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Depression Introduction This assignment will look at a case study of a adult female who presents herself with a three month of hospitalization. The patient is getting divorce after 22 years. She sees suicide as an ideal but has no plan of action. She also suffers from abnormal sleeping patterns, waking at night and lacks concentration on her work. In the context of the above scenario we will look at diagnostic possibilities, possible causes for the depression, impact on her life, relevant safety issues, socio-cultural aspects when making a diagnosis and management plan and issues when dealing with this patient. Depression is also defined as a repressed sense of loss and from anger unconsciously turned inward. (Psychopathologies Hand-Out Notes 27: 2002) Montgomery says that depression is a serious and life endangering illness, and also a common one, and its recognition and prompt and appropriate treatment is therefore of the utmost concern. (Montgomery 1990: 1) When considering the above paragraph it is clear that the impact depression can have on a patients normal functioning, in terms of their normal daily lifestyles and the graveness of the illness, must therefore not be underestimated.
Further information needed to make a diagnosis Diagnosis is the identification of disease from the examination of symptoms and whereby an opinion is reached. It also implicates a thorough analysis of facts or problems to gain understanding and whereby an opinion can be reached through such an understanding. (Psychopathologies Handouts 8: 2002) Montgomery says that depression is notoriously difficult to recognise in general practice. Even when depression is severe half the cases in the doctors waiting room apparently go unrecognised. (Montgomery 9: 2000) The first thing therefore that needs to be done is a full psychological analysis. This is required so that essential information, we do not yet have can be obtained, to make an appropriate diagnosis.
As much information as possible that may be indicative of an illness is essential to assist in making an appropriate diagnosis. In our patients case we still need to ascertain whether she has been consulting a doctor and for any physical symptoms, and what the result was of the physical done by his doctor. If at all possible a doctors report would be helpful. We need to know whether he has got any other medical conditions as some illnesses may cause depression. We need to know whether her doctor if any, has prescribed any medication and if so what medication has been prescribed. We also have to keep in mind patients bad experience with Prozac.
Wellbrutin and Lexapro are should not be considered as proper medication. The reason for this is that certain medications can cause symptoms that present themselves in a similar manner to depression. Patient also needs to be asked whether he has experienced any of the following symptoms over the last three months: If there has been any alcohol or drug use. Whether she has a diminished interest or pleasure in all or almost all activities most of the day, nearly every day.
Psychomotor agitation or retardation nearly every day. Fatigue or loss of energy nearly every day. Patient needs to be asked whether she has experienced a diminished ability to think, concentrate or is indecisive nearly everyday. Patient needs to be questioned as to whether any family members have had depression and what treatment they have received. (DSM-IV 327: 1994) It is necessary to remember that she may also be vulnerable to the illness as a person genetically predisposed to it.
There may therefore be a history of depression in her family. Her family circumstances when growing up and current family circumstances may also have played a role in the onset of the illness. If a family member suffered from depression as a child or currently she may be effected by the circumstances caused by their illness and start exhibiting similar symptoms. The death of patients father is a very important factor that most significantly could have contributed to the onset of his illness.
Biological factors also need to be considered in respect of whether he may be suffering from an illness. The other significant factor to remember is patients age. With the onset of his ageing he may start feeling depressed knowing that he is getting older. Environmental factors may also play a role in patients illness.
Impact on patients life in terms of relationships, self and work patient may begin to experience various difficulties in various parts of her life due brought about by his illness. Patient also needs to be informed of dosage and risks of non-compliance. A partner or wife may be of great assistance in helping with dosage compliance. As a result of his suicidal thoughts it may be beneficial to remove objects from easy access, with which he may harm himself. In this respect these objects may be guns, knives etc.
Socio-cultural aspects that might need to be considered when making a diagnosis and management plan. The Maori perspective on depression differs to the conventional Pakeha concept and this needs to be kept in mind. When getting a description of his feelings patient may describe it differently than the conventional way of doing it. Woman when depressed may be more open to drug and alcohol abuse and this often results violent or aggressive behavior. Patient may be more tolerant of erratic behavior and this may make a diagnosis more problematic. Less importance may be attributed to physical health like dull eyes and this may also make a diagnosis more difficult.
As therapist when dealing with patient it will be important to look at the key indicators like loneliness, sadness, listlessness, withdrawal and grief as these are important for patient. Ignoring social and cultural factors may lead to mis-diagnosis or miscalculation of the severity of the illness. Some of the issues for me as a potential therapist when dealing with this man As a therapist I would have to consider whether I understood cultural issues pertaining to Patient well enough, to be able to do therapy with him as my patient. I would need to consider whether I would be comfortable in dealing with a patient irrespective of whether I understood the culture or not. I would need to consider whether I would be comfortable in dealing with a professional person like patient or whether I would feel intimidated by him being a doctor. As a therapist I might also need to consider whether I have unresolved issues around the death of my own father, which may bring about difficulty in procuring a correct diagnosis as soon as possible.
If this were not the case in any of the above mentioned circumstances then I might need to consider referring patient to another therapist. Conclusion Depression is an illness that significantly impacts on the health and well being of individuals and is also at times an unbearable burden not only for subjects but also their families to carry. It requires patience, skill, understanding and compassion from therapists to deal effectively with these cases. This is especially important to remember because patients have the potential and often do commit suicide as in our patients case.
Therapists need to remember that some of the key issues in psychotherapy is quality management and the need for cultural sensitive counseling and psychotherapy services. (Thompson& Mathias 435: 2000) Bibliography: Diagnostic Manual of Mental Disorders, Fourth Edition. Washington, DC, American Psychiatric Association, 1994. Montgomery, A. (1990). Anxiety and Depression. Chicago. Year Book Medical Publishers.
Hand-Out Notes for Psychopathologies. (2000). Thompson, T& Mathias, P. (2000). Mental Health and Disorder. Third Edition.
London. Harcourt's Publishers.
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