Psychiatric Consumer: Depression - Case Study Example

Clinical decisions record of the psychiatric consumer Major Depression is one the affective disorders that result from the brain not being able to function properly. This condition has been noted to be chronic and keeps on relapsing with each subsequent relapse tending to be increasing the severity of the disorder. Mood is mainly altered as a result of the disorder (Habermann T & Ghosh A, pg 707). Etiology Depression has a genetic predisposition and hence it can be passed on from one member of the family with a history of depression. Depression could also arise as a manifestation of other disease conditions which might be affecting an individual and these conditions will range from stroke, the neoplasms and cancerous processes in the body. Disorders such as thyroid and the metabolic disorders could lead to depression. Other causes include epilepsy and degenerative processes of the neurons. Alteration of the levels of the neuro transmitters in the brain are also linked to the causation of depression (Habermann T & Ghosh A, pg 707). Social stressors cause depression and include elements such as the stressful conditions that one may undergo, the negative effects one gets in life or even from relationships that don’t seem to be working out. Substance abuse could also lead to depression for example the continuous and habitual use of alcohol in excess amounts could lead to depression. Depression can be subdivided into various groups or and this will be majorly based on how immensely the symptoms of depression are affecting an individual. Depression can be grouped to different types and this will include; Major depression Dysthymic disorder Depressive disorders that are not specified Major depression is a type of depression disorder in which the patients tend to be in very depressed moods for instance they will be feeling hopeless and also full of sadness. There could also be a marked change in the daily activities of the patient in that the patient has retardation from the way they carry out their psychomotor nomaly.Their speech, their thinking process and their body movements will also be affected. Changes in sleeping patterns with altered appetite and hence are likely to have changes in their weights (South-Paul et al, pg 52). Major depressive patients tend to have cognitive functions being impaired and this will manifest with them having difficulties in decision making and impared thinking and concentration. Lack passion in most of the activities that are enjoyed for example sex or even other hobbies they usually like doing and also have repeated suicidal thoughts (South-Paul et al, pg 52). Dysthymic disorders Includes the individuals who experience the depressive periods for some days and they would have this depressive episode after a period of at least two years. They have sadness and a low mood generally and also have appetite and sleeping patterns altered. They have problems in making decisions and are hopelessness (South-Paul et al, pg 52). Depressive disorder that has not been specified This will be grouped into four groups. First is premenstrual dysphoric disorder which will be exhibited when women having depression just before they have menses and they would have features of an altered mood and will have low interest in activities and will also tend to be anxious. The second group is depression that results from a medical condition which has brought about the changes in the mood of the patient. The third group will have the seasonal affective disorder which will be associated with hyper insomnia and a strong desire for sweets at a particular time within the year. The final group is the Substance induced mood disorder which will result from the abuse of drugs and medications (South-Paul et al, pg 52). The management of Joan’s major depression condition The features Joan presents with are suggestive of her having a major depressive disorder. This is due to her having the thoughts of committing suicide and according to her suicide is the only possible solution to the problems that she is facing and her emotional pain. Joan is also seen to be having problems with decision making and that’s why when she is given a promotion which she has for many years been yearning for she turns down the offer even though knowing very well that she really needs the promotion. Joan has also had a long period of being unhappy particularly with her life at work and even at home. She also reports to be unhappy with the current job she is having and also the colleagues she is working with. Joan seems to be having anhedonia due to loss of interest in social situations and feeling of worthlessness. During the conversation I would ask Joan various questions from her to be able to find out more about what she is facing To begin I will employ the five step triage of safety which will include the following; Being able to Know possible risk factors for Joan to be able to commit suicide, and being able to identify the protective factors that the patient will be able to use to prevent suicide. I would also conduct an inquiry on the suicide to get more information and the extent of self harm Joan is capable of inflicting on herself. Thereafter determination of the level at which the risk will be intervened to prevent the committing of suicide. Documentation is done about the risk factors as well as the protective factors and the possible interventions and the follow up of the Joan (Meichenbaum D et al, pg 1-10). Then I will ask Joan how many times and how often she has ever thinks about the committing of suicide and why at those specific times if any. Next I will ask about the duration with which she is able to have this suicidal thoughts come to her and if she tries to hurt herself during that period and if she has ever attempted suicide before and the possible reasons why. I will go ahead to inquire about the plans that she has concerning the committing of suicide and if she feels she is in control or at times she loses control of herself and also about her possible reasons as to why she wants to commit the suicide and I will also find out if she finds life worth living or not and also her future plans in life. I will ask her whether she feels sad or she is just happy the why she is and maybe get the reasons as to why she might not be happy. Next I will find out other activities and hobbies she was doing before and if she has stopped doing them or not. If she has stopped the activities I would want to know why as this could be features of anhedonia. I would make inquiry to find out if Joan has had changes in cognition like thinking and concentration abilities. Next I would find out more about her sleeping patterns if they are normal or altered (Meichenbaum D et al, pg 1-10). I will go ahead to ask more about her friends and also how she relates with them and even what the friends and people she interacts with say about her. I would inquire more about Joan’s social habits such as drinking where I would wish to know if she drinks alcohol heavily or takes other substances of abuse. I would then ask more questions in relation to the suicide which Joan considers being the only ultimate solution to her miseries. Here I would ask her why she thinks suicide is the solution to her problems. Then I would make more inquiry about the problems that the suicide is aimed at alleviating, the times she has ever thought of committing suicide and the methods the patients feels the ones that are suitable for her to commit the suicide. History of suicide in her family should also be established. Her social history whether she had had any physical or social abuse or even being put into isolation. Then I would ask of what she would do before suicide for example will she leave a note (Meichenbaum D et al pg 1-10). The management approach to suicide will include: The provision of the safety of the patient involves identification of possible locations the patient is likely to commit suicide at and advising them on avoiding such places or use of certain equipment they are likely to use to commit suicide (Nicholas L. & Golden R pg 1). Treatment of any under laying psychiatric disorder that is done by using psychotropic drugs to treat the psychiatric disorders if present. Mood stabilizers are used as a prophylactic in the prevention of suicide. Use of lithium or the anticonvulsant medication could be used since they all have effect of stabilizing and also have ant agitating effects. Antidepressants could also be used for example the serotonin reuptake inhibitors. Antipsychotics will be used to help in the controlling of the psychotic symptoms hence prevent suicide. Cognitive therapy is essential to make her understand that death or suicide is not the solution to her problem and go ahead to enumerate possible solutions or other coping mechanisms to avoid suicide. (Kumar & Clark, pg 1273-74). References Habermann T & Ghosh A,2008 .Mood disorders, Mayo clinic internal medicine Mayo ,clinic scientific press and information healthcare ,USA. http://www.melissainstitute.org/documents/35_Years_Suicidal_Patients.pdf Kumar & Clark, 2007.Mood disorders, Clinical Medicine, Elsevier. Meichenbaum D et al 2007, 35 years of working with suicidal patients, lessons learned Nicholas L. & Golden R, 2006.Managing the Suicidal Patient,http://www.dangerousbehaviour.com/Disturbing_News/Managing%20the%20Suicidal%20Patient.htm Psychiatry, University of North Carolina School of Medicine Chapel Hill, North Carolina South-Paul et al 2007 .psychological disorders, Current diagnosis and treatment, family medicine, McGraw-Hill companies. Read More

