case study depression examples

Mental Health Case Study: Understanding Depression through a Real-life Example

Through the lens of a gripping real-life case study, we delve into the depths of depression, unraveling its complexities and shedding light on the power of understanding mental health through individual experiences. Mental health case studies serve as invaluable tools in our quest to comprehend the intricate workings of the human mind and the various conditions that can affect it. By examining real-life examples, we gain profound insights into the lived experiences of individuals grappling with mental health challenges, allowing us to develop more effective strategies for diagnosis, treatment, and support.

The Importance of Case Studies in Understanding Mental Health

Case studies play a crucial role in the field of mental health research and practice. They provide a unique window into the personal narratives of individuals facing mental health challenges, offering a level of detail and context that is often missing from broader statistical analyses. By focusing on specific cases, researchers and clinicians can gain a deeper understanding of the complex interplay between biological, psychological, and social factors that contribute to mental health conditions.

One of the primary benefits of using real-life examples in mental health case studies is the ability to humanize the experience of mental illness. These narratives help to break down stigma and misconceptions surrounding mental health conditions, fostering empathy and understanding among both professionals and the general public. By sharing the stories of individuals who have faced and overcome mental health challenges, case studies can also provide hope and inspiration to those currently struggling with similar issues.

Depression, in particular, is a common mental health condition that affects millions of people worldwide. Disability Function Report Example Answers for Depression and Bipolar: A Comprehensive Guide offers valuable insights into how depression can impact daily functioning and the importance of accurate reporting in disability assessments. By examining depression through the lens of a case study, we can gain a more nuanced understanding of its manifestations, challenges, and potential treatment approaches.

Understanding Depression

Before delving into our case study, it’s essential to establish a clear understanding of depression and its impact on individuals and society. Depression is a complex mental health disorder characterized by persistent feelings of sadness, hopelessness, and loss of interest in activities. It can affect a person’s thoughts, emotions, behaviors, and overall well-being.

Some common symptoms of depression include:

– Persistent sad, anxious, or “empty” mood – Feelings of hopelessness or pessimism – Irritability – Loss of interest or pleasure in hobbies and activities – Decreased energy or fatigue – Difficulty concentrating, remembering, or making decisions – Sleep disturbances (insomnia or oversleeping) – Appetite and weight changes – Physical aches or pains without clear physical causes – Thoughts of death or suicide

The prevalence of depression worldwide is staggering. According to the World Health Organization, more than 264 million people of all ages suffer from depression globally. It is a leading cause of disability and contributes significantly to the overall global burden of disease. The impact of depression extends far beyond the individual, affecting families, communities, and economies.

Depression can have profound consequences on an individual’s quality of life, relationships, and ability to function in daily activities. It can lead to decreased productivity at work or school, strained personal relationships, and increased risk of other health problems. The economic burden of depression is also substantial, with costs associated with healthcare, lost productivity, and disability.

The Significance of Case Studies in Mental Health Research

Case studies serve as powerful tools in mental health research, offering unique insights that complement broader statistical analyses and controlled experiments. They allow researchers and clinicians to explore the nuances of individual experiences, providing a rich tapestry of information that can inform our understanding of mental health conditions and guide the development of more effective treatment strategies.

One of the key advantages of case studies is their ability to capture the complexity of mental health conditions. Unlike standardized questionnaires or diagnostic criteria, case studies can reveal the intricate interplay between biological, psychological, and social factors that contribute to an individual’s mental health. This holistic approach is particularly valuable in understanding conditions like depression, which often have multifaceted causes and manifestations.

Case studies also play a crucial role in the development of treatment strategies. By examining the detailed accounts of individuals who have undergone various interventions, researchers and clinicians can identify patterns of effectiveness and potential barriers to treatment. This information can then be used to refine existing approaches or develop new, more targeted interventions.

Moreover, case studies contribute to the advancement of mental health research by generating hypotheses and identifying areas for further investigation. They can highlight unique aspects of a condition or treatment that may not be apparent in larger-scale studies, prompting researchers to explore new avenues of inquiry.

Examining a Real-life Case Study of Depression

To illustrate the power of case studies in understanding depression, let’s examine the story of Sarah, a 32-year-old marketing executive who sought help for persistent feelings of sadness and loss of interest in her once-beloved activities. Sarah’s case provides a compelling example of how depression can manifest in high-functioning individuals and the challenges they face in seeking and receiving appropriate treatment.

Background: Sarah had always been an ambitious and driven individual, excelling in her career and maintaining an active social life. However, over the past year, she began to experience a gradual decline in her mood and energy levels. Initially, she attributed these changes to work stress and the demands of her busy lifestyle. As time went on, Sarah found herself increasingly isolated, withdrawing from friends and family, and struggling to find joy in activities she once loved.

Presentation of Symptoms: When Sarah finally sought help from a mental health professional, she presented with the following symptoms:

– Persistent feelings of sadness and emptiness – Loss of interest in hobbies and social activities – Difficulty concentrating at work – Insomnia and daytime fatigue – Unexplained physical aches and pains – Feelings of worthlessness and guilt – Occasional thoughts of death, though no active suicidal ideation

Initial Diagnosis: Based on Sarah’s symptoms and their duration, her therapist diagnosed her with Major Depressive Disorder (MDD). This diagnosis was supported by the presence of multiple core symptoms of depression that had persisted for more than two weeks and significantly impacted her daily functioning.

The Treatment Journey

Sarah’s case study provides an opportunity to explore the various treatment options available for depression and examine their effectiveness in a real-world context. Supporting a Caseworker’s Client Who Struggles with Depression offers valuable insights into the role of support systems in managing depression, which can complement professional treatment approaches.

Overview of Treatment Options: There are several evidence-based treatments available for depression, including:

1. Psychotherapy: Various forms of talk therapy, such as Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT), can help individuals identify and change negative thought patterns and behaviors associated with depression.

2. Medication: Antidepressants, such as Selective Serotonin Reuptake Inhibitors (SSRIs), can help regulate brain chemistry and alleviate symptoms of depression.

3. Combination Therapy: Many individuals benefit from a combination of psychotherapy and medication.

4. Lifestyle Changes: Exercise, improved sleep habits, and stress reduction techniques can complement other treatments.

5. Alternative Therapies: Some individuals find relief through approaches like mindfulness meditation, acupuncture, or light therapy.

