The point about manic depression or bipolar disorder, as its now more commonly called, is that its about mood swings. So, you have an elevated mood. When people think of manic depression, they only hear the word depression. They think ones a depressive. The point is, ones a manic-depressive (Fry qtd. in Brainy Quote par. 1).
The issue of manic depression, in my own opinion, has always been neglected in terms of study, or even disregarded. Everyone always seems to focus on one side of the disorder, forgetting that there may be another aspect to depression that contributes to the individuals mental state, and to the same extent. Patients discussed in Chapter Four, I Now Pronounce You Manic Depressive, and diagnosed with bipolar disorder had the signs of elevated mood when they were over-excited and chatty, as well as the signs of a downward spiraling mood, which even led them to attempting suicide.
While the opposite of a suicidal mood might be considered a good thing, on the other hand, the elevated mood is not always beneficial for the patients, since over-excited and speedy behavior can also lead to potentially dangerous consequences. Therefore, bipolar disorder is deceptively complex and should not be regarded as a one-sided illness, to be treated with one singular method; rather, bipolar disorder is a system of social, physical, and emotional conditions (Martin 106) that can be dealt with in a systematic way.
The gray case of Mr. Anderson, an economics professor, is especially worth mentioning, due to the fact that he was on lithium for twenty years until he suffered renal insufficiency as a consequence, and whose behavior became uncontrollable after the medication was discontinued. He was sexually inappropriate with students, and failed to control his anger and irritability, especially in the upper pole of his bipolar disorder. In addition, when he was down, he needed a lot more sleep than usual. The ups went around the downs in circles that could take from one hour to five months.
The newly prescribed medication did not seem to help, since Mr. Anderson claimed he had never felt normal after dropping lithium. It is evident that the initial medication prescribed to the patient two decades previously was not properly evaluated in terms of how it could potentially affect his health over a long term. Because bipolar is treated with medication that can adversely impact ones physical health, it was not the best decision to prescribe lithium for twenty years. Now, even as lithium has been proven to cause serious physical health damage, its absence has negatively impacted his mental state.
I cannot agree with the concluding diagnosis that Mr. Anderson belongs in the gray zone between mental illness and mental health, since his behavior shows that he is eager to recover and to feel normal again, and he is passionate about teaching and academia. Mr. Andersons mental illness has been controlled by lithium for years, so now, without the medication, the illness will continue to progress without proper intervention.
Mr. Burtons case is useful, in my opinion, for learning to differentiate whether a persons misuse of a substance caused manic depression, or if an underlying illness adversely influenced the patients condition (Martin 121). Born into an unstable family, Mr. Burton was heavily exposed to negative influences that caused him to try PSD and marijuana. Without support from the family, the patient had become paranoid and bought a gun to protect himself from imagined danger. The interview with the patient showed that he was dramatic in his speech, worried, and anxious.
The way he spoke about his family implied that Mr. Burton lacked recognition and comfort at home. Because of the lack of recognition, the patient strove to perform excellently at his studies, and this turned into an obsession. Thus, Burtons state was diagnosed as bipolar; however, in my opinion, such a diagnosis should not have been as unanimous as it came to be. Bipolar disorder does not go well with education, since a patient is often too unstable and unfocused to reach his or her goal. To this extent, Mr. Burton had the dedication to perform well in his academic accomplishment. His state can, indeed, be called repression, because he held in his unconsciousness the desire to perform and become recognized by his parents (Martin 124).
On the other hand, I agree with the manic characteristic of Mr. Burton, despite his rationality. One can be both rational and manic at the same time, which is a loose interpretation of manic depression or bipolar disorder. In addition, I agree with the postulated similarity between Mr. Burtons and Mr. Andersons cases, in the sense that they were both exponentially motivated by academic success, and both experienced a decrease in motivation as soon as they doubted themselves. Therefore, both patients were highly sensitive to the mood cycles that they experienced and that impacted their ability to function.
In my opinion, the discussion leading to the white versus black identity did not hold up well, despite the fact that some minor explanations were given. In the same way a white person can experience mania, a black person can deal with identity issues and overconfidence. Providing a rationale in assessing white versus black patients seems counterproductive, and may lead to a potentially inaccurate diagnosis.
It is mentioned that medical categories should work in conjunction with cultural background, which defines race in terms of human capacity (Martin 127). Of course, the cultural background of the patient should be taken into consideration while performing an assessment; however, it should be more about cultural upbringing, the influence of traditions, and the role of religion in persons life, rather than whether a patient is black or white. It is impossible to predetermine if a white person will struggle with overconfidence, or a black person will become manic at some point in his or her life.
Overall, the fact that the psychological assessment in the chapter included both women and men of different races implies that manic depression can affect anyone. However, the main reason it occurs is, in my opinion, a combination of many factors that distinguish ones life from others. A system of issues, for example, alcoholic parents and abuse of mild substances, can lead to a person becoming alienated and paranoid. In order to compensate for alienation and paranoia, a patient can become obsessed with a particular goal or idea that will drive his behavior up. Such ups will be intertwined with downs, creating a full circle of bipolar disorder behavior. Since a bipolar person struggles with a system of contradictory problems that do not allow stabilizing and finding middle ground, in my opinion, it should also be treated systematically.
This paper is aimed at evaluating two websites that are related to such a topic as depression. Both of them were visited on the 25th of March, 2015. It is necessary to assess the format in which the information is presented. Overall, these sources can be used as a starting point for researching this mental disorder.
The first website is maintained by the National Institute of Mental Health. It is one of the largest research organizations that study the underlying causes of various mental illnesses and their treatment. This institution is supposed to assist researchers as well as students who may want to learn more about different aspects of depression as well as other disorders.
In turn, the second website is operated by the National Alliance on Mental Illness. This non-governmental organization can be regarded as the advocacy group which assists those individuals who can be affected by various psychological disorders. One of its specific objectives is to increase public awareness about the symptoms of mental illnesses and the experiences of patients. These are some of the differences that should be taken into account.
While discussing the website of the National Institute of Mental Health, one should mention that several positive aspects can be of great benefit to researchers and students. One of the main advantages is that this online resource contains an index of health topics. Thus, a person can find relevant information relatively quickly. Furthermore, this resource includes a search engine that helps people identify relevant pages. However, it is also possible to speak about some limitations. In particular, the page, which presents the overview of depression, does not include a bibliography or any other links to relevant empirical or theoretical studies (National Institute of Mental Health). Apart from that, this page does not include information about the author, his/her professional background, and the date when the article was created or updated. Nevertheless, it is important to mention that this website contains separate pages that can give readers an in-depth insight into various aspects of this disease, for instance, one can speak about the effect of depression on cancer patients. In this case, the reader can find links to academic books or articles that can be used in various academic papers.
It should be mentioned that the website of the National Alliance on Mental Illness is similar in terms of design. In this case, one can speak about the presence of a search engine and the index of topics. These tools can enable people to navigate this website (National Alliance on Mental Illness). Nevertheless, some drawbacks should be taken into account. In particular, this site does not include information about the author of the article about depression. Furthermore, the article does include a reference list of articles or books that were used for writing this article. This information can be of great benefit to people who want to examine depression in greater detail. Thus, this online resource is not fully sufficient for researchers. This is one of the issues that should not be overlooked.
One cannot give preference to one of these websites because they serve slightly different purposes. In particular, the site of the NIMH can best serve the needs of people who want to start research about this mental disorder. This online resource can help students identify relevant empirical articles. In contrast, the website maintained by the NAMI can benefit individuals who struggle with depression or other mental diseases. This argument is particularly relevant if one speaks about the precautions that should be taken by patients to overcome the effects of this disorder. These are some of the differences that should be taken into account.
There are several things that I learned about depression by using the website of the National Institute of Mental Health. In particular, a person can get a better idea about the main symptoms and diagnosis of depression, different types of this disorder, and available therapies (National Institute of Mental Health). These are some of the main aspects that attracted my attention. Additionally, this website includes information about the current empirical studies of this psychological disorder.
In turn, the website maintained by the National Alliance on Mental Illness provides valuable information about the potential causes of depression and the experiences of patients who may be affected by this disease. Apart from that, this website includes valuable guidelines about how patients can minimize the impacts of this disease. For instance, this individual should refrain from consuming alcohol.
This discussion shows how important to appraise informational resources that are available online. The assessment of these resources can be useful for finding valid information. Overall, the website maintained by the National Institute of Mental Health is more suitable for people who want to carry out in-depth research on this topic. However, the site of the National Alliance on Mental Illness can help patients and relatives. These are the main arguments that can be put forward.
Works Cited
National Alliance on Mental Illness. Depression. NAMI. n. d. Web.
