconvulsive therapy should absolutely be a last resort treatment method due to the prevalence of risks of using this treatment option. The Mayo Clinic (2014) indicates that patients exposed to ECT often experience persistent memory loss, a phenomenon known as retrograde amnesia. Individuals who have been administered electroshock often have difficulty remembering events that occurred weeks or even months after succumbing to ECT (Mayo Clinic). Additionally, ECT has common outcomes on human physical health such as persistent nausea, jaw pain, muscle spasms, vomiting and headaches (Mayo Clinic). These side effects of electroshock can be treated using a variety of medications. However, individuals that underwent ECT as a substitute for medicinal treatment methodologies may not desire to take further medications to effectively cure these difficult physical side effects. In some cases, patients undergoing ECT have experienced long-term heart problems. When considering the viability of cognitive behavioral therapy as a treatment option for depressive psychosis, this methodology should be ultimately rejected as a viable solution for the patient. It is well understood and supported by empirical data that major depression and psychosis are a product of disharmonious regulation of serotonin and dopamine in the brain which alter mood and behaviors. While cognitive behavioral therapy might be effective for those who suffer from minor depression and require a better self-regulating cognitive system, it would likely not be beneficial in changing imbalance of known hormones in the brain that are highly influential in the onset of major depression and psychosis. Critics of this approach state that CBT is much too simplistic to be of any legitimate value and that it is the rather unsophisticated elements of the approach that have made it a popular solution for today’s psychologists looking for a one-dimensional treatment ideology. Critics cite that there is no empirical evidence supporting its practical viability for treating those with schizophrenia or major depression which makes this treatment option questionable and rather unreliable (Psychologist World, 2014). Furthermore, cognitive behavioral therapy is a common treatment option for those suffering from Post-Traumatic Stress Disorder, which is a type of mental disturbance occurring as a product of witnessing shocking, hurtful or distressing events. CBT changes how one perceives the event and copes with it. Depressive psychosis, however, is so severe and not brought on by any specific event that it would be questionable as to whether cognitive rehearsals could be substantial enough to promote any legitimate recovery for the severely maladjusted individual sustaining depressive psychosis symptoms. Additionally, psychotic thoughts and behaviors are severe mental disturbances that significantly dissociates the afflicted from genuine reality. Cognitive behavioral therapy is rather rudimentary in its approaches to improve one’s self-esteem and motivate more effective coping responses in the face of stressful situations. Genuine psychosis is so radically disturbing in the severity of dissociation, such as the manifestation of catatonic behaviors, that CBT’s rather unsophisticated approach would simply not be substantial for altering profound agitated states which accompany psychotic symptoms. As a result, evidence would seem to support that the use of antipsychotics such as Olanzapine and Fluoxetine are most effective in treating depressive psychosis. Since it is well supported by empirical studies that the majority of problems related to this mental illness are caused by chemical dysregulation in the brain and body, antipsychotics and their ability to regulate serotonin production and dopamine dissemination would seem to be the most relevant and reliable strategies for treatment. There is little (if any) evidence that antipsychotics maintain the ability to impose long-term harm on the patient when utilized under controlled conditions. Weight gain and nausea are the most common side effects of this treatment option, which is far less significant than other options, such as ECT which can pose severe long-term health implications. Furthermore, considering that severe anhedonia is often a product of depressive psychosis, the aforementioned loss of interest in once-pleasurable activities, enjoyment of food as an outcome of the Olanzapine/Fluoxetine treatment would seem to indicate that this method of treatment overcomes anhedonic responses. Limitations of using only Olanzapine/Fluoxetine Treatment Though the antipsychotic and antidepressant combination of using Olanzapine and Fluoxetine as effective treatments seem the most relevant for treating depressive psychosis, there is a limitation of restricting treatment methodologies to only this method. First, science is not sophisticated enough to ensure that substantial hormone regulation in the brain is being achieved through the administration of these drugs. Behavior changes would have to be measured using observation or perhaps even qualitative consultation with the patient and it would be substantially difficult to use science to quantify success of this option. Measuring potential chemical changes in the brain would also be a costly and laborious effort which could impose risks on the patient or even cause more emotional disturbances as a result of being violated by rigorous scientific studies. Invasive measurement methodologies to ensure that chemical production is being altered through the combination of the two drugs might involve tissue extraction from the brain or other invasive techniques. A person facing the severe difficulties of depressive psychosis may not be equipped with the capacity to cope effectively with such an invasive scientific intrusion, hence defeating the purpose of this treatment option. Conclusion As supported by Rothschild, et al. (2004), the combination of Olanzapine and Fluoxetine drugs should be the most effective and relevant treatment methodology for major depression with psychotic symptoms. ECT is potentially hazardous to human health and CBT with its unsophisticated structure of treatment would likely not create the long-term success outcomes expected of administering treatment. Antipsychotic and antidepressant drugs, due to the tangible brain chemical problems in the patient, should have the most effective long-term outcomes. References Gelder, M. (2005). Psychiatry. New York: Oxford University Press. Hales, E. & Yudofsky, J.A. (2003). The American Psychiatric Press Textbook of Psychiatry. Washington D.C.: American Psychiatric Publishing Inc. Hoffman, S.G., Sawyer, A.T. & Fang, A. (2010). The Empirical Status of the New Wave of Cognitive Behavioral Therapy, Psychiatry Clinic North America, 33(3), pp.701-710. The Mayo Clinic. (2014). Electroconvulsive Therapy (ECT): Risks. Retrieved June 1, 2014 from http://www.mayoclinic.org/tests-procedures/electroconvulsive- therapy/basics/risks/prc-20014161 Murray, E.D., Buttner, N. & Price, B.H. (2012). Depression and Psychosis in Neurological Practice, in W.G. Bradley, R.B. Daroff, G.M. Fenichel & J. Jankovic (eds), Neurology in Clinical Practice (6th ed.). Butterworth Heinemann. Psychologist World. (2014). Cognitive Behavioral Therapy. Retrieved June 1, 2014 from http://www.psychologistworld.com/treatments/cognitive-behavioral-therapy.php#5 Rothschild, A.J., Williamson, D.J., Tohen, M.F., Schatzberg, A., Andersen, S.W., van Campen, L.E., Sanger, T.M. & Tollefson, G.D. (2004). A Double-Blind, Randomized Study of Olanzapine/Fluoxetine Combination for Major Depression with Psychotic Features, Journal of Clinical Psychopharmacology, 24(4), pp.365-372. Shorter, E. (2007). A History of Electroconvulsive Treatment in Mental Illness. New Brunswick: Rutgers University Press. Zarate, C., Brutsche, N., Ibrahim, L., Franco-Chaves, J., Diazgranados, N., Cravchik, A., Selter, J., Marquardt, C., Liberty, V. & Luckenbaugh, D. (2012). Replication of Ketamine’s Antidepressant Efficacy in Bipolar Depression: A Randomized Controlled Add-On Trial, Biological Psychiatry, 71(11), pp.939-946. Read More