Depression and Its Treatment - Case Study Example

Diagnostic Case Reports Major Depression Background Major depression is a mental disorder in which feelings of melancholy, loss, exasperation or frustration disrupt an individual’s daily life for weeks or longer (Pollit, 2013). Signs of major depression consist of diminished thinking memory and decision-making; clients have a negative mood and lack motivation, apathy and social withdrawal. An individual with the disorder also feel physically unwell and run down hence may suffer pains. These symptoms persist for weeks or months with 18 to 24 year olds being the most vulnerable. The client is named Tara, a white woman whose depression began during her childhood. She works as a professional drug abuse counselor in spite of her emotional status. She descended into dark depression during high school when her boyfriend died; something made her attempt suicide several times. Poor family relationships and social relationships with her teachers may have also disposed her into this disorder. Observations Tara’s memory is diminished, as she does not remember when she started experiencing depression. She spent most of the time in isolation- alone in her room since she had very few friends. The negative mood is evident when she says that she hated the world after her boyfriend’s death, and this affected her ability to make decisions because she wanted to die in order to be with him. Apart from attempting suicide, she also shows symptoms of apathy because she is not interested in getting into a relationship nor is she interested in any extracurricular activities. However, apathy is not consistent since she has not lost interest in working as a drug abuse counselor. Diagnosis According to DSM IV, Tara is suffering from major depression because she has a negative mood that made her attempt suicide. She has symptoms of apathy and diminished memory as well as low self-esteem. No evidence was observed on general medical conditions that may lead to the advancement of the disorder. The loss of her loved one is a psychosocial problem whereas suffering child abuse was an environmental problem that might contribute to the disorder. On suicidality or homicidality, she is still vulnerable since she has low self-esteem about what her family feels about her. Therapeutic Intervention The appropriate short-term objectives for this intercession are to relieve signs of a major depressive episode (Nathan & Gorman, 2015). Secondly, the interventions should be aimed at recognizing and reforming the ability of the patient to function in the society. The long-term goal should be reducing the risk of recurrence of symptoms hence improve the clients’ safety. It should also aim at changing how the clients perceive themselves and consequently their behavior. Psychotherapy is the best strategy since its major aim is to change self-perception and behavior of clients through reforming their self-esteem. Cognitive behavioral therapy is the most appropriate therapeutic modality since it enables patients to add, remove or change the way they think or behave in order to regulate a particular effect (Melnyk & Fineout-Overholt, 2011). Bipolar Disorder Background Bipolar disorder on the other hand is a mental condition that causes uncommon transpositions in one’s mood, energy, levels of activity and their ability to carry out every day jobs (Teixeira, et al., 2014). Drastic changes in one’s usual mood and behavior is represented by the mood episode, which is either manic or depressive. The symptoms for this disorder include the following: longer periods of feeling overly happy, extreme irritability and having little sleep. Such individuals talk very fast, have racing thoughts and usually jump from one topic or idea to another. They are easily distracted, have unrealistic belief in their abilities and behave impulsively as well as engaging themselves in high risky pleasurable behaviors. They are extremely restless, irritable have problems with concentration, recollecting and decision making. The clients also experience overly long periods of sadness and hopelessness, loss of interest in activities once enjoyed and as a result, they think of death or committing suicide. The client is known as Bernie, a 38-year-old black American man who grew up in a middle-class neighborhood in central New Jersey. Bernie started showing signs of bipolar disorder when he was about 17 years old. Bernie is unemployed and had no health insurance, which makes it difficult for him to afford the medications. Unemployment is one of the predisposing factors for this disorder since Bernie cannot afford the medication, which makes him suffer acute mood changes. Genetics, breaking up with his girlfriend that made him enter a deep and protracted depression are also predisposing factors. Observations Bernie has experienced alternating depression and manic episodes in his life, with the major manic episode coming after he suffered depression when he broke up with his girlfriend. The energy escalated to uncontrollable levels, he had racing thoughts and could hardly sleep. He has also had cognitive problems as evidenced by his illogical actions like painting his mother’s house without consulting her. During emotional extremes, Bernie spends days or even weeks alone in his apartment drinking alcohol. However, isolation is not consistent since he attends a group and interacts with some