The patient can be exposed to selective serotonin reuptake inhibitors (SSRIs), which are the most used antidepressants in the United States to tackle symptoms of major depression during pregnancy (Grzeskowiak et al., 2011). The most widely used SSRIs in pregnant women include fluoxetine, paroxetine, and escitalopram. Based on the personal and medical history of the patient, the first line of treatment would be to introduce fluoxetine at a starting dose of 10mg po each am and may increase to 20 mg po q am after the first four weeks of treatment. The dose may be increased to a maximum of 80 mg po q am by 10-20 mg q 4 weeks as tolerated or needed. Available literature demonstrate that fluoxetine has a good safety record with pregnant and lactating mothers, and it is well tolerated by most people since it has less histaminergic, dopaminergic and a-adrenergic side effects (Edmunds & Mayhew, 2004).
In the event that the patient is unable to tolerate flouxetine, escitalopram should be administered at 10 to 20 mg per day for 4 weeks, but extra caution should be taken in administering the drug if the patient is in her last 3 months of pregnancy as it may cause harm to the fetus (Dodd et al., 2011). Another alternative for the patient is paroxetine, with the recommended starting dose of 20mg per day because the patient is in a safe age and suffers from no renal or liver impairments (Dolder et al., 2010). Paroxetine is usually administered for 4 weeks before its benefits show (Pridmore & Turnier-Shea, 2004).
Available literature demonstrates that &SSRIs exert their pharmacological effects by selectively inhibiting the reuptake of serotonin (5-HT) at the presynaptic junction, resulting in an increased concentration of serotonin in the synaptic cleft and thus enhanced serotonergic neurotransmission (Grzeskowiak et al., 2011, p. 1028). Elsewhere, it is reported that the pharmacology of most SSRI agents is centered on reversing possible dysfunction of the monoamine neurotransmitters serotonin and nerepinephrine, which is often achieved by inhibiting the reuptake of these neurotransmitters into presynaptic neurons by obstructing the function of their respective reuptake transporters (Dolder et al., 2010).
Side Effects
The patient should be monitored very closely upon administration of the SSRIs for symptoms of drug intolerance and also due to the fact that she is pregnant. The discussed SSRIs are perceived by many health professionals as having a more favorable safety profile and reduced toxicity in overdose, especially in pregnant women. However, caution should be exercised in administering the SSRIs as they are associated with increased risk of omphalocele, craniosynostosis, anencephaly, and low birthweight (Dolder et al., 2010). Paroxetine is individually associated with increased risk of congenital malformations, suicidal ideation, and cardiovascular malformations following exposure to the drug at an average daily dose of >25 mg (Grzeskowiak et al., 2011). It is reported in the literature that the most commonly reported cardiovascular malformations in fetuses upon exposure to SSRIs are the ventricular septal defects (Tyrka et al., 2006).
Available literature demonstrates that &specific adverse effects associated with antidepressant treatments may be reduced or identified earlier by baseline screening and agent-specific monitoring after commencing treatment (Dodd et al., 2011, p. 712). Drugs with serious adverse events on patients should be withdrawn and another line of treatment started using antidepressants that are well tolerated by the patient. Drug augmentation is also a valid possibility in the treatment of major depression.
List of Prices of 3 Drugs
Escitalopram 20 mg tablets: cost of 100 tablets $85.00, available from CanDrugStore.com (2012)
Fluoxetine 20 mg generic version: cost of 30 tablets is $11.99, available from NorthWestPharmacy.com (PharmacyChecker.com, 2012)
Paroxetine 10 mg original version: cost of 30 tablets is $124.16 (BuckADayPharmacy.com, 2012).
Population Specific Implications
The drug escitalopram should be administered cautiously in geriatric patients and patients presenting with hepatic impairment as its half-life is enhanced in these patients, hence the need to reduce dosage (Dodd et al., 2011). Although the drug should also be given cautiously to patients with a history of hypersensitivity, suicidal ideation, seizures, and severe renal impairment, the patient in this case can use the drug as she does not have any history of hepatic, renal impairment, or suicidal ideation. Escitalopram enters breast milk during distribution and therefore may cause adverse effects in infants. The patient is not lactating at the present, so the drug can be prescribed. It should however be noted the patient is pregnant, and thus the drug should be used with a lot of caution as the fetus may develop drug discontinuation syndrome (e.g., respiratory distress, feeding problems, and petulance) upon exposure (Tyrka et al., 2006).
Apart from the usual adverse effects exhibited in decreased sexual desire, dizziness, dry mouth, loss of appetite, and trouble sleeping (Dodd et al., 2011), fluoxetine should be administered cautiously as the patient is pregnant. Unconfirmed findings have associated the drug with premature birth, low birth weight, high blood pleasure in mother and child, not mentioning that the child could experience symptoms such as irritability, feeding challenges and difficulty sleeping (Dolder et al., 2010). Paroxetine should also be administered with caution as it is associated with increased suicidal ideation, withdrawal effects, and increased risk of congenital malformations if it is taken within the first trimester of pregnancy (Grzeskowiak et al., 2011).
Prescription Form
CSU
Sample Prescription Form
Mary Washington, FNP # 9876
Name: __Samuel Doe________ DOB: 07-26-1978
Address: 456 Southern Drive, LA; Date: 06-09-2012
Rx: Escitalopram 10 mg per day for at least 4 weeks. Dose can be increased to 20 mg per day depending on tolerance and side effects
Dodd, S., Malhi, G.S., Tiller, J., Schweitzer, I., Hickie, I., Khoo, J.P&Berk, M. (2011). A consensus statement for safety monitoring guidelines of treatments for major depressive disorder. Australian & New Zealand Journal of Psychiatry, 45(9), 712-725.
Dolder, C., Nelson, M., & Stump. A. (2010). Pharmacological and clinical profile for newer antidepressants: Implications for the treatment of elderly patients. Drugs & Aging, 27(8), 625-640.
Edmunds, M.W., & Mayhew, M.S. (2009). Pharmacology for the primary care provider (3rd ed.). St. Louis: Mosby-Elsevier.
Grzeskowiak, L.E., Gilbert, A.L., & Morrison, J.L. (2011). Investigating outcomes following the use of selective serotonin reuptake inhibitors for treating depression in pregnancy. Drug Safety, 34(11), 1027-1048.
Pridmore, S., & Turnier-Shea, Y. (2004). Medication options in the treatment of treatment-resistant depression. Australian & New Zealand Journal of Psychiatry, 38(4), 219-225.
Tyrka, A.R., Price, L.H., Mello, M.F., & Carpenter, L.L. (2006). Psychotic major depression: A benefit-risk assessment of treatment options. Drugs Safety, 29(6), 491-508.
Depression is a rather common psychological disorder that is one of the most popular objects of research among scholars and healthcare practitioners (Goodwin 259). This health condition may lead to such adverse effects as aggression, guilt, sadness, and even suicidal tendency. The history of investigating depression takes its roots from Ancient Greece where the disease was referred to as melancholy (Hofmann et al. 174). Over time, it became considered a mental disorder and was addressed with a combination of medication and therapy (Hofmann 182). Over the past ten years, some of the approaches to the treatment of depression remained the same whereas many new methods replaced the old ones. In general, it is possible to say that the scholarly conversation on depression has changed over time. A comparison and contrast of sources from within 2006-2010 and 2013-2017 will demonstrate the divergences in scholarly thought on depression.
Evidence from Research
As the article by Goodwin indicates, the scholarly thought of a ten-year-ago period was concentrated on physical illnesses associated with depression (259). The author emphasizes that such health conditions as heart disease or stroke may have a putative direct impact on depression neurobiology (260). Goodwin explains that patients who have such diseases are more exposed to depression since they realize the mortality risks associated with their illnesses (260). The author also investigates the association between depression and such nonspecific somatic issues as chronic fatigue, fibromyalgia, and chronic pain (Goodwin 261). According to research, depression starts with minor depression that used to cause much misunderstanding about the disease (Goodwin 261-262). The confusion appeared because of similar symptoms such as low energy and self-esteem, pessimism, reduced productivity, and irritability.
With the increased responsiveness to treatment, such clinical cases started to be considered as depression (Goodwin 262). Chronic pain and chronic fatigue are also defined as syndromes causing controversial diagnosis (Goodwin 262-263). However, as the author notes, no sufficient interventions have been performed due to the lack of financial support. The article by Hofmann et al. also focuses on the difficulties associated with the management of depressive disorders in the first decade of the twenty-first century (169). The scholars investigate the effect of mindfulness-based therapy (MBT) on patients with depression. As a result of a meta-analytic review, Hofmann et al. conclude that MBT has a positive impact on patients with depression (180). Although MBT is not diagnosis-specific, it can help to manage processes that appear in multiple disorders by altering a variety of emotional and evaluative dimensions (Hofmann et al. 180). The authors remark that MBT may be applied in general practice.