Treatment Plan for Sarah: After careful consideration of Sarah’s symptoms, preferences, and lifestyle, her treatment team developed a comprehensive plan that included:

1. Weekly Cognitive Behavioral Therapy sessions to address negative thought patterns and develop coping strategies.

2. Prescription of an SSRI antidepressant to help alleviate her symptoms.

3. Recommendations for lifestyle changes, including regular exercise and improved sleep hygiene.

4. Gradual reintroduction of social activities and hobbies to combat isolation.

Effectiveness of the Treatment Approach: Sarah’s response to treatment was monitored closely over the following months. Initially, she experienced some side effects from the medication, including mild nausea and headaches, which subsided after a few weeks. As she continued with therapy and medication, Sarah began to notice gradual improvements in her mood and energy levels.

The CBT sessions proved particularly helpful in challenging Sarah’s negative self-perceptions and developing more balanced thinking patterns. She learned to recognize and reframe her automatic negative thoughts, which had been contributing to her feelings of worthlessness and guilt.

The combination of medication and therapy allowed Sarah to regain the motivation to engage in physical exercise and social activities. As she reintegrated these positive habits into her life, she experienced further improvements in her mood and overall well-being.

The Outcome and Lessons Learned

Sarah’s journey through depression and treatment offers valuable insights into the complexities of mental health and the effectiveness of various interventions. Understanding the Link Between Sapolsky and Depression provides additional context on the biological underpinnings of depression, which can complement the insights gained from individual case studies.

Progress and Challenges: Over the course of six months, Sarah made significant progress in managing her depression. Her mood stabilized, and she regained interest in her work and social life. She reported feeling more energetic and optimistic about the future. However, her journey was not without challenges. Sarah experienced setbacks during particularly stressful periods at work and struggled with the stigma associated with taking medication for mental health.

One of the most significant challenges Sarah faced was learning to prioritize her mental health in a high-pressure work environment. She had to develop new boundaries and communication strategies to manage her workload effectively without compromising her well-being.

Key Lessons Learned: Sarah’s case study highlights several important lessons about depression and its treatment:

1. Early intervention is crucial: Sarah’s initial reluctance to seek help led to a prolongation of her symptoms. Recognizing and addressing mental health concerns early can prevent the condition from worsening.

2. Treatment is often multifaceted: The combination of medication, therapy, and lifestyle changes proved most effective for Sarah, underscoring the importance of a comprehensive treatment approach.

3. Recovery is a process: Sarah’s improvement was gradual and non-linear, with setbacks along the way. This emphasizes the need for patience and persistence in mental health treatment.

4. Social support is vital: Reintegrating social activities and maintaining connections with friends and family played a crucial role in Sarah’s recovery.

5. Workplace mental health awareness is essential: Sarah’s experience highlights the need for greater understanding and support for mental health issues in professional settings.

6. Stigma remains a significant barrier: Despite her progress, Sarah struggled with feelings of shame and fear of judgment related to her depression diagnosis and treatment.

Sarah’s case study provides a vivid illustration of the complexities of depression and the power of comprehensive, individualized treatment approaches. By examining her journey, we gain valuable insights into the lived experience of depression, the challenges of seeking and maintaining treatment, and the potential for recovery.

The significance of case studies in understanding and treating mental health conditions cannot be overstated. They offer a level of detail and nuance that complements broader research methodologies, providing clinicians and researchers with invaluable insights into the diverse manifestations of mental health disorders and the effectiveness of various interventions.

As we continue to explore mental health through case studies, it’s important to recognize the diversity of experiences within conditions like depression. Personal Bipolar Psychosis Stories: Understanding Bipolar Disorder Through Real Experiences offers insights into another complex mental health condition, illustrating the range of experiences individuals may face.

Furthermore, it’s crucial to consider how mental health issues are portrayed in popular culture, as these representations can shape public perceptions. Understanding Mental Disorders in Winnie the Pooh: Exploring the Depiction of Depression provides an interesting perspective on how mental health themes can be embedded in seemingly lighthearted stories.

The field of mental health research and treatment continues to evolve, driven by the insights gained from individual experiences and comprehensive studies. By combining the rich, detailed narratives provided by case studies with broader research methodologies, we can develop more effective, personalized approaches to mental health care. As we move forward, it is essential to continue exploring and sharing these stories, fostering greater understanding, empathy, and support for those facing mental health challenges.

References:

1. World Health Organization. (2021). Depression. Retrieved from https://www.who.int/news-room/fact-sheets/detail/depression

2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

3. Beck, A. T., & Alford, B. A. (2009). Depression: Causes and treatment. University of Pennsylvania Press.

4. Cuijpers, P., Quero, S., Dowrick, C., & Arroll, B. (2019). Psychological treatment of depression in primary care: Recent developments. Current Psychiatry Reports, 21(12), 129.

5. Malhi, G. S., & Mann, J. J. (2018). Depression. The Lancet, 392(10161), 2299-2312.

6. Otte, C., Gold, S. M., Penninx, B. W., Pariante, C. M., Etkin, A., Fava, M., … & Schatzberg, A. F. (2016). Major depressive disorder. Nature Reviews Disease Primers, 2(1), 1-20.

7. Sapolsky, R. M. (2004). Why zebras don’t get ulcers: The acclaimed guide to stress, stress-related diseases, and coping. Holt paperbacks.

8. Yin, R. K. (2017). Case study research and applications: Design and methods. Sage publications.

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Home > Blog > How to Write a Treatment Plan for Depression (with Examples)

How to Write a Treatment Plan for Depression (with Examples)

Gargi Singh

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Depression is a complex mental health illness that affects people's emotional, cognitive, and physical well-being. Depression, which is characterized by persistent sadness, loss of interest, and a variety of other symptoms, can have a major impact on everyday functioning and well-being. This page presents an overview of depression, including its classification in the most recent DSM-5 , typical treatment modalities, and a thorough treatment plan that combines two prominent therapeutic techniques. We'll wrap up with significant insights and recommendations for mental health providers.

This guide aims to refine your existing knowledge and provide fresh insights into creating comprehensive, evidence-based treatment plans for your clients struggling with depression.

We'll cover the following key areas:

Understanding Depression: Clinical Presentation and Differential Diagnosis

Dsm-5 classification and diagnostic criteria, components of a comprehensive treatment plan, evidence-based treatment modalities, pharmacological interventions.

• Holistic Care
• Case Studies and Sample Treatment Plans

Let's dive into each section to deepen our understanding and improve our clinical practice.

As mental health professionals, it's crucial to distinguish between clinical depression and transient feelings of sadness. Here's a quick refresher:

Clinical Depression:

• Persistent symptoms lasting at least two weeks
• Significant impairment in daily functioning
• May not have a clear external trigger
• Often involves feelings of worthlessness or excessive guilt

Regular Sadness:

• Usually triggered by a specific event
• Typically resolves with time
• Limited impact on daily functioning
• Self-esteem generally remains intact

Differential Diagnosis:

Remember to consider other conditions that may present with similar symptoms, such as:

• Bipolar disorder
• Anxiety disorders
• Substance-induced mood disorders
• Medical conditions (e.g., thyroid disorders, chronic pain)

The DSM-5 classifies depressive disorders into several categories. For this guide, we'll focus on Major Depressive Disorder (MDD) and Persistent Depressive Disorder (Dysthymia).