Dysthymic disorders Includes the individuals who experience the depressive periods for some days and they would have this depressive episode after a period of at least two years. They have sadness and a low mood generally and also have appetite and sleeping patterns altered. They have problems in making decisions and are hopelessness (South-Paul et al, pg 52). Depressive disorder that has not been specified This will be grouped into four groups. First is premenstrual dysphoric disorder which will be exhibited when women having depression just before they have menses and they would have features of an altered mood and will have low interest in activities and will also tend to be anxious.

The second group is depression that results from a medical condition which has brought about the changes in the mood of the patient. The third group will have the seasonal affective disorder which will be associated with hyper insomnia and a strong desire for sweets at a particular time within the year. The final group is the Substance induced mood disorder which will result from the abuse of drugs and medications (South-Paul et al, pg 52). The management of Joan’s major depression condition The features Joan presents with are suggestive of her having a major depressive disorder.

This is due to her having the thoughts of committing suicide and according to her suicide is the only possible solution to the problems that she is facing and her emotional pain. Joan is also seen to be having problems with decision making and that’s why when she is given a promotion which she has for many years been yearning for she turns down the offer even though knowing very well that she really needs the promotion. Joan has also had a long period of being unhappy particularly with her life at work and even at home.

She also reports to be unhappy with the current job she is having and also the colleagues she is working with. Joan seems to be having anhedonia due to loss of interest in social situations and feeling of worthlessness. During the conversation I would ask Joan various questions from her to be able to find out more about what she is facing To begin I will employ the five step triage of safety which will include the following; Being able to Know possible risk factors for Joan to be able to commit suicide, and being able to identify the protective factors that the patient will be able to use to prevent suicide.

I would also conduct an inquiry on the suicide to get more information and the extent of self harm Joan is capable of inflicting on herself. Thereafter determination of the level at which the risk will be intervened to prevent the committing of suicide. Documentation is done about the risk factors as well as the protective factors and the possible interventions and the follow up of the Joan (Meichenbaum D et al, pg 1-10). Then I will ask Joan how many times and how often she has ever thinks about the committing of suicide and why at those specific times if any.

Next I will ask about the duration with which she is able to have this suicidal thoughts come to her and if she tries to hurt herself during that period and if she has ever attempted suicide before and the possible reasons why. I will go ahead to inquire about the plans that she has concerning the committing of suicide and if she feels she is in control or at times she loses control of herself and also about her possible reasons as to why she wants to commit the suicide and I will also find out if she finds life worth living or not and also her future plans in life.

I will ask her whether she feels sad or she is just happy the why she is and maybe get the reasons as to why she might not be happy. Next I will find out other activities and hobbies she was doing before and if she has stopped doing them or not. If she has stopped the activities I would want to know why as this could be features of anhedonia. I would make inquiry to find out if Joan has had changes in cognition like thinking and concentration abilities.

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