Articles published within the current decade have a different focus and suggest modernized approaches to the problem of depression. Hawton et al. dedicate their study to suicide as the most crucial threat of depressive disorder (17). Although research has a small sample, the outcomes of the analysis are significant. Hawton et al. investigate the connections between depression and suicide and note that nine out of ten people who commit suicide suffered from some depressive disorder (18). What is particularly valuable about the study is the analysis of differences between males and females disposition to suicide. Hawton et al. remark that men suffering from depression are more likely to commit suicide than women with depressive disorder (20-21).
Apart from gender peculiarities, the authors identify such suicide-related factors in depressive people as family psychiatric history, a severe form of depression, comorbid disorders, a previous attempt to commit suicide, and hopelessness (Hawton et al. 27). Based on the analysis of many sources, researchers remark a variety of new approaches to the treatment of depression. A study by Zupan et al. also outlines modern ways of managing the investigated disorder and focus on such mechanism as memory bias (300). The authors analyze the impact of positive and negative biases on peoples emotional regulation in depression. Zupan et al. remark that there is a lack of positive self-referent bias in older patients (309). As a result, such individuals are less likely to cope with depressive disorders. The authors conclude that patients negative self-views may reduce the saliency of positive memories and lead to mood disorders (Zupan et al. 309).
Comparison and Contrast of the Sources to Support the Argument
The sources from 2006-2010 and 2013-2017 have in common the general theme of investigation, all of them being focused on depression. However, the approaches to managing depressive disorder are different in the two decades of the twenty-first century. Goodwin and Hofmann et al. emphasize the physical illnesses associated with depression and remark that research is limited due to insufficient financial possibilities of researchers. Hawton et al. and Zupan et al. concentrate on the psychological implications of depression and discuss modern interventions and approaches to managing this condition.
Despite the differences, there are also some similarities between the analyzed articles. While Goodwin focuses his study on physical illnesses related to depression, he also mentions that there is a high likelihood of depression leading to suicidal tendencies in people (259). Thus, this article has a common element with the study by Hawton et al. that is concentrated on risk factors for suicide in patients suffering from depression (26). This element, as well as the general description of depressive disorder, constitutes some correlation between the articles. However, Hawton et al. pay more attention to investigating the connection between depression and suicide that Goodwin does.
A significant divergence between older and more recent sources is the description of the possibilities of research in 2006-2010 and 2013-2017. Upon the analysis, it becomes apparent that there has been a great improvement in research of depressive disorder. Scholars have proved that this condition is rather threatening, and more attention has led to more funding for analysis and interventions. Prominent progress in the investigation is revealed through specific angles if research in recent articles. Hawton et al. analyze the differences in exposure to depression and its adverse outcomes in males and females. Zupan et al. investigate age peculiarities of depression. Therefore, modern sources provide deeper analysis and more possibilities for investigating depressive disorder than outdated studies.
The Purpose of the Project
The project aimed to demonstrate the similarities and divergences between approaches to treating depression in modern scholarly thought and the research studies performed nearly ten years ago. Literature review made it possible to elucidate the major concerns of scholars and practitioners about depression, its forms, complications, and ways of treatment. As a result of the project, it may be concluded that present-day scholars pay more attention to the psychological dimension of depression as opposed to physiological focus preferred by older studies. However, despite some divergences in research, there is a common opinion about depression and its manifestations. Both modern studies and the ones published nearly ten years ago concentrate on the issue of depressions highly negative psychological outcomes and emphasize the need for a thorough investigation of this condition.
Works Cited
Hawton, Keith, et al. Risk Factors for Suicide in Individuals with Depression: A Systematic Review. Journal of Affective Disorders, vol. 147, no. 1, 2013, pp. 17-28.
Hofmann, Stefan G., et al. The Effect of Mindfulness-Based Therapy on Anxiety and Depression: A Meta-Analytic Review. Journal of Consulting and Clinical Psychology, vol. 78, no. 2, 2010, pp. 169-183.
Goodwin, Guy M. Depression and Associated Physical Diseases and Symptoms. Dialogues in Clinical Neuroscience, vol. 8, no. 2, 2006, pp. 259-265.
Zupan, Zorana, et al. Memory Bias in Depression: Effects of Self-Reference and Age. Journal of Social & Clinical Psychology, vol. 36, no. 4, 2017, pp. 300-315.
Health needs related to risk for depression in adults
Serotonin is a neurotransmitter that aids in transmitting signals in the brain. Its primary source and area of function are in the brain. However, 90% of the serotonin produced is found in the blood platelets and the digestive tract. Serotonin influences various functions in the body, especially the brain cells linked to appetite, mood swings, sleep, sexual functioning, temperature regulation, learning and memory, and social behavior.
It also influences the functioning of the muscles, endocrine system, cardiovascular system, and breast milk production. The burden of handling this vulnerable group lies with the primary care providers (Shellman, Granara & Rosengarten, 2011). They face the complication of identifying the depression symptoms because other medications or medical conditions can lead to depression. These include hypersomnia or insomnia, loss of appetite and weight, energy loss, psychomotor retardation, and concentration difficulties.
Determinants and contributing factors
Many studies indicate that an imbalance in the level of serotonin may affect ones moods causing depression, especially in old age. This may be due to reduced production of serotonin by the brain cells, absence of receptor sites that serotonin can work on, the inability of serotonin to be transported to the receptor sites, or a reduced level of tryptophan. These factors cause depression in old age together with other symptoms such as anxiety, panic, or anger (Hussain, 2010). The development of depression dominates in the regeneration of new brain cells. The production of serotonin mediates the process of cell regeneration and proceeds in the entire lifetime of an individual.
Depression results from the inhibition of newly formed brain cells, with the most determining precipitator of depression being stress. It is, however, not clear if the reduction in levels of serotonin leads to depression, or depression results in a drop in the levels of serotonin (Hussain, 2010). Common medications of antidepressants have been designed to increase the levels of serotonin, aid in the production or regeneration of new brain cells, and reduce the levels and incidences of depression. There is a common belief that deficiency or low levels of serotonin cause depression, but it is still not possible to estimate the levels of serotonin in the brain (Shellman, Granara & Rosengarten, 2011).
Use of PHQ9 as a screening tool for depression
The challenge of depression in the elderly is the recognition of signs and symptoms or the frequent underreporting of the symptoms of depression in adults over the age of 65. Patient Health Questionnaire-9 (PHQ9) is a screening tool for identifying the symptoms of depression and can be applied in elderly patients. It enables straightforward identification of depression symptoms and improved treatment strategies that ultimately improve the survival, function, and life quality. A PHQ-9 depression scale is a self-reporting form of a questionnaire that serves the purpose of primary care usage and reflects the diagnostic depression criteria derived from the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders).
The PHQ-9 scale evaluates the endorsed number of items as well as their pattern in diagnosing minor and major depression. Its suitability for use in elderly patients links to the shorter period for testing than measures of screening for depression, excellent criteria, responsiveness, improved test reliability, and construct validity (Shellman, Granara & Rosengarten, 2011).
Plan of action and steps to take to minimize the risk of depression in adults
Exercise proves to be an effective depression treatment in the same or higher magnitude than psychotherapy or antidepressant medication. A simple plan of exercising can result in tremendous effects in improving ones moods, which translates to reduced depression levels (Lach, Chang & Edwards, 2010). However, the mechanism by which exercise reduces depression is still not clear, even though several studies have been interested in exploring the antidepressant impact of exercise on depression. For example, an exercise intervention group for the elderly can plan to walk for 30 minutes, thrice a week for 8 weeks.
This will yield effective results in alleviating depression symptoms. An individual plan of walking on a treadmill for about 40 minutes twice or thrice a week can also achieve significant results in reducing the symptoms of depression. According to Lach, Chang & Edwards, (2010), the elderly group can join various related community groups or resources to get motivation, determination, and consistency in dealing with depression.
Intervention
It is also evident that the benefits of involvement in exercise are long-lasting, with the elderly people involved in a fitness program reporting significant achievements in alleviating depression symptoms, self-concept, and anxiety, than those who never enrolled in such fitness or exercise programs. The elderly patients tend to be sedentary and must be motivated before initiation into a fitness or exercise program (Hussain, 2010). Recommendations can be issued on the exercising routines, for example, all participants must exercise daily for 30 minutes each day with a vigorous intensity. The elderly patients also need counseling in a stepwise magnitude and making them begin with enjoyable exercises. They should also be taught techniques for self-monitoring in order to add to the awareness of reinforcement and involvement in exercises (Lach, Chang & Edwards, 2010).