Major Depressive Disorder Criteria:

Five or more of the following symptoms present for at least two weeks, with at least one symptom being depressed mood or loss of interest/pleasure:

• Depressed mood most of the day, nearly every day
• Markedly diminished interest or pleasure in activities
• Significant weight loss/gain or appetite changes
• Insomnia or hypersomnia
• Psychomotor agitation or retardation
• Fatigue or loss of energy
• Feelings of worthlessness or excessive guilt
• Diminished ability to think or concentrate
• Recurrent thoughts of death or suicidal ideation

Persistent Depressive Disorder Criteria:

Depressed mood for most of the day, for more days than not, for at least two years. Presence of two or more of the following:

• Poor appetite or overeating
• Low energy or fatigue
• Low self-esteem
• Poor concentration or difficulty making decisions
• Feelings of hopelessness

A well-structured treatment plan should include:

a) Problem Statement: Concise description of the presenting issue

b) Goals: SMART (Specific, Measurable, Achievable, Relevant, Time-bound) treatment goals

c) Objectives: Concrete steps to achieve each goal d) Interventions: Specific therapeutic techniques and strategies

e) Evaluation Criteria: Methods to assess progress f) Timeline: Estimated duration and frequency of treatment g) Collaboration: Involvement of other healthcare providers or support systems

Consider incorporating these proven approaches:

• Cognitive Behavioral Therapy (CBT)
• Interpersonal Therapy (IPT)
• Behavioral Activation
• Mindfulness-Based Cognitive Therapy (MBCT)
• Acceptance and Commitment Therapy (ACT)
• Psychodynamic Therapy

Common classes of antidepressants include:

• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
• Atypical Antidepressants
• Tricyclic Antidepressants (TCAs)
• Monoamine Oxidase Inhibitors (MAOIs)

Remember to consider potential side effects, interactions, and the need for careful monitoring when prescribing.

Case Studies and Example Treatment Plans

Case study 1: sarah, 32-year-old female.

Presenting Problem:

Sarah reports feeling persistently sad and unmotivated for the past three months. She has lost interest in her usual hobbies, struggles to concentrate at work, and often feels worthless. She has been experiencing insomnia and has lost 10 pounds without trying.

Major Depressive Disorder, Single Episode, Moderate (F32.1)

Treatment Plan:

Goal 1: Reduce depressive symptoms as measured by a decrease in PHQ-9 score from 15 to 5 or less within 12 weeks.

Objectives:

• Engage in CBT sessions weekly for 12 weeks
• Practice mindfulness meditation for 10 minutes daily
• Increase physical activity to 30 minutes of moderate exercise 3 times per week

Interventions:

• Provide psychoeducation about depression and its treatment
• Teach cognitive restructuring techniques to challenge negative thoughts
• Introduce behavioral activation strategies to increase engagement in pleasurable activities
• Implement sleep hygiene techniques to improve sleep patterns

Goal 2: Improve work functioning by increasing concentration and productivity within 8 weeks.

• Develop and implement time management and organizational strategies
• Practice mindfulness techniques to enhance focus
• Gradually increase work responsibilities as symptoms improve
• Teach prioritization and task-breaking techniques
• Introduce mindfulness exercises specifically for improving concentration
• Collaborate with employer on reasonable accommodations if needed

Evaluation:

• Weekly PHQ-9 assessments
• Daily mood and activity logs
• Bi-weekly review of work performance and concentration

Medication: Start sertraline 50mg daily, to be reviewed after 4 weeks

Case Study 2: Michael, 45-year-old male

Presenting Problem: Michael has been experiencing low mood, irritability, and fatigue for over a year. He reports feeling "stuck" in his life, has strained relationships with his family, and has been drinking alcohol more frequently to cope with his emotions.

Diagnosis : Persistent Depressive Disorder (Dysthymia) with anxious distress (F34.1)

Goal 1: Reduce depressive symptoms and improve overall mood stability over 16 weeks.

• Attend weekly individual therapy sessions
• Reduce alcohol consumption to no more than 2 drinks per week
• Establish a regular sleep schedule, aiming for 7-8 hours per night
• Utilize Interpersonal Therapy (IPT) to address relationship issues and social support
• Implement CBT techniques to manage negative thought patterns
• Provide psychoeducation on the relationship between alcohol use and depression
• Introduce relaxation techniques and stress management strategies

Goal 2: Improve family relationships within 12 weeks.

• Attend bi-weekly family therapy sessions
• Practice effective communication skills daily
• Plan and engage in one positive family activity per week
• Facilitate family therapy sessions focusing on communication and conflict resolution
• Teach assertiveness skills and emotion regulation techniques
• Assign homework to practice new communication skills in daily interactions
• Bi-weekly administration of Beck Depression Inventory (BDI)
• Weekly alcohol consumption log
• Family member feedback on relationship quality

Medication: Start bupropion XL 150mg daily for 2 weeks, then increase to 300mg daily if tolerated. Review after 6 weeks.

Case Study 3 : Emily, 19-year-old female college student

Presenting Problem: Emily reports feeling overwhelmed with academic pressures, experiencing frequent crying spells, and having difficulty getting out of bed. She has been isolating herself from friends and has had thoughts of "not wanting to exist" but denies active suicidal ideation.

Diagnosis : Major Depressive Disorder, Single Episode, Severe without Psychotic Features (F32.2)

Goal 1: Ensure safety and stabilize mood within 4 weeks. Objectives:

• Develop a safety plan and crisis management strategies
• Attend therapy sessions twice weekly for the first month
• Engage in daily mood tracking and journaling
• Conduct a thorough suicide risk assessment and create a detailed safety plan
• Implement crisis management techniques, including distress tolerance skills from Dialectical Behavior Therapy (DBT)
• Provide psychoeducation on depression and its impact on academic performance
• Teach and practice grounding techniques for managing overwhelming emotions

Goal 2 : Improve academic functioning and social engagement within 8 weeks.

