Mental Health Problem: Depression - Case Study Example

Mental Health Problem: Depression Nature and Scope of Depression Depression is deemed as the most common diagnosable mental illness. In Australia, it is estimated that one in five persons will experience a major mental illness such as depression at some phase in their lives (Elson 2001). The symptoms of this mental health include depressed mood, loss of interest or pleasure, significant weight loss or change in appetite, insomnia or hypersomnia, psychomotor agitation or retardation, feeling of worthlessness or inappropriate guilt and recurrent thoughts of death or suicide ideation. Note that to be considered as having a major depressive episode, the presence of five or more of these symptoms for two weeks should be observed (Stanard 2000). According to a study conducted by the World Health Organization (WHO), the core symptoms found universally in 76% to 100% of patients observed included sadness, anxiety, anergia, anhedonia, impaired concentration and feelings of worthlessness. The study asserts that the above symptoms could be found in majority of patients across cultures (Andary, Stock & Klemidis 2003). In terms of causes and risk factors, the persistence and escalation of experiencing stressful events significantly increase the risk of developing depression (Stanard 2000). On the other hand, some studies explore the hereditary nature of depression. Findings show that those with depressed parents are at a higher risk of psychopathology (Herring 2002). There are also some who believe in the fertile ground theory that the interplay of hereditary and environmental factors causes depression (Ainsworth 2002). Case Overview The client, Mr Jacob Summer, is a 24-year old college student. His medical records show that he has been diagnosed with fibromyalgia three years ago. This is accompanied by episodes of depression. According to client’s parent, he has been the acute muscle pain shortly after his older sister died due to sleeping pills overdose. This is coupled with the client’s frequent depressed mood. Last 20 March 2006, the client was admitted to the medical ward after complaining of severe muscle pains that is debilitating. The physician recommends that client should be confined for about a week for observation and further treatment. Based on studies, patients who suffer from fibromyalgia often experience depression. Until now, little is know whether depression is the cause or effect of fibromyalgia (Beck, et al 2002). This paper intends to provide a mental state assessment focusing on the client’s depression. Moreover, this paper discusses a short-term clinical management program that the registered general may adhere to for treating the client’s depression. Mental State Assessment Mr Summer looks drowsy this past three days and has dark circles around the eyes. He complains that he has only been sleeping lightly and frequently wakes up at night. He said this is because of disturbing dreams he has about his sister, who passed away four years age due drug overdose. He also said that he has nightmares about the devil. The client looked unkempt and has a slumping posture. He can barely keep eye contact and often looks at the ceiling or wall. He speaks slowly, in a slurred manner and sometimes inaudibly. He is restless as he keeps tossing and turning in bed. When asked about why he is restless, he answered that the sharp pain in his joints has been bothering him severely when he stops moving. Mr Summer is always disoriented and often forgets the names of attending physician, nurses as well as the time and date. He has refused to eat because he has no appetite and drove the wardsmen away when it is time for him to shower. He also sometimes refuses to take prescribed medicine for pain and anti-depressants. He does not want to watch television and objects to getting out of the hospital room. The client always requests to turn off the light or shut the blinds during daytime. During interviews, Mr Summer has a hard time focusing on one subject or question and shifts from one topic to another. When asked about how he is feeling about himself, he answers, “I am in no mood to talk today, I am feeling down.” or that he is feeling “empty” and “worthless.” Asking further queries as to why he is in a down mood, he usually replies, “ I don’t know, I just feel down.” He would eventually touch on how he misses his sister and that he should have been the one who died instead of his sister because everyone would be happier that way and his family would not suffer as much, although he denies suicide ideation. However, he would quickly shift to another topic. He usually evades inquiries about his sister and often answers irritably that he is very tired and not in the mood to talk. The client finds it difficult to open up when the topic is about the death of his sister. One time, upon attempting to discuss his feelings, he snapped that I should not be bringing up this issue because he knows that I am only paid to do this so I should stop acting concerned. After having said this, Mr Summer immediately apologised but turned his back on me and said that it would be better if he would be left alone. Short-term Nursing Management Plan Given the above mental state assessment, it is evident that successful treatment that is in congruence with fibromyalgia treatment is critical for the improvement of the patient’s condition. This may be addressed by undertaking pharmacotherapy or psychotherapy interventions consisting of cognitive techniques that facilitate constructive thinking, enhancement of coping skills, self-monitoring and goal-setting (Stanard 2000). In this regard, I opted to recommend the combined treatment of psychotherapy or psychiatric therapy and drug therapy. According to study conducted by Sutherland, Sutherland and Hoehns (2003), this treatment strategy has shown better response in several tests conducted that either therapy undertaken alone. With