References
Hussain D. (2010). Stress, Immunity, and Health: Research Findings and Implications. International Journal of Psychosocial Rehabilitation. Vol 15(1) 94-100.
Lach, H. Chang, Y. & Edwards, D. (2010). Can Older Adults with Dementia Accurately Report Depression Using Brief Forms? Journal of Gerontological Nursing, 5: 30-37.
Shellman, J. Granara, C. & Rosengarten, G. (2011). Barriers to Depression Care for Black Older Adults: Practice and Policy Implications. Journal of Gerontological Nursing, 37: 13-17.
Depression may be used to refer to a wide range of effects from transient sadness to persistent symptoms to a clinical diagnosis (Ainsworth, 2000). Symptoms of depression increase with age. The increase can be attributed to the age-related changes in risk factors rather than to aging itself. It is not the process of aging per se that leads to mental ill-health (White, 2001). Older people are more susceptible to the risk factors implicated in depression such as chronic ill-health, disability and bereavement.
Statistics indicate that depression is common in individuals with other chronic ailments such as diabetes and arthritis. Depression is often identified as the most prevalent psychiatric disorder in the elderly and is usually determined by symptoms that belong to somatic, affective, and cognitive categories (Ainsworth, 2000). These symptoms can affect a persons daily physical and social functioning and can result in severe consequences if not addressed adequately.
Many people with depression are usually taken care of at home and treated by general practitioners, while others require more intensive attention and ongoing care by mental healthcare professionals (Marriner-Tomey & Martha, 2006). This paper seeks to discuss depression in older patients from the patients/ caregivers/relatives/carers perspective. The paper will also discuss the implications for and innovations in nursing care regarding depression in older patients.
Depression in older patients
Many older persons often show chronic illnesses. Depression is recognized as the most common complication of chronic illnesses and is classified as dangerous because it tends to worsen the chronic condition (Greenglass, Fiksenbaum, & Eaton, 2007). Studies indicate that the prevalence of depression in older patients with chronic conditions is approximately 30% worldwide. Persistent depression is problematic and is often associated with potentially harmful symptoms. As people grow older their ability to function decreases and many of them become unable to do things that they used to do for themselves. Studies indicate that certain demographic factors are associated with loss of function. These factors include age, female gender, and chronic ailments such as diabetes, arthritis, hypertension, and heart disease (Jeon, 2004).
Additionally, certain chronic conditions may also become more prevalent as people grow older and they include stomach ailments, vision and hearing problems, and respiratory conditions (Burgess, 2006, p. 45). General symptoms for depression include the presence of a depression mood; lack of interest in different recreational activities; reduction in body energy levels; poor concentration and attention; low levels of self-esteem and confidence; feeling guilty and unworthy; negative views regarding the future; self-harm ideas, including those of suicide; sleep disturbances; and a diminished appetite (Greenglass, Fiksenbaum, & Eaton, 2007). Depending on the number and type of symptoms observed, a patient can be categorized as having a mild depressive episode, moderate depressive episode, or severe depressive episode (DePaulo, Raymond, & Leslie, 2002). Additionally, the patient must have presented with this symptom for approximately two weeks.
Older people who show the above-mentioned conditions are likely to be depressed. These categories of individuals need resources in terms of coping strategies and social support. The support provided should be adequate to help the patient reduce distress. Previous research indicates that greater social support results in a significant reduction of depression and helps the elderly to attain better mental health (Solomon, 2001). It has also been established that older adults who are actively involved in social activities tend to have higher levels of physical and mental health, which includes lower incidences of depression, than those who are less socially active (Bacorn, 2003). Thus its advised that aging persons should select emotionally supportive relationships for them to successfully adjust to the problems related to aging.
Relative/caregivers role
Having an older relative with depression can be stressful and burdensome to family members. The immediate family members and other carers are integral in the provision of care for such patients and will often spend hours with their sick loved ones providing the support required (DePaulo, Raymond, & Leslie, 2002). Carers/caregivers are thought to play an important role in helping older adults to cope with aging diseases and the resultant depression. There is little research concerning the participation of family members in the hospital care of older depressed adults (Jeon, 2004). Coping as used in this paper refers to a multidimensional process that involves cognitive, behavioral, and emotional efforts to deal with stressful events that create demands on a person (Greenglass, Fiksenbaum, & Eaton, 2007, p. 61).
Community and mental health nurses also share in the role of providing care for older depressed patients. Most family members/ caregivers require the support of a community nurse to effectively supplement the care provided to their relatives. Indeed research shows that the family caregiver appreciates the presence of a nurse and often feels comfortable.
Most family care providers who look after the older depressed relatives generally perform the following tasks: being there to provide moral support; maintaining the patients connection with the outside world; giving reassurance and emotional support; engaging in religious activities such as praying; informing other relatives on the patients progress and bringing the different things requested by the patient; assisting with drinking, eating, bathing, going to the toilet, moving about and dressing; providing important information regarding the patient to the healthcare tram; ensuring that the healthcare team provides everything that is requested by the sick relative; working with the healthcare team to care for the family member; and giving an opinion on different decisions about the patients care (Nay & Sally, 2009).
Family caregiving is often challenging for nurses and other healthcare professionals as it demands a significant amount of tolerance. Some caregivers use culturally specific methods that may not be agreeable as per the established healthcare standards. Nurses are required to ensure the development of mutually beneficial relationships with caregivers. Additionally, they are required to talk to the caregivers and understand the kind of care that will be offered once the patient is discharged from the hospital or rehabilitation center (Miller, 2008). Thus before discharging older frail patients, the medical team should ensure that proper family arrangements are made for home care.
Implication for nursing care
Nurses from different specialties will often encounter depressed patients. Most nurses have been equipped with the basic approaches to care for depressed and physically ill patients. Nursing care for older depressed patients should ensure that synergy is established between the support provided and coping to result in better physical functioning. This can be achieved through effective relationship building, giving the required support and information, and thus facilitating a change in thinking patterns, activity, and skills (Gail, Shaffer, & Parmelee, 2000).
The nursing care needed for older depressed patients should be guided by the following principles: thorough assessments of the depressive symptoms should be carried out; a multidimensional approach that entails social, psychological, and physical approaches should be used; care should be provided in a coordinated manner; interventions used should be well-timed; physical conditions should be well monitored and any issues solved promptly; finally, the nurse should involve family members and other carers in the care of depressed patients (Marriner-Tomey & Martha, 2006).
Registered mental nurses may use a generic approach that is developed regarding specific assessments that may include risk assessment; detailed interventions that may comprise psychological treatment and management of different medications indicated; the registered nurse may additionally offer coordination of care functions, advice, and supervision of other healthcare professionals (Demitri, Demitri, & Janice, 2007).
Generally, nurses are required to have good personal qualities for them to offer effective care to depressed patients. The nurses should be able to understand how the patient is feeling and communicate the same to the patient in a warm, positive and accepting attitude (Jeon, 2004). Evidence-based practice indicates success rates are high when a nurse genuinely shares his/her feelings with older depressed patients.
Nurses are required to use their counseling skills to help older depressed individuals express how they are thinking or feeling. Such expression will result in relief and will also help the nurse assess the mental state of the patient. Some physical aspects of care that need to be put into consideration include monitoring of food and fluid intake; provision of preferred diets regularly but in smaller quantities; weight monitoring; sleep enhancement and assistance with personal care (Ainsworth, 2000).
Community mental health nurses should additionally establish a sound personal relationship with other caregivers as they all share a common goal of helping the patient to recover (Greenglass, Fiksenbaum, & Eaton, 2007). Such nurses who work in rehabilitative or community home settings should be able to see through the eyes of other caregivers who are supporting older depressed patients. Nurses should initiate the process of establishing constructive mutuality with caregivers/ carers through validation of their attitudes, action, and interactions; transformation of practice through activities such as formal meetings and informal talks (Nay & Sally, 2009).
The process of seeking mutuality with caregivers should involve the acceptance of the presence and open willingness to resolve negative emotions. Research shows that good working relationships between nurses and caregivers help nurses to pursue a professional position based on mutuality. As a result, the caregivers will be able to appreciate the presence of nurses and feel comfortable.
Generally, nurses should use evidence-based approaches to provide sufficient care for older adults suffering from depression and other associated ailments.
Conclusion
This paper sought to discuss depression in older patients from the patients/ caregivers/relatives/carers perspective. The paper has also discussed the implications for and innovations in nursing care regarding depression in older patients. Depression has been identified to be one of the most common conditions affecting older people. It is mostly associated with the chronic ailments acquired due to aging. Carers/caregivers play an important role in helping older adults to cope with depression. Nurses on the other hand use their professional skills, to assess, treat and offer effective care to depressed older patients. Evidence-based approaches must be utilized by nurses to ensure that depression is effectively tackled for best treatment results.