• Establish a structured daily routine, including regular study times
• Reconnect with at least two friends per week through in-person or virtual meetings
• Utilize campus academic support services weekly
• Use CBT techniques to address perfectionism and academic-related anxiety
• Implement behavioral activation strategies to increase social engagement
• Collaborate with academic advisor to develop a manageable course load and utilize accommodations if needed
• Teach time management and study skills

Goal 3 : Develop long-term coping strategies and relapse prevention plan within 12 weeks. Objectives:

• Identify and practice at least three effective coping strategies
• Create a written relapse prevention plan
• Join a peer support group for young adults with depression
• Introduce mindfulness-based stress reduction techniques
• Develop a personalized wellness plan incorporating self-care activities
• Facilitate connection with campus support groups or online peer support communities
• Weekly administration of PHQ-9 and Columbia-Suicide Severity Rating Scale (C-SSRS )
• Bi-weekly review of academic performance and attendance
• Monthly assessment of social engagement and support system

Medication : Start escitalopram 10mg daily, with close monitoring for the first 4 weeks due to age and severity of symptoms. Consider referral to psychiatrist for medication management.

These case studies and treatment plans demonstrate the individualized approach necessary in treating depression. Each plan addresses the specific needs, circumstances, and goals of the client while incorporating evidence-based interventions and regular evaluation of progress.

Remember that treatment plans should be flexible and may need adjustment as therapy progresses and the client's needs or circumstances change. Regular collaboration between the therapist, client, and other healthcare providers is crucial for effective depression treatment.

Holistic Care:

Cultural factors in treatment planning:.

During the development of treatment plans, one should keep in mind that clients' cultural backgrounds are very important in the way they experience depression, in help-seeking behaviors, and in how they react to treatments. Culturally adapted interventions may be required for effectiveness and engagement.

Trauma-Informed Care:

Many people who experience depression may have experienced trauma. Elements of trauma-informed care, if incorporated into basic treatment plans, will help maximize their efficiency and avoid re-traumatization.

Collaborative Care Model:

A collaborative care model is one in which mental health is brought into a primary care setting. This may improve access to care and increase treatment adherence, potentially improving outcomes in patients with depression.

Digital Health Interventions:

Consider the use of evidence-based digital tools allowing for mood tracking via mobile apps or offering online modules for CBT to supplement traditional therapy and increase engagement during intervening periods between sessions.

Lifestyle Interventions:

Include discussions regarding exercise, nutrition, and sleep hygiene within the treatment plan. These things have a huge impact on mood and overall well-being.

Peer Support:

Consider referring them to peer support groups or peer recovery specialists, which can provide social support and share coping skills that are very useful for patients experiencing depression.

Measurement-Based Care:

Routinely implement the use of standardized assessment tools in order to track progress, inform treatment decisions, outline when treatment plans must be changed, and demonstrate the effectiveness of interventions to clients and other stakeholders.

Relapse Prevention:

Once the clients start to recover, much of the work will focus on building a robust relapse prevention plan that outlines early warning signs, wellness strategies, and when and how to seek extra help if symptoms worsen.

These things, integrated within our treatment planning and clinical practice, can produce more holistic and effective care for people dealing with depression. Keep in mind that every client is unique, and treatment plans must take into account the needs, preferences, and specific circumstances of each client.

Depression is a very serious mental health condition which requires a comprehensive approach, both by medicines and psychotherapy. The formulation of effective treatment plans for depression requires extensive knowledge of the disorder, comprehensive assessment of the client as a unique individual, and skillful application of evidence-based interventions. By tailoring our approach to the individual needs and circumstances of each client, we are well positioned to make a real difference in the outcomes and assist our clients on their path to long-lasting recovery.

Key Points to Remember:

• Individualization : Modify the treatment plans for the unique needs and situations of each patient. Regular evaluation and modification of the treatment plan are very important for the good results.
• Patient Engagement: Patients must co-construct the treatment plan and be actively involved in it. Encourage cooperation and be sure that the goals and interventions they present have in mind their personal values and needs.
• Ongoing Support: In most cases, the treatment for depression lasts for a long time and the support is continuous. Regular check-ups and maintenance strategies are the fundamental components of a healthy life that are important for relapse prevention and continuous healing.

All examples of mental health documentation are fictional and for informational purposes only.

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Patient Case Presentation

Figure 1.  Blue and silver stethoscope (Pixabay, N.D.)

Ms. S.W. is a 48-year-old white female who presented to an outpatient community mental health agency for evaluation of depressive symptoms. Over the past eight weeks she has experienced sad mood every day, which she describes as a feeling of hopelessness and emptiness. She also noticed other changes about herself, including decreased appetite, insomnia, fatigue, and poor ability to concentrate. The things that used to bring Ms. S.W. joy, such as gardening and listening to podcasts, are no longer bringing her the same happiness they used to. She became especially concerned as within the past two weeks she also started experiencing feelings of worthlessness, the perception that she is a burden to others, and fleeting thoughts of death/suicide.

Ms. S.W. acknowledges that she has numerous stressors in her life. She reports that her daughter’s grades have been steadily declining over the past two semesters and she is unsure if her daughter will be attending college anymore. Her relationship with her son is somewhat strained as she and his father are not on good terms and her son feels Ms. S.W. is at fault for this. She feels her career has been unfulfilling and though she’d like to go back to school, this isn’t possible given the family’s tight finances/the patient raising a family on a single income.

Ms. S.W. has experienced symptoms of depression previously, but she does not think the symptoms have ever been as severe as they are currently. She has taken antidepressants in the past and was generally adherent to them, but she believes that therapy was more helpful than the medications. She denies ever having history of manic or hypomanic episodes. She has been unable to connect to a mental health agency in several years due to lack of time and feeling that she could manage the symptoms on her own. She now feels that this is her last option and is looking for ongoing outpatient mental health treatment.

Past Medical History

• Hypertension, diagnosed at age 41

Past Surgical History

• Wisdom teeth extraction, age 22

Pertinent Family History

• Mother with history of Major Depressive Disorder, treated with antidepressants
• Maternal grandmother with history of Major Depressive Disorder, Generalized Anxiety Disorder
• Brother with history of suicide attempt and subsequent inpatient psychiatric hospitalization,
• Brother with history of Alcohol Use Disorder
• Father died from lung cancer (2012)

Pertinent Social History

• Works full-time as an enrollment specialist for Columbus City Schools since 2006
• Has two children, a daughter age 17 and a son age 14
• Divorced in 2015, currently single
• History of some emotional abuse and neglect from mother during childhood, otherwise denies history of trauma, including physical and sexual abuse
• Smoking 1/2 PPD of cigarettes
• Occasional alcohol use (approximately 1-2 glasses of wine 1-2 times weekly; patient had not had any alcohol consumption for the past year until two weeks ago)

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Patient case navigator: major depressive disorder.

