Case Study on Adolescent Depression

Case Study on Adolescent impressionThis case ask concerns a teenage religious service enforcer whom we shall refer to using a pseudo name, Katie, to maintain confidentiality in line with the nurse midwifery Council Code of Conduct (NMC, 2015). Katie suffers from a comorbidity of Type 1 Diabetes (T1D) and depressive disorder, and the focus of case study is on thedepression component. Managing and treating depression has proved to be sometimes difficult for both practitioners and diligents due to its multi-dimensional aetiology which is attributed to a combination of biological, environ amiable and personal factors. Its partake is equally challenging as it usually associated with poor disease control, adverse health outcomes and quality of life impairment (Andreoulakis, Hyphantis, Kandylis, Iacovides, 2012).The case study will explore pathophysiological and psychological perspectives in the aetiology of depression. The verifiable of the survey is to undertake a systematic e nquiry (Holloway, Wheeler, 2010). Using a real earth situation to gain a deeper understanding of the situation to try and solve a job and improve the current situation (Aitken Marshall, 2007).The utility of cognitive demeanour Therapy (CBT) is discussed as the discussion that was prescribed for Katie. The rationale is that CBT is relevant to the assessment outcomes and the symptoms presented by Katie.The GP referral to the Community kind Health Team rural beas that Katie is a 16-year-old enthusiastic teenager, who is in full-time education and savours extramural activities in school and in addition enjoys socialising. Recently Katie was diagnosed with type 1 diabetes (T1D) and prescribed insulin pump therapy. Following this diagnosis, Katie became remarkably withdrawn from friends and family, with expressions of hopelessness and low self-esteem. She has lost interest in the activities that she has been enjoying in her life. Her GP diagnosed depression. The condition has been getting worse and persistent for three weeks, putting a signifi backsidet lead on her parents, including two siblings who live with her. The GP concluded the case warranted specialist attention and referred Kate to the Community Mental Health Team.Katies referral notes suggested that her depression should be assessed further due to deterioration in her cordial health. The assessment highlighted significant depression symptoms much(prenominal) as poor sleeping patterns, burthen loss, burdensomeness, constant touching of sadness (National give for Health and Care Excellence, 2016). Also, self- loathing, insomnia, omit of energy, irritable mood, physical pains and a gloomy outlook on life including diminished pleasure in sweet activities were the contemporary (National Institute for Health and Care Excellence, 2016). The symptoms are likely to force on the ability to cope, personal relationships and the general quality of life (Pryjmachuk, 2011). To determine the severi ty of Katies rational health, the Registered Nursing Practitioner took the lead in completing a Patient Health Questionnaires (PHQ-9) with Katie. Katie scored as having major depression. This self-reporting tool is critical in aiding practitioners to bear depression as it can be apply to monitor, diagnose, and measure the severity of depression (Wu, 2014). The risk of harm is critical to the assessment of depression (NICE, 2016). Studies show that mental disorders are present in 90% of suicide cases in the UK, with depression found in 60% of the cases (Centre for Suicide Research, 2012). Hence, Katie was assessed on the risk of self-harm. However, she did not state any thoughts or actions of self-harm or suicide attempts. Due to the severity and the diverse nature of her symptoms an appointment was arranged for Katie to see the team Psychiatrist. Katie agreed to the decision. This led to the intervention discussed later in the essay.Katies symptoms include loss of appetite, and t here is substantial evidence that links eating disorders with depression, especially among young females (Allen, Crosby, Oddy, Byrne, 2013). As pointed out by Allen et al. (2013) alimentation disorders can lead to over eating, which contributes to some opposite problems such as obesity and type 2 diabetes, Loss of appetite can lead to malnutrition, Loss of weight and fatigue. Eating problems also lead to stomach aches, cramps and constipation (Allen et al. 2013). Literature also shows that depression is linked to nearly every other physical and mental illness, as according to the joint report (Royal College of Psychiatrists and Royal College of General Practitioners, 2009). Also, there is sufficient of evidence that physical illness disturbs our feelings and thinking, just as social, and personal melodic line can cause ill health (Royal College of Psychiatrists and