this, the clinical management program for the client would focus on this two-method approach. For the psychotherapy, the nurse would undertake the quality improvement therapy. This entails encouraging the client to seek cognitive behavioural therapy for his depression (Sherbourne, et al 2001). In particular, given the nature of client’s depression, family treatment is recommended to facilitate conflict resolution within the family and improvement in communication among family members (Stanard 2000). The nurse may also refer the client to a mental health team, which provides specialised support as to how his depression may be improved (Arthur 2002). Prior to discharge, the nurse would also have the client and his parents to watch a video that may aid them in knowing more about his mental condition. Moreover, leaflets would be distributed to the client and his family for reference (Katon, et al 2001). Discussing the client’s condition would form part of psychotherapy. The parents would have to be briefed about the persistence of the client’s depression. They would have to be aware that openly communicating with their son is critical since the client needs better support system to handle his condition. Based on studies, simple education strategies to improve recognition and management of depression as proposed above have minimal impact on clinical practice and outcome of depression when given alone (“Improving the recognition and management of depression” 2002). As such, this would be used in collaboration with drug therapy. For the pharmacotherapy, anti-depressants prescribed by doctor classified as selective serotonin reuptake inhibitors (SSRIs) that have simpler dose schedules (Sutherland, Sutherland & Hoehns 2003). The nurse would ensure that anti-depressant is administered promptly and note changes in client’s condition resulting from drug therapy. Before discharge of client, the nurse would also check on pharmacy records to help ensure that client would adhere to the prescribed medication (Katon, et al 2001). Aside from these, the nurse may also encourage the client to perform some simple exercises since physical activity is said to play an important role in treating depression (Sutherland, Sutherland & Hoehns 2003) and even fibromyalgia (Macfarlane 2002). In randomised controlled trial, findings showed that aerobic exercise program is observed to be effective in treating depression. Systematic review and meta-analysis claim that exercise helps reduced depression symptoms in the short-term (Sutherland, Sutherland & Hoehns 2003). Alternatively, exercises also recommended to treat include yoga and tai chi. According to some studies, these exercises that require mindfulness and attention to breathing help alleviate the pain suffered by patients (Macfarlane 2002). However, should the client be not ready to do highly physical activities, then doing simple physical activities is recommended. Conclusion In view of the above, it can be seen that client’s poor physical condition is aggravated by his depressed mental state. This depression, symptoms of which he has been exhibiting beyond the normal threshold, is largely attributed to his failure to cope with the death of his sibling. His sister’s death apparently was highly traumatic experience for him. Four years after his sister’s death, the client is still hesitant to discuss this. Such may pose some degree of difficulty for the nurse since it may be quite hard to illicit desired response from the client. As part of the clinical management for the client, the two-pronged treatment strategy involving psychotherapy and pharmacotherapy is adopted. The nurse would help encourage the client to seek cognitive behavioural therapy or family treatment. Furthermore, the nurse would monitor the prompt administration of prescribed anti-depressants for client. As an adjunctive therapy, the nurse may also encourage the client to perform physical activities or simple exercises. This combined treatment strategy is deemed as relatively more effective than undertaking either therapy alone. Works Cited Ainsworth, P. 2002, Understanding Depression, University of Mississippi, Jackson. Andary, L., Stok, Y. and Klemidis, S. 2003, Assessing Mental Health Across Cultures, Australian Academic Press Pty. Ltd. Arthur, A., Jagger C., Lindesay, J., et al. 2002 “Evaluating a mental health assessment for older people with depressive symptoms in general practice”, British Journal of General Practice, vol. 52. Beck, A., Elis, G., Hays, J. Miller, K. and Reaven, N. 2002, “Multidisciplinary group intervention for fibromyalgia: A study of psychiatric symptom and functional disability outcomes”, The Permanente Journal. (20 March 2006), Available at: http://xnet.kp.org/permanentejournal/spring 02/fibromyalgia.html Elson, S. 2001, “The Active Participants in Mental Health Services” in Meadows, G and Singh, B. (ed.) Mental Health in Australia, Collaborative Community Practice, Oxford University Press, Melbourne. Herring, M. 2002, “Depression and attachment in families”, Family Process, vol.4. “Improving the recognition management of depression in primary care”, Effective Health Care, vol. 7, no. 5, 2002. Katon, W., Rutter, C., Ludman E.J., et al. 2001, “A randomized trial of relapse prevention of depression in primary care”, Archives of General Psychiatry, vol. 58. MacFarlane, D. 2002, “Fibromyalgia: Beat the frustration, battle the pain”, Well Journal. (20 March 2006), Available at: http://www.welljournal.com Sherbourne, M., Unutzer, J., et al. 2001, “Cost effectiveness of practice-initiated quality improvement for depression”, Journal of the American Medical Association, vol. 4. Stanard, R.P. 2000, “Assessment and Treatment of Adolescent Depression and Suicidality”, Journal of Mental Health and Counseling, vol. 22, no. 3. Sutherland, J.E., Sutherland, S.J. and Hoehns, J.D. 2003. “Achieving the best outcome in treatment of depression”, Journal of Family Practice, March 2003. Read More