Introduction

Learning Objectives

• How to perform a structured psychiatric interview
• Standardized psychiatric rating scales appropriate for patients with depressive symptoms
• Common barriers to adequate treatment response
• How to assess and monitor patients for treatment side effects and adequate treatment response

Watch the video:

History and Examination

Medical History

Examination

History of Present Illness

Eric is a 60-year-old man who presents to his primary care nurse practitioner, Tina, with irritability, excessive sleeping, and a lack of interest in his usual hobbies, such as attending baseball games and going to the movies with his wife. He also has been spending much time at home alone, watching television, rather than spending time with his friends or wife, as he usually does. Eric recently retired from his job as a general contractor remodeling people’s kitchens and bathrooms. He enjoyed his job very much and felt a sense of pride in helping people make their homes more functional and attractive. However, his job was very physical, and at times stressful, so Eric felt it was time to retire and find something new with which to occupy his time.

Eric was diagnosed with hypothyroidism 5 years ago and has been on medication ever since. Annual lab tests indicate his thyroid levels have remained within the normal range for the past few years. He also has mild hypertension, which is well-controlled at an adequate dose.

Psychosocial History

Eric reports that he has several close friends and that he got along well with people at work. He denies a history of substance misuse and reports that he occasionally drinks a glass of wine with dinner. He does not smoke. Eric describes his marriage as “very good.” He is also close with his adult daughter and enjoys spending time with his 2 grandchildren.

At age 33, Eric experienced a period of depressed mood after losing his job. During that time, he had problems getting out of bed in the morning because he felt hopeless and sad, stopped socializing with friends, and lost about 4 lbs of body weight in 4 weeks without intentionally dieting. He sought treatment from his primary care physician, who referred him to a psychiatrist for medication and a psychologist for outpatient cognitive-behavioral therapy (CBT). Eric worked with his psychiatrist and tried 4 different selective serotonin reuptake inhibitors (SSRIs) before he ultimately found one that seemed to work for him. He and his psychiatrist decided together that he could stop taking the medication after 1 year because his mood had improved and stabilized. He saw his therapist once weekly for approximately 2.5 years and reports that CBT also helped improve his mood and functioning.

Family History

Eric reports that, throughout his life, his mother had “very low periods” when she seemed extremely sad and had trouble functioning. However, she never sought treatment for these episodes.

Eric’s physical examination indicates he is generally healthy for his age. His vital signs are all within the normal range, and the mental status examination indicates he is fully oriented and alert. Eric’s appearance is that of an older man. His affect is flat, and he has trouble making eye contact, often staring at the floor instead.

Patient Interview

Quiz #1: initial presentation and diagnosis, dsm-5 diagnostic criteria for mdd.

MDE Diagnostic Criteria

Safety Plan

Major Depressive Episode (MDE)

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous function; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

• Depressed mood most of the day, nearly every day, as indicated by either subjective report or observation made by others
• Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
• Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day
• Insomnia or hypersomnia nearly every day
• Psychomotor agitation or retardation nearly every day
• Fatigue or loss of energy nearly every day
• Feelings of worthlessness or excessive or inappropriate guilt nearly every day
• Diminished ability to think or concentrate, or indecisiveness, nearly every day
• Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of function

C. The episode is not attributable to the physiological effects of a substance or another medical condition

Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013.

• It is important to thoroughly review each of these 9 symptoms with your patients when assessing them for MDD.
• Clinical rating scales can help identify which patients require more in-depth screening for depression.

Quiz #2: DSM-5 Diagnostic Criteria for MDD

Scales for mdd.

PHQ-9 Scale Scoring

QIDS Scale Scoring

Patient Health Questionnaire-9 (PHQ-9)

This scale was developed by Drs Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke, and colleagues with an educational grant from Pfizer inc. No permission required.

Scoring Criteria

Kroenke K, Spitzer RL. Psychiatric Annals. 2002;32:509-521.

The Quick Inventory of Depressive Symptomatology (QIDS)

• The QIDS is a 16-item, multiple-choice questionnaire in which depressive symptoms are rated on a 0-3 scale according to severity
• Items are derived from the 9 diagnostic criteria for major depressive disorder used in the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV), including sadness, loss of interest or pleasure, poor concentration or decision-making, self-outlook, suicidal ideation, lack of energy, sleep disturbance, appetite change, and psychomotor agitation
• Although the QIDS was initially developed based on DSM-IV criteria, the scale is also compatible with the DSM-5. The core criteria for MDD are consistent across these editions

Rush AJ, et al. Biol Psychiatry. 2003;54(5):573-583.

Bernstein IH, et al. Int J Methods Psychiatr Res. 2009;18(2):138-146.

Quiz #3: Scales for MDD

Treatment initiation and monitoring.

APA Guidelines

Eric's PHQ-9 Score

Treatment Options

American Psychiatric Association (APA) Guidelines for Treatment of MDD

1-2 weeks: Improvement from pharmacologic therapy can be seen as early as 1-2 weeks after starting treatment

2-4 weeks: Some patients may achieve improvement in 2-4 weeks

4-6 weeks: Short-term efficacy trials show antidepressant therapy appears to require 4-6 weeks to achieve maximum therapeutic effects

4-8 weeks: The APA recommends 4-8 weeks of adequate* treatment is needed before concluding that a patient is partially responsive or unresponsive to treatment *Adequate dose and duration Practice Guideline for the Treatment of Patients With Major Depressive Disorder. 3rd ed. American Psychiatric Association; 2010.

*Adequate dose and duration

Practice Guideline for the Treatment of Patients with Major Depressive Disorder. 3rd ed. American Psychiatric Association; 2010.

Quiz #4: Treatment Initiation and Monitoring

Assessing for treatment challenges.

Treatment Challenges

Eric's Updated PHQ-9 Score

Possible Challenges to Antidepressant Therapy

• Suboptimal efficacy due to the wrong dose, inadequate length of time on the medication, or the person's individual biology not being responsive to the medication
• Unpleasant side effects of antidepressants can occur, such as weight gain, insomnia, and sexual dysfunction
• Nonadherence to the antidepressant
• As a reminder, the American Psychiatric Association (APA) recommends 4-8 weeks of adequate* treatment is needed before concluding that a patient is partially responsive or unresponsive to treatment

Practice Guideline for the Treatment of Patients With Major Depressive Disorder. 3rd ed. American Psychiatric Association; 2010.

MDD Diagnosis

Clinical Probes

Treatment Assessment

Monitoring Considerations

Factors to Consider When Making a MDD Diagnosis

• Take a thorough patient history
• Previous or current depressive episodes
• Previous or current manic or hypomanic episodes
• Family history of MDD, bipolar disorder
• Medical comorbidities
• Consider a broad differential diagnosis

Clinical Queries That Aid in Diagnosing Major Depressive Episodes

1. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. American Psychiatric Association; 2013. 2. Kroenke K, et al. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613.