Royal College of General Practitioners, 2009). Also, other diseases can trigger stress and onset depression, as is the case with Katie who got depressed after a diagnosis of diabetes. Oladeji Gureje (2013) suggest that patients can be caught in a vicious circle in which depression contributes to other present conditions and vice versa.Conceptualising the pathophysiology of depression is do complicated by the fact that while the majority of patients respond to pharmacological interventions such as antidepressants, some patients remain partially or wholly insensitive to drugs (Cryan, Leonard, 2010).In these illustrations, there are individual differences in the manifestation of depression that cannot be addressed in current drug regimes. It follows that treatment for depression need to be observed according to how each patients solution to treatment(Andersson, Cuijpers, 2008).And this should result centering in formulating Katies care plan in this study. However, there is research evidence that links depression for the maintenance of the homoeostasis and stress levels (Leonard, 2005 Crya n, Leonard, 2010). Stress is often surface-defined as a state of real or perceived threat to homoeostasis (Leonard, 2005). The homoeostasis process function is to provide the essential balance and stability in the proboscis systems to enable cells to sustain life (Clancy, McVicar, 2011).Stress to the homoeostasis will activate stress response to provide the required body function balance (Leonard, 2005). Critically to the depression paradigm, the stress response mechanism is mediated by multiple responses that involve the endocrine, nervous, and immune systems, which are collectively cognise as the hypothalamic-pituitary-adrenal axis (HPA) (Cryan, Leonard, 2010). Changes that happen to the HPA and the immune system as a result of chronic stress can trigger anxiety and depression (Leonard, 2005). Depression is also ascribed to imbalances that arise in the brain about serotonin, norepinephrine and dopamine (Charney, Feder Nestler, 2009).Evidence suggests that the physiological functions that are mediated by neurotransmitter serotonin include sleep, aggression, eating, inner behaviour and mood (Nutt, Demyttenaere, Janka, Aarre, Bourin, Canonico, Stahl, 2007). All these symptoms are much dominant in most depression cases, and indeed symptoms such as insomnia, loss of appetite undergo by Katie. Research also suggests that reduced production of serotonergic neurones that make serotonin has an impact on mood states and contributes to depression (Nutt et al. 2007). However, several lines of evidence suggest that neurotransmitter dopamine is twisting in motivating that drives to seek reward and pleasure, and it is believed low levels on this transmitter play a role when depressed stack cease to enjoy activities that they enjoyed in the past (Charney et al. 2009). Katie had been a vibrant juvenile and lost all the passion for passion when she was diagnosed with depression. Research suggests antidepressants play a role in astir(p) neurotransmitter imbalance s (Anderson, 2013). However, in the case of Katie, National Institute for Health and Care Excellence, NICE (2017), recommends that antidepressants should be used in young people and children only after choice therapies have been considered.The psychological impact of depression on the patient is concern with the patients concepts of self, how they conceptualise their illness and the world around them (Barlow, 2014). It is quite critical as this impact on behaviour and treatment outcomes (Sanders Hill, 2014). Above all, an analysis of Katies symptoms and assessment suggest there are significant psychological issues. The symptoms that relate to behaviour include lack of motivation as shown by poor school work and lack of interest in social events that she enjoyed before. She is no longer taking responsibility for occasional actions and routines. Katies care plan and treatment should aim to address this. There are also symptoms that relate to self. She felt continuously sad about he r present condition, resulting in emergency visits to her GP. In other words, Katie may have felt a loss of status and purpose, having become remarkably withdrawn from friends and family, she was not able to keep back a sense of confidence in her the future. Some of Katies psychological concerns can be addressed within the Community Mental Health Team workings with other paids and Katies Care-Coordinator, and also with Katies family. The support of family and friends could be mobilised to give emotional, spiritual and financial assistance, with her family assuming an influential ever-changing role and responsibilities when one person is ill (Washington Leaver, 2009). The motivation for Katies to participate in daily activities could be initiated by working with the Occupational