two or three dear friends outside the group especially when he has no medication. The disorder is genetic, but can also develop due to struggles with difficult events in life like separations. Diagnosis Almost all clients diagnosed with bipolar disorder had issues to do with the structure and functioning of the brain (McWilliams , 2011).The client’s family has a history of mental disorders, which is the only observable medical disorder that contributed to the development of this disorder. In addition, the psychosocial and environmental issues that might lead to the disorder include breaking up with his girlfriend as well as having bad relationships at his workplace. Bernie has excessive energy, which he sometimes misuses and finds himself in trouble with the law. He can hurt his colleagues and as he puts it during the interview, he almost used his weapon because he hated himself. According to DSM IV diagnostic features, Bernie is suffering from Bipolar I Disorder because he has experienced several manic episodes, each lasting for at least a week. Therapeutic interventions The short-term objective of this intervention is to ensure that Bernie’s moods are stabilized, hence relieve symptoms and reform his ability to work normally. The appropriate long-term goal of this intervention is to enable him lead a normal, productive life within the society. The therapeutic strategy that seems most appropriate is medication since this disorder is mostly neurological and has no permanent cure. Mood stabilizers such as Lithium are highly recommended since they effectively reduce manic episodes. Persistent Depressive Disorder (Dysthymia) Background Persistent depressive disorder is a form of long-standing depression whose symptoms are less severe but persistent compared to other forms of depression (Horwitz & Wakefield, 2007). This condition is characterized by a depressive mood that takes place for the larger part of the day, which may persist for at least one year for children, adolescents, and two years for adults. Individuals with this disorder are also characterized by disturbances in appetite and sleep, low energy, poor concentration, low self-esteem and difficulties in making decisions. The client’s name is Robert, an American man, aged 39 who lives alone in a tiny apartment. He has struggled with the condition for more than 20 years and he works in a sheltered workshop specifically designed for persons with disabilities. He suffered childhood abuse, which is a predisposing factor for the disease. The stress endured during separation of his parents as well as the life of isolation he lives and smoking predisposes him to his disorder. Working with people with disabilities may also dispose him to the behavioral process known as learnt helplessness. Observations Robert is a very sad man and he says that he lives a sad life in general. He does not go to work on time, has problems with sleep, isolates and spends time fantasizing. Robert feels sorry for his life and he would not want another person to live that life, which is a sign of low self-esteem. He has difficulties in making decisions and that is why he doubts whether he can really do charity. However, isolation and lack of motivation does not seem consistent with Robert since he sometimes visits a friend and goes to work some other time. The disorder may develop as a result of having another medical condition like spinal meningitis and cancer. People struggling with difficult life events such as abuse and separations also do develop this disorder. Diagnosis According to the DSM IV diagnostic features, Robert has persistent depressive disorder since he has had longer periods of depression. There is evidence that spinal meningitis and parental separation may have contributed to Robert’s disorder. He was bullied hence suffered childhood abuse, which is a psychosocial problem that might contribute to this disorder. Robert has low self-esteem and this may make him vulnerable to thoughts about death and committing suicide. Therapeutic Intervention The short-term objectives for this intercession is to reduce the signs and enable the client enjoy a better quality life. The long-term goal is minimizing the effect of these symptoms on both the individual and the society; and psychotherapy seems the best strategy since drugs have no side effects. Cognitive behavior therapy is the best modality, as it will challenge the client’s unrealistic ideas and pessimistic expectations. In addition, this modality will assist clients cope with difficult situations and communicate better with their colleagues and family, thus reducing their social isolation. References Horwitz, A. V., & Wakefield, J. C. (2007). The loss of sadness: How psychiatry transformed normal sorrow into depressive disorder. Oxford: Oxford University Press. McWilliams, N. (2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process. New York City: Guilford Press. Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Lippincott Williams & Wilkins. Nathan, P. E., & Gorman, J. M. (2015). A guide to treatments that work. Oxford: Oxford University Press. Pollit, J. (2013). Depression and its Treatment. Oxford: Butterworth-Heinemann. Teixeira, S., Machado , S., Velasques, B., Sanfim, A., Minc, D., Perressutti, C., et al. (2014). Integrative parietal cortex processes: Neurological and psychiatric aspects. Journal of the neurological sciences, 338(1), 12-22. Read More