APA Practice Guidelines on Treatment Assessment

• Wait 4 to 8 weeks to assess treatment response to antidepressants
• In patients without adequate response, clinicians can consider changing or augmenting with a second medication
• Changes to treatment plans, such as augmenting with a second-generation antipsychotic medication, are reasonable if a patient does not have adequate improvement in 6 weeks
• Consistently follow-up with patients to assess treatment effects, adverse medication effects, and risk of self-harm

APA Practice Guidelines note that the frequency of monitoring should be based on:

• Symptom severity (including suicidal ideation)
• Co-occurring disorders (including general medical conditions)
• Treatment adherence
• Availability of social supports
• Frequency and severity of side effects with medication

Tina Matthews-Hayes is a paid consultant for Abbvie Medical Affairs and was compensated for her time.

American Psychiatric Association. Practice Guideline for the Treatment of Patients with Major Depressive Disorder. 3rd ed. American Psychiatric Association; 2010.​

• American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders . 5th ed. American Psychiatric Association; 2013. ​
• Kapfhammer HP. Somatic symptoms in depression. Dialogues Clin Neurosci . 2006;8(2):227-239.​
• Bobo WV. The diagnosis and management of bipolar I and II disorders: clinical practice update. Mayo Clin Proc . 2017;92(10):1532-1551.​
• Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med . 2001;16:606-613.​
• Smarr KL, Keefer AL. Measures of depression and depressive symptoms. Arthritis Care Res . 2011;63(S11):S454-S466. doi:10.1002/acr.20556​
• Rush AJ, Trivedi MH, Ibrahim HM, et al. The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), Clinician Rating (QIDS-C), and Self-Report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biol Psychiatry. 2003;54:573-583.​
• Brown ES, Murray M, Carmody TJ, et al. The Quick Inventory of Depressive Symptomatology–Self-report: a psychometric evaluation in patients with asthma and major depressive disorder. Ann Allergy Asthma Immunol. 2008;100(5):433-438. doi:10.1016/S1081-1206(10)60467-X​
• Liu R, Wang F, Liu S, et al. Reliability and validity of the Quick Inventory of Depressive Symptomatology-Self-Report Scale in older adults with depressive symptoms. Front Psychiatry . 2021;12:686711. doi:10.3389/fpsyt.2021.686711 ​
• Bernstein IH, Rush AJ, Suppes T, et al. A psychometric evaluation of the clinician-rated Quick Inventory of Depressive Symptomatology (QIDS-C16) in patients with bipolar disorder. Int J Methods Psychiatr Res . 2009;18(2):138-146. doi:10.1002/mpr.2855​
• Bernstein IH, Rush AJ, Trivedi MH, et al. Psychometric properties of the Quick Inventory of Depressive Symptomatology in adolescents. Int J Methods Psychiatr Res. 2010;19(4):185-194. doi:10.1002/mpr.321 ​
• Kroenke K. Enhancing the clinical utility of depression screening. CMAJ . 2012;184(3):281-282.doi:10.1503/cmaj.112004 ​
• Levinstein MR, Samuels BA. Mechanisms underlying the antidepressant response and treatment resistance. Front Behav Neurosci . 2014;8:208. doi:10.3389/fnbeh.2014.00208​
• Haddad PM, Talbot PS, Anderson IM, McAllister-Williams RH. Managing inadequate antidepressant response in depressive illness. Br Med Bull. 2015;115(1):183-201. doi:10.1093/bmb/ldv03​

This resource is intended for educational purposes only and is intended for US healthcare professionals. Healthcare professionals should use independent medical judgment. All decisions regarding patient care must be handled by a healthcare professional and be made based on the unique needs of each patient.

This is not a diagnostic tool and is not intended to replace a clinical evaluation by a healthcare provider.

Reach out to your family or friends for help if you have thoughts of harming yourself or others, or call the National Suicide Prevention Helpline for information at 800-273-8255.

ABBV-US-00976-MC, V1.0 Approved 12/2023 AbbVie Medical Affairs

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A Case Study of Depression in High Achieving Students Associated With Moral Incongruence, Spiritual Distress, and Feelings of Guilt

Bahjat najeeb.

1 Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, PAK

Muhammad Faisal Amir Malik

Asad t nizami, sadia yasir.

Psychosocial and cultural factors play an important, but often neglected, role in depression in young individuals. In this article, we present two cases of young, educated males with major depressive disorder and prominent themes of guilt and spiritual distress. We explore the relationship between moral incongruence, spiritual distress, and feelings of guilt with major depressive episodes by presenting two cases of depression in young individuals who were high-achieving students. Both cases presented with low mood, psychomotor slowing, and selective mutism. Upon detailed history, spiritual distress and feelings of guilt due to internet pornographic use (IPU) and the resulting self-perceived addiction and moral incongruence were linked to the initiation and progression of major depressive episodes. The severity of the depressive episode was measured using the Hamilton Depression Scale (HAM-D). Themes of guilt and shame were measured using the State of Guilt and Shame Scale (SSGS). High expectations from the family were also a source of stress. Hence, it is important to keep these factors in mind while managing mental health problems in young individuals. Late adolescence and early adulthood are periods of high stress and vulnerabe to mental illness. Psychosocial determinants of depression in this age group generally go unexplored and unaddressed leading to suboptimal treatment, particularly in developing countries. Further research is needed to assess the importance of these factors and to determine ways to mitigate them.

Introduction

More attention needs to be paid to the psychological and societal factors which precipitate, prolong, and cause a relapse of depression in high-achieving young individuals. A young, bright individual has to contend with the pressures of -- often quite strenuous -- moral and financial expectations from the family, moral incongruence, spiritual distress, and feelings of guilt.

Moral incongruence is the distress that develops when a person continues to behave in a manner that is at odds with their beliefs. It may be associated with self-perceptions of addictions, including, for example, to pornographic viewing, social networking, and online gaming [ 1 ]. Perceived addiction to pornographic use rather than use is related to the high incidence of feelings of guilt and shame and predicts religious and spiritual struggle [ 2 - 3 ]. Guilt is a negative emotional and cognitive experience that occurs when a person believes that they have negated a standard of conduct or morals. It is a part of the diagnostic criteria for depression and various rating scales for depressive disorders [ 4 ]. Generalized guilt has a direct relationship with major depressive episodes. Guilt can be a possible target for preventive as well as therapeutic interventions in patients who experience major depressive episodes [ 5 ].

We explored the relationship between moral incongruence, spiritual distress, and feelings of guilt with major depressive episodes in high-achieving students. Both patients presented with symptoms of low mood, extreme psychomotor slowing, decreased oral intake, decreased sleep, and mutism. The medical evaluation and lab results were unremarkable. The severity of depressive episodes was measured using the Hamilton Depression Scale (HAM-D). Themes of guilt and shame were measured by using the State of Guilt and Shame Scale (SSGS). This case study was presented as a poster abstract at the ‘RCPsych Faculty of General Adult Psychiatry Annual Conference 2021.’