References
Ainsworth, P. (2000). Understanding Depression. Mississippi: University Press of Mississippi.
Bacorn, B. (2003). Nurse As Educator:Principles of Teaching and Learning for Nursing Practice. New York: Jones & Bartlett Learning.
Burgess, W. (2006). The Bipolar Handbook:Real-Life Questions with Up-To-Date Answers. New Jersey: Penguin.
Demitri, P., Demitri, P., & Janice, P. (2007). The Bipolar Child: The Definitive and Reassuring Guide to Childhoods Most Misunderstood Disorder. New York: Broadway Books.
DePaulo, R., Raymond, D., & Leslie, A. H. (2002). Understanding Depression:What We Know and What You Can Do About It. New York: John Wiley & Sons.
Gail, M. W., Shaffer, D. R., & Parmelee, P. (2000). Physical Illness and Depression in Older Adults:A Handbook of Theory, Research, and Practice. New York: Springer.
Greenglass, E., Fiksenbaum, L., & Eaton, J. (2007). The relationship between coping, social support, functional disability and depression in the elderly. Anxiety,stress and coping journal , 19(1) 15-31.
Jeon, Y.-H. (2004). Shaping mutuality: Nurse-family caregiver interactions in caring for older people with depression. International Journal of Mental Health Nursing , (13): 126-134.
Marriner-Tomey, A., & Martha, R. A. (2006). Nursing Theorists And Their Work. London: Mosby/Elsevier.
Miller, C. (2008). Nursing for Wellness in Older Adults. New York: Lippincott Williams & Wilkins.
Nay, R., & Sally, G. ( 2009). Nursing Older People:Issues and Innovations. Sydney: Elsevier Health Sciences.
Solomon, A. (2001). The Noonday Demon:An Atlas Of Depression. New Jersey: Scribner.
White, L. (2001). Foundations of Nursing:Caring for the Whole Person. California: Cengage Learning.
Peoples well-being is a complex phenomenon that focuses on physical, psychological, and social components. If a person experiences a problem with any of them, their life quality deteriorates. As psychological issues, they are widespread in the modern world, and depression is a typical example. According to Lewis et al. (2019, p. 904), the condition will be the leading cause of disability in developing nations in 2030. Furthermore, Kuehner (2017) claims that women have this mental disorder two times more oftener compared to men. Multiple factors contribute to the given state of affairs, and this fact means that depression should deserve sufficient attention. That is why it is necessary to take a comprehensive approach to analyze the issue. What are the typical symptoms of depression that are also found in the patient video, and what are the diagnostic criteria? How is it possible to describe the etiology of the given condition? What are the treatment guidelines considering the disorder under analysis? Thus, the case report will present the answers to these questions.
Depression Symptoms
In the beginning, it is reasonable to comment on the typical clinical features of depression. The given mental disorder is well represented in research, meaning that multiple scholarly articles consider the topic. For example, the study by Peres et al. (2017) focuses on depression symptoms. The scientists indicate that hopelessness, sadness, changes in appetites, fatigue and sleep disturbance are the typical clinical features of the condition under analysis (Peres et al. 2017, p. 6). It means that the mental disorder implies both physical and emotional symptoms. Additionally, Fitzpatrick et al. (2017) expand the number of potential clinical signs. Further features include little interest in the world, decreased self-esteem, low energy, and others (Fitzpatrick et al. 2017, pp. 6-7). All these symptoms indicate that depression significantly affects people subjecting them to multiple adverse consequences. As a result, depressive individuals cannot be fully-fledged members of society and even their families. It is so because their mental health issue catches all their attention.
Since the paragraph above has offered typical depression signs, it is reasonable to identify whether some of them are present in the case under analysis. A video by Coelho (2020) depicts a woman who is sitting in a flat. A state of disorder is evident after watching the video because the dishes are dirty, the clothes are lying on the floor, and the table is overloaded with multiple objects. These facts can demonstrate that the woman has decreased self-esteem. Furthermore, she can be considered hopeless and sad because she is crying. Appetite problems are also present because there is some food in front of the woman, but she draws no attention to it. Moreover, the presence of sertraline on her table also indicates that depression is a possible diagnosis because this medication reduces depressive symptoms in twelve weeks (Lewis et al. 2019, p. 904). However, this information is insufficient to claim that the woman is suffering from depression because different mental disorders have similar symptoms. Consequently, it is necessary to use specific and relevant criteria to find the answer.
Considering the claim above, one should focus on the professional documents, and the World Health Organisations (WHO) guidelines are a suitable option in this situation. It refers to the ICD-10 classification that presents criteria for medical specialists to make the correct diagnosis. According to the WHO (1993, p. 94), two weeks is the minimum duration of a mental disorder to qualify for a depressive episode. The video makes it impossible to state the precise duration of the womans condition, but the presence of dying plants on the table indicates that it is close to two weeks. Furthermore, hypomanic or manic symptoms are absent, meaning that it is possible to talk about a depressive episode. Now, it is necessary to determine its severity which can be mild, moderate, or severe.
The WHOs guidelines provide all the necessary information to make a specific diagnosis. The video shows that the woman has decreased energy and no interest in anything. Furthermore, it seems that she has feelings of excessive guilt and a change in appetite. The presence of dirty dishes shows that the woman used to have a decent appetite, but the current food in front of her does not evoke any interest. According to the WHO (1993), these symptoms allow supposing that the person has a mild depressive episode (F32.0). This conclusion is essential since it can help choose the most appropriate treatment approach to achieve the best health outcomes.
Etiology of the Condition
Since it is challenging to determine the etiology of the condition from the video at once, it is reasonable to identify the possible options found in the scholarly literature. Since it has already been mentioned that depression is a significant issue for the healthcare industry, it is not a surprise that many peer-reviewed articles address the topic. That is why this section will present all possible causes and conclude regarding which ones are the most suitable for the given case.
Firstly, it is necessary to mention that biological factors represent the etiology of depression. According to Anushivarani et al. (2018, p. 6373), they are alterations in hormonal regulation, immunological disturbances, fluctuations in biogenic amines, genetic factors, and others. This information demonstrates that numerous internal processes are responsible for developing this condition. For example, it is a popular idea that changes in serotonin levels can be interpreted as a depression cause since this neurotransmitter deals with relaying signals from one area of the brain to another. It results in the fact that various people consider bad brain chemistry or chemical imbalance the leading element of depression etiology. There is some reasoning behind this claim, which leads to the fact that clinical assessments are a valuable instrument to determine whether a person has this specific mental disorder. It is useful to analyze a patients blood sample to identify whether the values of some chemicals are elevated or lowered.
Secondly, one should mention that social factors can also become depression causes. The article by Hellman (2018) demonstrates that the environment can subject a person to mental disorders. It refers to the fact that the ambiance of the family determines whether people are more exposed to depression. For instance, it was shown that living with family members who abuse substances increases the chance of developing a mental condition (Hellman 2018, p. 150). Furthermore, people can often experience depressive symptoms when one of their relatives has a gambling addiction (Hellman 2018, p. 150). It is possible to assume that being in close contact with a person who has depression also increases the probability of experiencing its symptoms. This claim has a direct connection to the idea that a family history of mental disorders leads to an individual being at risk of suffering from possible symptoms.
Thirdly, it is worth emphasizing that psychological factors also contribute to developing depression. These factors encompass a wide variety of events and conditions that affect peoples feelings, emotions, and thoughts. Thus, Anushivarani et al. (2018, p. 6373) report that adverse life events and environmental stress are typical causes of depression. It is so because the loss of a family member or a quarrel with a friend can lead to depressive symptoms. Psychodynamic factors are included in this group of causes since the condition under analysis can develop if people fail to establish healthy relationships with the desired individuals. Additionally, Anushivarani et al. (2018, p. 6373) note that cognitive distortions have a direct relation to depression etiology. These phenomena are habitual negative thoughts that determine how people approach and interpret various situations. Disqualifying the positive is a typical example of cognitive distortion. It occurs in those cases when people only focus on adverse aspects of a situation, meaning that they cannot identify and value good events.
The information above has demonstrated that multiple factors constitute the etiology of the condition under analysis. It is impossible to mention that any of them is more influential than the others, meaning that each of them can equally result in depression. It allows supposing that every sphere of life provides individuals with sources of mental disorders, which explains the international spread of psychological conditions. In other words, since personal relationships, blood and brain chemistry as well as specific genetic background can result in depression, virtually no one can feel protected against the given condition. This information also denotes that sufficient attention should be drawn to every specific case to ensure that the causes are correctly established, which is necessary for the selection of an appropriate treatment approach.
When it comes to the patient video, it is challenging to determine a specific factor that has contributed to depression. Firstly, the video does not depict the womans clinical assessments, making it impossible to exclude biological factors. Secondly, social factors are not evident in the video, but it does not mean that they do not affect the patient. Thirdly, psychological factors that could be caused by an adverse life event are likely to be present in the case. It refers to the fact that the presence of felt pens and for For My Mum postcard allows supposing that something tragic has happened to the womans child. Although the psychological factors are more presented in the case, it is reasonable to consider applying the biopsychosocial model in the management of the condition under analysis to implement a comprehensive treatment approach.
Depression Treatment Guidelines
To begin with, one should explain what a biopsychosocial management approach is. According to Babaola et al. (2017, p. 291), this approach stipulates that mental health issues are caused by biological, psychological, and social factors, while no group has a predominant role over the others. In essence, this model stipulates that it is challenging to mention that a specific element is responsible for a condition since their combination results in a mental disorder.
When it comes to offering guidelines, it is essential to rely on evidence-based and reliable information. That is why it is reasonable to consider the National Institute for Health and Care Excellence (NICE) recommendations. These guidelines ensure that the most effective and suitable solutions are offered to achieve the best health outcomes. This resource is also essential because it mentions particular actions based on a specific depression type. However, it is worth noting that every depression case, irrespective of its severity, should imply common management steps. It refers to providing information, obtaining informed consent, supporting families and others (NICE 2009). These activities are essential because the depressive symptoms denote that people should be particularly approached to address their issues. The steps also make it possible to establish contact between a patient and a practitioner, which is significant because a trust-based relationship will allow the patient to disclose all the relevant information without doubt.
Since the case under analysis implies mild depression, the first step is to recommend general measures. According to the NICE (2009) guidelines, it is essential to make the woman address her sleep hygiene. Although the video does not show whether she has some sleep issues, patients with depression typically report such problems. Thus, it will be essential if the patient sleeps sufficiently, which is possible by avoiding excess eating and alcohol drinking. If the woman does not want an intervention, it is possible to provide her with information about the course of depression and arrange a further meeting. These simple measures can be useful if the patient has an evident desire and internal strength to overcome the impact of depression.
In contrast, if the patient wants to overcome the issue but does not know how to act, she should agree to participate in the intervention that implies a few possible options. Firstly, it is suitable to recommend individual guided self-help programs based on the principles of cognitive-behavioral therapy (CBT) (NICE 2009). This psychosocial intervention implies the provision of written materials and the assistance of an experienced practitioner to help the patient interpret the information and apply it. Secondly, it is possible to use computerized cognitive behavioral therapy (CCBT) that relies on a computer program to monitor the patients behavior, thoughts, and outcomes (NICE 2009). This option also implies specific tasks between sessions, which is considered more beneficial for patients. Physical activity programs in groups are also a practical step to address mild depression because this approach can provide the patient with social support. All these low-intensity psychosocial interventions should last for approximately twelve weeks to ensure that they affect the condition and generate positive results.
Since the previous paragraph has considered a psychosocial management approach, it is reasonable to comment on the biological factors of the biopsychosocial model. As has been mentioned, it is not known whether the woman has some issues with brain or blood chemistry. That is why she should be advised to stop taking sertraline. It is so because antidepressants should be prescribed if a person previously experienced moderate or severe depression, the symptoms are present for two years or other interventions are useless (NICE 2009). As a consequence, the absence of these conditions can denote that the intake of the drug will bring more harm than benefit. The biological factor indicates that it is not necessary to take medications unless there is clinical justification to prescribe some of them.
Conclusion
The paper has demonstrated that depression is a significant and widespread mental disorder in the modern world. Numerous people suffer from this condition, which exposes them to multiple symptoms. Even though different mental illnesses have similar symptoms, it is not challenging to diagnose depression because there are specific criteria to cope with the task. It refers to the World Health Organisations ICD-10 guidelines that are helpful for medical professionals to make the correct diagnosis. As for the case under analysis, the leading symptoms are decreased self-esteem, appetite problems, reduced energy, and a loss of interest. The report has also commented on the etiology of the condition. Evidence from scholarly articles has revealed that biological, psychological, and social factors cab become depression causes, which emphasizes the significance of the given issue.
Based on the information above, the paper offered specific steps to manage the patients depression. The National Institute for Health and Care Excellence guidelines were consulted to generate the most effective course of action. The proposed solutions can be considered adequate since they meet the requirements of a biopsychosocial approach. It refers to the fact that the low-intensity interventions address the psychosocial aspects of the issue, while the recommendation to avoid medication can improve a biological domain.
The information above denotes that the questions highlighted in the introduction have been answered in detail. The answers can be considered reliable since they are supported by the evidence from professional guidelines as well as scholarly and peer-reviewed articles. To conclude, the paper shows that a depression case can be effectively managed if diagnostic and treatment options are attentively selected and followed and if a multi-faceted approach is utilized.
References
Anushivarani, M. et al. 2018. Depression from the perspective of modern and Persian medicine. Electronic Physician 10(2), pp. 6372-6376. Web.
Babalola, E. et al. 2017. The biopsychosocial approach and global mental health: synergies and opportunities. Indian Journal of Social Psychiatry 33(4), pp. 291-296.
Coelho, N. 2020. Clinical case 1 MET461 anxiety and depression. Web.
Fitzpatrick, K. K. et al. 2017. Delivering cognitive behaviour therapy to young adults with symptoms of depression and anxiety using a fully automated conversational agent (Woebot): a randomised controlled trial. JMIR Mental Health 4(2), pp. 1-11. Web.
Hellman, M. 2018. Social causes of depression, anxiety and stress. Nordic Studies on Alcohol and Drugs 35(3), pp. 149-151. Web.
Kuehner, C. 2017. Why is depression more common among women than among men? The Lancet Psychiatry 4(2), pp. 146-158. Web.
Lewis, G. et al. 2019. The clinical effectiveness of sertraline in primary care and the role of depression severity and duration (PANDA): a pragmatic, double-blind, placebo-controlled randomised trial. The Lancet Psychiatry 6(11), pp. 903-914. Web.
Peres, M. F. P. et al. 2017. Anxiety and depression symptoms and migraine: a symptom-based approach research. The Journal of Headache and Pain, 18(37), pp. 1-8. Web.
World Health Organisation [WHO]. 1993. The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research. Geneva: WHO. Web.
Human beings become anxious in different situations that are uncertain to them. Depression and anxiety occur at a similar time. Anxiety is caused due to an overwhelming fear of an expected occurrence of an event that is unclear to a person. More than 25 million people globally are affected by anxiety disorders. People feel anxious in moments such as when making important decisions, before facing an interview panel, and before taking tests. Anxiety disorders are normally brained reactions to stress as they alert a person of impending danger. Most people feel sad and low due to disappointments. Feelings normally overwhelm a person leading to depression, especially during sad moments such as losing a loved one or divorce. When people are depressed, they engage in reckless behaviors such as drug abuse that affect them physically and emotionally. However, depression manifests in different forms in both men and women. Research shows that more women are depressed compared to men. This essay reflects on anxiety disorders and depression regarding from a real-life experience extracted from a publication.
Description Section
Every year almost 20% of the general population suffers from a common mental disorder, such as depression or an anxiety disorder (Cuijpers et al. 2016, p.245). I came across a publication by Madison Jo Sieminski available who was diagnosed with depression and anxiety disorders (Madison 2020). She explains how she was first diagnosed with anxiety disorders and depression and how it felt unreal at first. She further says that she developed the need to get a distraction that would keep her busy so that she wont embrace her situation. In her case, anxiety made her feel that she needed to do more, and everything needed to be perfect.
Madison further said that the struggle with anxiety is that it never seemed to happen, but it happened eventually. She always felt a feeling of darkness and loneliness. She could barely stay awake for more than 30 minutes for many days. Anxiety and depression made her question herself if she was good enough, and this resulted in tears in her eyes due to the burning sensation and overwhelmed emotions. In her own words, she said, Do I deserve to be here? What is my purpose? (Madison 2020). Anxiety made her lose confidence in herself and lowered her self-esteem. She could lay in bed most of the time and could not take any meal most of the days.
Madison said that since the sophomore year of high school, all was not well, and she suddenly felt someone in her head telling her to constantly worry and hold back from everything. She could wake up days when she could try a marathon to keep her mind busy. However, she sought help on 1 January 2020, since she felt her mental health was important, and she needed to be strong. She was relieved from her biggest worries, and what she thought was failure turned into a biggest achievement. She realized that her health needed to be her priority. Even after being diagnosed with depression disorders, she wanted to feel normal and have a normal lifestyle like other people.