Case presentation

A 25-year-old Sunni Muslim, Punjabi male educated till Bachelors presented with a one-month history of fearfulness, weeping spells during prolonged prostration, social withdrawal, complaints of progressively decreasing verbal communication to the extent of giving nods and one-word answers, and decreased oral intake. His family believed that the patient's symptoms were the result of ‘Djinn’ possession. This was the patient’s second episode. The first episode was a year ago with similar symptoms of lesser severity that resolved on its own. Before being brought to us, he had been taken to multiple faith healers. No history of substance use was reported. Psychosexual history could not be explored at the time of admission. His pre-morbid personality was significant for anxious and avoidant traits. 

On mental state examination (MSE), the patient had psychomotor retardation. He responded non-verbally, and that too slowly. Once, he wept excessively and said that he feels guilt over some grave sin. He refused to explain further, saying only that ‘I am afraid of myself.’ All baseline investigations returned normal. His score on the Hamilton Depression Rating Scale (HAM-D) was 28 (Very Severe). A diagnosis of major depressive disorder was made. The patient was started on tab sertraline 50 mg per day and tab olanzapine 5 mg per day. After the second electroconvulsive therapy (ECT), his psychomotor retardation improved and he began to open up about his stressors. His HAM-D score at this time was 17 (moderate). He revealed distress due to feelings of excessive guilt and shame due to moral incongruence secondary to internet pornography use (IPU). The frequency and duration of IPU increased during the last six months preceding current illness. That, according to him, led him to withdraw socially and be fearful. He felt the burden of the high financial and moral expectations of the family. He complained that his parents were overbearing and overinvolved in his life. His family lacked insight into the cause of his illness and had difficulty accepting his current state. All these factors, particularly spiritual distress, were important in precipitating his illness. He scored high on both the shame and guilt domains (14/25, and 20/25, respectively) of the State of Shame and Guilt Scale (SSGS).

He was discharged after three weeks following a cycle of four ECTs, psychotherapy, and psychoeducation of the patient and family. At the time of discharge, his HAM-D score was 10 (mild) and he reported no distress due to guilt or feeling of shame. He has been doing well for the past 5 months on outpatient follow-up.

A 21-year-old Sunni Muslim, Punjabi male, high-achieving student of high school presented with low mood, low energy, anhedonia, weeping spells, decreased oral intake, decreased talk, and impaired biological functions. His illness was insidious in onset and progressively worsened over the last 4 months. This was his first episode. He was brought to a psychiatric facility after being taken to multiple faith healers. Positive findings on the MSE included psychomotor slowing, and while he followed commands, he remained mute throughout the interview. Neurological examination and laboratory findings were normal. His score on HAM-D was 24 (very severe). He was diagnosed with major depressive disorder and started on tab lorazepam 1 mg twice daily with tab mirtazapine 15 mg which was built up to 30 mg once daily. He steadily improved, and two weeks later his score on HAM-D was 17 (moderate). His scores on SSGS signified excessive shame and guilt (16/25, and 21/25; respectively). He communicated his stressors which pertained to the psychosexual domain: he started masturbating at the age of 15, and he felt guilt following that but continued to do so putting him in a state of moral incongruence. He perceived his IPU as ‘an addiction’ and considered it a ‘gunahe kabira’ (major sin) and reported increased IPU in the months leading to the current depressive episode leading to him feeling guilt and anguish. Initially, during his illness, he was taken to multiple faith healers as the family struggled to recognize the true nature of the disease. Their understanding of the illness was of him being under the influence of ‘Kala Jadu’ (black magic). His parents had high expectations of him due to him being their only male child. After 3 weeks of treatment and psychotherapy, his condition improved and his HAM-D score came out to be 08 (mild). He was discharged on 30 mg mirtazapine HS and seen on fortnightly visits. His guilt and shame resolved with time after the resolution of depressive symptoms and counseling. We lost the follow-up after 6 months.

Late adolescence and young adulthood can be considered a unique and distinct period in the development of an individual [ 6 ]. It is a period of transition marked by new opportunities for development, growth, and evolution, as well as bringing new freedom and responsibilities. At the same time, this period brings interpersonal conflicts and an increased vulnerability to mental health disorders such as depression and suicidality. Biological, social, and psychological factors should all be explored in the etiology of mental health problems presenting at this age [ 6 ].

Socio-cultural factors played a significant role in the development and course of disease in our patients, and these included the authoritarian parenting style, initial lack of awareness about psychiatric illnesses causing a delay in seeking treatment, high expressed emotions in the family, and the burden of expectations from the family and the peer group. The strict and often quite unreasonable societal and family expectations in terms of what to achieve and how to behave and the resultant onus on a high-scoring, bright young individual make for a highly stressful mental state. 

We used the ICD-10 criteria to diagnose depression clinically in our patients and the HAMD-17 to measure the severity of symptoms [ 7 ]. Both our patients had scores signifying severe depression initially. Psychomotor retardation was a prominent and shared clinical feature. Psychomotor retardation is the slowing of cognitive and motor functioning, as seen in slowed speech, thought processes, and motor movements [ 8 - 9 ]. The prevalence of psychomotor retardation in major depressive disorder ranges from 60% to 70% [ 10 ]. While psychomotor retardation often responds poorly to selective serotonin reuptake inhibitors (SSRI), both tricyclic antidepressants (TCAs) and noradrenergic and specific serotonergic antidepressants (NaSSA) produce a better response [ 9 , 11 ]. In addition, ECT shows a high treatment response in cases with significant psychomotor retardation [ 11 - 12 ].

A growing body of evidence shows that shame and guilt are features of numerous mental health problems. Guilt is the negative emotional and cognitive experience that follows the perception of negating or repudiating a set of deeply held morals [ 4 ]. Guilt can be generalized as well as contextual and is distinct from shame [ 13 ]. The distinction between guilt and shame allows for an independent assessment of the association of both guilt and shame with depressive disorder. As an example, a meta-analysis of 108 studies including 22,411 individuals measuring the association of shame and guilt in patients with depressive disorder found both shame and guilt to have a positive association with depressive symptoms. This association was stronger for shame (r=0.43) than for guilt (r=0.28) [ 14 ]. In our study, we used the State of Shame and Guilt Scale (SSGS), to measure the feelings of guilt and shame [ 15 ]. The SSGS is a self-reported measure and consists of 5 items each for subsets of guilt and shame. SSGS scores showed high levels of guilt and shame in both of our patients.