Madison was happy with her decision to seek medical help even though she had her doubts. She was happy that she finally took that step to see a doctor since she was suffering in silence. She noted that the background of her depression and anxiety disorders was her family. It was kind of genetic since her mom also struggled with depression and anxiety disorders. Her mom was always upset, and this broke her heart. She said it took her years to better herself, but she still had bad days. Madison decided to take the challenge regarding her mothers experience. Also, Madison said she was struggling to get over depression since her childhood friends committed suicide, and it affected her deeply. She also told the doctor how she often thought of harming herself. The doctor advised her on the different ways she could overcome her situation after discovering she had severe depression and anxiety disorders.
Feelings Section
After going through Madisons story, I was hurt by the fact that he had to go through that for a long time, and something tragic could have happened if she had not resorted to medical help. I felt emotional by the fact that she constantly blamed herself due to her friends who committed suicide, and she decided to accumulate all the pain and worries. The fact that I have heard stories of how people commit suicide due to depression and anxiety disorders made me have a somber mood considering her case. In this case, you will never know what people are going through in their private lives until they decide to open up. We normally assume every person is okay, yet they fight their demons and struggle to look okay. Hence, it wont cost any person to check up on other people, especially if they suddenly change their social characters.
Evaluation
Madisons story stood out for me since she had struggled since childhood to deal with depression and anxiety disorders. In her case, she was unable to seek help first even when she knew that she was suffering in silence (Madison 2020). However, most people find it hard to admit they need help regardless of what they are going through, like Madison. People who are depressed cannot work as they lack the motivation to do anything. In my knowledge, depression affects people close to you, including your family and friends. Depression also hurts those who love someone suffering from it. Hence, it is complex to deal with. Madisons situation stood out for me since her childhood friends committed suicide, and she wished silently she could be with them. Hence, this leads to her constant thoughts of harming herself. Childhood friends at one point can become your family even though you are not related by blood due to the memories you share.
Analysis
Depression and Anxiety disorders have been common mental health concerns globally for a long time. Depression and anxiety disorders create the impression that social interactions are vague with no meaning. It is argued by Cuijpers (2016, p.245) that people who are depressed normally have personality difficulties as they find it hard to trust people around them, including themselves. In this case, Madison spent most of her time alone, sleeping, and could not find it necessary to hang around other people. Negativity is the order of the day as people depressed find everything around them not interesting.
People who are depressed find it easy to induce negativity in others. Hence, they end up being rejected. Besides, if someone is depressed and is in a relationship, he/she may be the reason for ending the relationship since they would constantly find everything offensive. Research shows that people who are clinically depressed, such as Madison, prefer sad facial expressions to happy facial expressions. Besides, most teenagers in the 21st century are depressed, and few parents tend to notice that. Also, most teenagers lack parental love and care since their parents are busy with their job routines and have no time to engage their children. Research has shown that suicide is the second cause of death among teenagers aged between 15-24 years due to mental disorders such as suicide and anxiety disorders.
Action Plan
Despite depression being a major concern globally, it can be controlled and contained if specific actions are taken. Any person needs to prioritize their mental health to avoid occurrences of depression and anxiety orders. Emotional responses can be used to gauge if a person is undergoing anxiety and depression. The best efficient way to deal with depression and anxiety is to sensitize people about depression through different media platforms (Cuijpers et al. 2016). A day in a month should be set aside where students in colleges are sensitized on the symptoms of depression and how to cope up with the situation. Some of the basic things to do to avoid anxiety and depression include; talking to someone when you are low, welcoming humor, learning the cause of your anxiety, maintaining a positive attitude, exercising daily, and having enough sleep.
Conclusion
Depression and anxiety disorders are different forms among people, such as irritability and nervousness. Most people are diagnosed with depression as a psychiatric disorder. Technology has been a major catalyst in enabling depression among people as they are exposed to many negative experiences online. Besides, some people are always motivated by actions of other people who seem to have given up due to depression. Many people who develop depression normally have a history of anxiety disorders. Therefore, people with depression need to seek medical attention before they harm themselves or even commit suicide. Also, people need to speak out about what they are going through to either their friends or people they trust. Speaking out enables people to relieve their burden and hence it enhances peace.
This presentation is going to provide an overview of a project dedicated to the implementation of NICE (2016) guidelines (the guidelines developed by the National Institute for Health and Care Excellence) at the VEGA Medical Center.
Problem Statement and Purpose
Objectives: project overview; discussion.
Depression: major, relatively widespread health concern (CBHSQ, 2016; Petrosyan et al., 2017).
VEGA Medical Center (Miami, FL): no guidelines!
Project purpose: providing VEGA specialists with NICE (2016) guidelines.
The objectives of this presentation are to review the key information about the project, including its PICOT, methodology, and outcomes, and to start a discussion with questions about it.
The project is devoted to a rather significant healthcare issue that is also relatively widespread in the US and the world: depression. Depression has negative consequences for patients, decreases their quality of life, and increases healthcare spending (Petrosyan et al., 2017). Moderate and severe types of depression have been affecting about 6% of the US population in the past few years (CBHSQ, 2016). As a result, the quality of depression management is of great importance. One of the approaches to improving it consists of the use of high-quality, evidence-based guidelines (Petrosyan et al., 2017). However, within the settings of the project, which is a primary care center VEGA, no direct guidelines were employed prior to the beginning of the project. During the needs assessment, it was determined that the potential negative consequences of the issue were acknowledged by VEGAs staff. Consequently, the purpose of the project was to rectify the problem and provide VEGA and its specialists with appropriate guidelines: NICE (2016) guidelines.
PICOT Question
In nursing staff at VEGA Medical Center (Miami, FL) (P), how does the implementation of NICE (2016) guidelines (I) affect (C) the accuracy of depression management (O) in the geriatric population within 8 weeks (T)?
The presented PICOT question was used for the project. As you can see, the population is the nursing staff of VEGA who adopted NICE (2016) guidelines as a form of intervention. No comparison was employed; instead, the nurses performance with respect to depression management in geriatric population was measured before and after the intervention. The intervention was adopted within the timeframe of 8 weeks, and the improvement of depression management quality was the desired outcome.
Theoretical Framework
Blend of change frameworks:
Iowa Model of EvidenceBased Practice (Iowa Model Collaborative, 2017): major steps.
Since the project consisted of a change, its theoretical framework was comprised of change frameworks. In particular, the Iowa Model of EvidenceBased Practice was used as the primary framework that can organize the entire project from its planning to information dissemination (Iowa Model Collaborative, 2017). The attention of the model on healthcare settings, change, and evidence-based practice introduction was considered its key advantage. Apart from that, Kotters (2012) 8-step change model and Rogers (2010) innovation diffusion theory (particularly, its part pertinent to innovation attributes) were integrated into the Iowa model to ensure the sustainability of the project. Kotters (2012) model provided the framework for leading the change, and Rogers (2010) theory introduced a model for individual change management. The resulting framework combined the positive features of every of the mentioned models.
Project Design -Methodology
Settings: VEGA Medical Center (Miami, FL):
Barriers: resistance to change, adoption period;
Facilitators: culture, stakeholders, alignment;
Final sample: 10 nurses;
Sampling: purposive, flyers;
Design: pre/posttest mixed methods study;
Quantitative data collection: NICE (2017) quality standards:
no exact validity/reliability data;
Qualitative data collection: group interview guide:
trialed and reviewed.
Step 1: Week 1:
Recruitment finalization;
First group meeting: training, feedback;
Step 2: Weeks 2-7:
Work with patients;
Performance recording: NICE (2017) standards;
Meetings: feedback, sustainability-related efforts (models by Kotter (2012) and Rogers (2010) to manage concerns);
Step 3: Week 8:
Final meeting: drawing conclusions;
Submitting performance reports.
Summative evaluation:
Eleven NICE (2017) quality indicators;
Weeks 1 and 8;
Secondary and primary data;
Formative evaluation:
Meetings (group interview guide);
Weeks 1-8;
Primary data.
The settings of the project should be briefly considered. VEGA is a primary care center that serves a diverse population, including geriatric patients and patients with depression. The settings were rather beneficial for the project; in particular, they had multiple facilitators, including all the stakeholders (managers and nurses), who were very supportive. Also, VEGAs culture and vision and mission were in line with those of the project. The anticipated barriers included the resistance to change, which proved to be nearly non-existent and was prevented with the help of Kotters (2012) and Rogers (2010) models. Apart from that, the adoption period proved to be a barrier, but it was brought down with the help of training and the same models. The timeframe and budget were also initially viewed as a potential problem, but both proved to be sufficient.
The project engaged the total of ten nurses with the help of flyers; the nurses of VEGA center were purposefully approached.
The project took the form of a pre/posttest pilot change that used both qualitative and quantitative methods. In particular, NICE (2017) quality standards were employed to collect quantitative data for summative assessment, and a specifically developed interview guide provided the tool for qualitative formative assessment. According to NICE (2017), the quality standards are reliable and valid, but the present study failed to find the specific figures that would describe their validity and reliability. The permission to use the standards, as well as the guidelines, was obtained. The qualitative tool was developed specifically for the project and has no validity or reliability statements, but it was reviewed with the help of specialists and trialed to ensure that it performs its function. The tool was employed during the meetings that were carried out throughout the project.
The intervention itself was first introduced to the nurses during the first week of the project. After signing the informed consent forms and, therefore, finalizing the recruitment process, the nurses were provided with all the information about the guidelines, as well as the relevant tools (decision-making flowchart and quality standards), all of which are offered by NICE (2016) free of charge. After the initial discussion, which demonstrated the preliminary approval of the guidelines, the nurses returned to their duties, with which they proceeded throughout the 8 weeks of the project while also recording their performance with the help of the NICE (2017) standards.
Apart from that, the nurses participated in meetings every week. The latter used the before-mentioned interview guide to gather feedback, provide support and training, and ensure the sustainability of change with the help of the principles of the models by Kotter (2012) and Rogers (2010). Eventually, during the final week, the final meeting took place and demonstrated the success of the project, and the performance reports were submitted.
As it was mentioned, the project employed the NICE (2017) quality standards for summative evaluation during weeks 1 and 8. During the first week, the secondary data that was already available for the nurses was used, and during the final one, new data was collected. As for formative evaluation, the meetings played the role throughout the project, producing primary qualitative data.
Evaluation Analysis
Summative evaluation:
NICE (2017) indicators;
Quantitative data;
SPSS: sign test (Frey, 2018);
Extraneous variable: justified non-compliance;
Formative evaluation:
Meetings (group interview guide);
Qualitative data;
Thematic analysis (Polit & Beck, 2017).
The analysis of the data was conducted accordingly. Thematic analysis was applied to qualitative data, which is a relatively common approach for this type of information (Polit & Beck, 2017). The quantitative summative evaluation was carried out with the help of SPSS and sign test, which was employed because it is a non-parametric test that works with non-normally distributed data and can be used for a pre/posttest study (Frey, 2018). Here, it should be mentioned that the quality standards by NICE (2017) are more rigid than its guidelines. As a result, the extraneous variable of reasonable non-compliance was introduced: such cases were not viewed as non-compliance if they could be explained with the help of the guidelines.
Results
By the end of the project:
100% compliance (except for reasonable non-compliance)
100% approval of nurses
No issues with usage
The following results can be reported. Each of the nurses had between 16 and 21 patients, but most quality indicators were applicable to fewer patients. For example, some of the standards describe the management of mild depression, and other ones are concerned with severe depression. Statistically significant changes were observed for Quality Standard 1 (assessment in accordance with NICE (2016) guidelines), Quality Standard 2a (depression management in accordance with NICE (2016) guidelines), and Quality Standard 11 (monitoring patients treating with pharmacotherapy in accordance with NICE (2016) guidelines). You can see the results for the first two standards. Note that the performance of the nurses with respect to these standards was relatively high pre-intervention. That was true for most quality indicators.
The Quality Standard 11 is presented as well. Note that the Quality Standard refers to a specific monitoring procedure not employed by VEGA before the introduction of the guidelines, which explains the changes in the figures.
However, as was shown during the interviews, the nurses approve of the new guidelines, and by the end of the project, 100% compliance was achieved with the exception of reasonable non-compliance. Similarly, the final meeting showed that by the end of the project, the nurses had brought down all the barriers, including the adjustment period, and had successfully adopted the guidelines.
Sustainability
Kotters (2012) and Rogers (2010) principles.
Nurses approval.
Positive outcomes.
Data for future change.
Barriers:
Adjustment period;
Training;
Resources (time, effort);
Lower speed;
Facilitators:
Appropriate guidelines;
NICE materials;
Training/recapping;
Support.
Thus, the guidelines have the nurses approval, and the project had demonstrated some positive outcomes while also providing some data on the processes of change, barriers, and facilitators that can be used by VEGA for future changes. The positive outcomes of the project may be connected to its management with the help of Kotters (2012) and Rogers (2010) models. All these features seem to suggest that the project can be sustainable.
The present slide shows specific barriers, as well as facilitators, that nurses reported throughout the project.
Implications for Practice
Proceeding with the change seems reasonable:
NICE (2016) can improve quality at VEGA;
Nurses approve of the guidelines;
Future change: data on guideline adoption (barriers, facilitators);
Future research: larger sample.
Important limitations of the study include the sample size and the lack of definite statements regarding the reliability and validity of the tools. Still, as a pilot change, the project has fulfilled its purpose: it showed that proceeding with the change appears reasonable since some statistically meaningful quality improvements are visible. Apart from that, the nurses are satisfied with the guidelines. The results cannot be generalized due to the small sample, but for the chosen microsystem, the decision to proceed with the change seems appropriate. Moreover, the study supplies some data for future change (for example, regarding the settings facilitators), and said change with a larger sample could also be used to produce more generalizable data concerning the effectiveness of the guidelines.
Conclusion
Pre/posttest mixed methods study; 10 nurses;
NICE (2017) standards and specifically developed interview guide;
Iowa, Kotters (2012), and Rogers (2010) models;
NICE (2016) guidelines can improve depression management at VEGA;
Future research with bigger samples.
In summary, the presented pre/posttest mixed methods study recruited 10 nurses from VEGA for a pilot change involving the implementation of NICE (2016) guidelines. It used NICE (2017) standards along with a specifically developed interview guide for evaluation. The project proved to be successful, demonstrating that NICE (2016) guidelines can result in quality improvement and are also favored by its nurses. Therefore, proceeding with the change seems reasonable, but future research with a larger sample could produce more generalizable results.
Acknowledgements
Dr. Pedro Martinez, my preceptor;
Managers, nurses, and staff of VEGA.
I would also like to thank the people who contributed to the development of this work. The support and feedback of my preceptor Dr. Pedro Martinez and the hard work of VEGAs managers, nurses, and staff made this project possible.
Every stage of life, including pregnancy, benefits from regular physical activity. It might be a key element in keeping women from developing depressive disorders after giving birth. Additionally, exercising during pregnancy is safe and beneficial for most women. Some alterations and safety measures to exercise routines may be required due to specific anatomical and physiological changes and fetal considerations.
Guidelines for Physical Activity
Regular exercise continues to benefit a womans overall health over a typical postpartum time. Studies have shown that womens mood and cardiorespiratory fitness improve when they engage in moderate-intensity physical activity in the weeks and months after giving birth to a child. The official guidelines by the U.S. Department of Health have been updated over the past years. Consequently, they confirm earlier advice to engage in at least 150 minutes per week of moderate-intensity physical activity during pregnancy and postpartum (U.S. Department of Health and Human Services, 2018). Spread out this activity over the course of the entire week. The guidelines suggest that women who were physically active before becoming pregnant or who regularly engaged in vigorous physical exercise continue doing so during pregnancy and postpartum.
Precautions and Considerations
However, a few alterations must be made for pregnancy exercises that the exercise professional must apply for safety. Suppose the new clients condition is after the first trimester of pregnancy. In that case, the woman should not perform workouts that require her to lie on her back since this position can block blood flow to the uterus and fetus (Committee on Obstetric Practice, 2020). Additionally, professionals should keep women from engaging in contact with crash sports and dangerous pursuits like horseback riding, downhill skiing, and other sports involving falling or other abdominal injuries. Additionally, professionals must control heat exposure and prolonged activity that should be undertaken in a thermoneutral setting or under-regulated environmental circumstances.
Conclusion
Therefore, when there is no fitness restriction, pregnancy outcomes improve, and there is no evidence that exercise causes harm. Exercise and physical activity during pregnancy helps women stay physically fit and may help them avoid gaining too much weight throughout the pregnancy. Preeclampsia, gestational diabetes and cesarean delivery risk may all be decreased by physical activity.
References
Committee on Obstetric Practice. (2020). Physical activity and exercise during pregnancy and the postpartum period. Obstetrics & Gynecology, 135(4). 178-188.
U.S. Department of Health and Human Services. (2018). Physical activity guidelines for Americans, (2nd ed.). U.S. Department of Health and Human Services.