During the course of treatment, we paid special attention to the psychological, cultural, and social factors that likely contributed to the genesis of the illness, delayed presentation to seek professional help, and could explain the recurrence of the depressive episodes. In particular, we observe the importance, particularly in this age group, of family and societal pressure, spiritual distress, moral incongruence, and feelings of guilt and shame. Moral incongruence is when a person feels that his behavior and his values or judgments about that behavior are not aligned. It can cause a person to more negatively perceive a behavior. As an example, the presence of moral congruence in an individual is a stronger contributor to perceiving internet pornographic use (IPU) as addictive than the actual use itself [ 16 ]. Therefore, moral congruence has a significant association with increased distress about IPU, enhanced psychological distress in general, and a greater incidence of perceived addiction to IPU [ 16 ].

Self-perceived addiction is an individual’s self-judgment that he or she belongs to the group of addicts. The pornography problems due to moral incongruence (PPMI) model is one framework that predicts the factors linking problematic pornographic use with self-perceived addiction. This model associates moral incongruence with self-perceived addiction to problematic pornographic use [ 17 ]. A recent study on the US adult population also showed a high association of guilt and shame with moral incongruence regarding IPU [ 18 ]. Another factor of importance in our patients was spiritual distress, which is the internal strain, tension, and conflict with what people hold sacred [ 19 ]. Spiritual distress can be intrapersonal, interpersonal, or supernatural [ 20 ]. Research indicates that IPU causes people to develop spiritual distress that can ultimately lead to depression [ 16 - 17 ].

Conclusions

In both our cases the initial presentation was that of psychomotor slowing, selective mutism, and affective symptoms of low mood, therefore, a diagnosis of depressive illness was made. One week into treatment, improvement was noted both clinically as well as on the psychometric scales. Upon engaging the patients to give an elaborate psychosexual history, moral incongruence, spiritual distress, and feelings of guilt, linked particularly to self-perceived addiction to IPU were found. Sensitivity to the expectations of the parents, the cognizance of failing them because of illness, and their own and family’s lack of understanding of the situation were additional sources of stress. Hence, it is imperative to note how these factors play an important role in the initiation, progression, and relapse of mental health problems in young individuals. 

Acknowledgments

We are thankful to the participants of this study for their cooperation.

The authors have declared that no competing interests exist.

Human Ethics

Consent was obtained or waived by all participants in this study

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Case study on depression, 5-axis diagnosis case study.

Lucy suffers of a major depression or depressive condition. She is getting the attention or medication with the antidepressants. This depressive episode is causing a lot of disturbance in her daily life activities. The medical pain is extreme hence making her to fail going to her workplace.

She is suffering from a personality disorder, which has contributed to the development of the depression. The attempted to commit suicide shaped her condition of depression. Her history of depression is as a result of the medical pain and being diagnosed with fibromyalgia. The personality disorder induces the depressive episode in axis I.

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B. Strategies

C. Holistic Nursing Plan

C.1 Functional Ability

C.2 Providing Care

D. Chronic Depression

Community Health Nursing: Quality of Life and Functioning

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On June 20th 2001, a mother of five did the unthinkable and killed her five children within one hour (O'Malley, 2004). The woman, Andrea Yates confessed to drowning her four sons and one daughter in the bathtub within the family’s house. The crime shocked American society and brought a lot of consideration to the psychological health of mothers and possible risks it presented for the family (Ewing, 2008).

Case Study On Diagnosis And Treatment Planning

Free case study on psychological case report (template), age __________________________.

Medical Conditions(s): _______________________________________________ Reason for Referral The patient was experiencing difficulties in getting sleep and was irritable most of the time. The patient constantly sinks into depression and has even in a number of occasions attempted suicide. Furthermore, the patient has lost interest in certain activities, which they used to like such as that of playing with friends.

Tests Administered/Test Scores & Interpretation/Behavioral Observations:

Free case study on mental health, mental health.

Introduction One of the main branches of psychology is mental assessment. This part of psychology calls for numerous observations and ability to relate a certain behavior or response to a set of responses to comprehensively understand the mental status of a person (http://yalepress.yale.edu/yupbooks/excerpts/hicks_50.pdf).

It usually involves careful observation of any possible or visible cue that might give a clue to the mental status a person, a lot of careful questioning and taking of notes as well as mental history of the person under observation. It also calls for human behavior understanding and causes of the various types of mental ailments (http://yalepress.yale.edu/yupbooks/excerpts/hicks_50.pdf).

Assessment procedure

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[Professor’s name appears here] [University name appears here] [Date appears here]

SCENARIO 1:

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James is a community counseling student and an intern at a local university. Recently, he began working with Lisa a 21-year-old female who presented symptoms associated with depression. Lisa disclosed experiencing physical abuse from her mother’s partner. As a result, she drugged him, and he later died. The decision to diagnose her or not is a dilemma. Lisa has told her counselor something that she had never disclosed to anyone. Referring her to another counselor would make her uncomfortable, and she could decide to give up on counseling.

Step 2: identify the potential issues involved

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Nutrition is an indispensable component of care. It is from food intake that the body obtains the micro and macro nutrients needed to maintain and improve health. Diet is also an area of regulation for the management of chronic diseases such as diabetes. Care plans focused on nutrition necessarily must be individualized to take into account unique needs arising from specific medical conditions, the client’s developmental stage, and cultural preferences. Developing a care plan entails evaluating for nutritional risk, defining the goals of nutrition therapy, identifying interventions and expected outcomes, implementing the interventions, providing education, and promoting safety.

Evaluation of Nutritional Risk

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Part A: Assessment Cause Hank’s pain comes from a two-year-old surgery and radiotherapy for his left lung mesothelioma. Objective Data Hank is alert, oriented and can respond to questions in an appropriate manner. Hank’s skin appears pale with slight perspiration. The VAS assessment kit shows an intensity score of 2/10. Furthermore, Hank demonstrates distress on movement with visible restrictions on trunk movements. Finally, Hank’s chest is clear though with reduced air entry.

Subjective Data

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<Course instructor>

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Based on 2-20 year old male CDC growth chart, Jacob is considered obese. His height indicates he is at the 96th percentile and weight is at the 90th percentile. His BMI is at the 95th percentile (Kuczmarski et al, 2002). Based on 2-20 year old female CDC growth chart, Mollie is considered to be of normal weight. Her height indicates that she is between the 60th percentile and weight is at the 45th percentile. Her BMI is at the 27th percentile (Kuczmarski et al, 2002).

The three common types of eating disorder includes Binge Eating disorder, Anorexia Nervosa and Bulimia nervosa

The key issues case study sample.

There are many issues surrounding the life of Marci, the 23 year old young woman that seems to be losing her mind because of perceived indulgence into drugs. Among the primary issues surrounding the life of Marci, the young woman, are such things as:

List in order of importance

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