Therapy to engage in activities at the community centre.Sanders and Hill (2014) examined the psychological impact of depression, in so far as it is conceptualised by the patient, as grounded in the concep t of self. They assert that the idea of self is concerned with perceptions and awareness of being, the pattern of perceptions, which is also concerned with consequences for personality and change (Sanders Hill, 2014). Also, a well-functioning self-characterised by assimilation and ability to respond to new experiences. However, a good self-process can become impeded by other impaired person -processes such as intrusive thoughts and any other perceptions that pose a threat and target the self (Sanders Hill, 2014). Threats to the self, which can be indispensable or external, can culminate in patterned restrictions on perceptions and response which is configured as depression expressed in symptoms such as permeative feelings of negativity (Sanders and Hill, 2014). This conceptualisation encapsulates Katies perception of herself as Katie could still enjoy her life only if she could change her perception of herself. Katies intervention needs to focus on changing her perception of hers elf.Specifically, the Nursing process involves identification of priorities as well as the determination of appropriate patient-specific outcomes and arbitration, thus determine the urgency of the identified problem and prioritising the patients needs (Ackley, Ladwig, 2013). In other words, mutual goal setting, along with symptom, pattern, recognition and triggers, will help prioritise interventions and determine which intervention is going to provide the greatest impact (Ackley, Ladwig, 2013). Heeramun-Aubeeluck, Luo, (2012) assert that collaborative care, behavioral interventions, and psycho-education are helpful in encouraging patients to maintain treatment and enhance psychological well-being and quality of life. The intervention elect for Katie in this case study is Cognitive Behaviour Therapy (CBT). CBT can be accessed through referral to Improving Access to Psychological Therapies (IAPT). CBT is supported by NICE (2017), and also various government publications over the y ears have recommended the use of CBT such as No Health without Mental Health (Department of Health, 2011) and Talking Therapies. CBT is concerned with how people think (cognition), how they feel (emotion) and how they act (behaviour) (Daniels, 2015). CBT is psychoeducational and focused on changing the way people conceptualise illness to influence their behaviour and attitude (Daniels, 2015). The objective of cognitive processing is to examine patients thoughts and help them to learn the skills of acknowledging negative thoughts, often referred to as negative automatic thoughts (NATs). They will then be able to re-evaluate these ideas using an objective framework, and this can involve using approach to gathering evidence for the validity of ideas, such as proof against and for, surveys, or asking a trusted other (Grist, 2011). The rationale for CBT in this study is that its characteristics as a therapy would be helpful to address Katies symptoms and profile, as mostly the symptoms t hat impact on her quality of life are of cognitive and behavioural nature.Equally important, a problem-solving approach will be adopted to structure and organise Katies nursing care and treatment. Katie will be involved in the whole process to empower her in her care plan through a person-centred approach and intervention that is evidence-based. Evidence-based interventions are practices or programs that have peer-reviewed, document empirical evidence of effectiveness. Evidence-based interventions use a continuum of activities, strategies, integrated policies, and services whose effectiveness has been verified or informed by research and evaluation (National Resources Centre for Mental Health Promotion Youth Violence Prevention, 2017).Gulanick Myers (2016) contend that intervention is a basis for excellence in nursing practice, which includes correctly identifying existing needs, as well as recognising potential needs or risk, planning, delivering care in own fashion to address actual and prospective needs as well as evaluating the effectiveness care. More importantly, nurses must be able to work autonomously with confidence with significant others, such as families, friends, and carers to ensure Katies needs are met, including self-care arrangement (Nursing and Midwifery Council, 2015). Besides, as the name suggests, CBT comprises distinct therapy approaches that the address either the cognitive or the behavioural aspects associated with mood disorders, including depression. In CBT cognitive and behavioural approaches can be used in combination or unilaterally (Dobson Dozois, 2009).The behavioural perspective in CBT looks at the surroundings and behaviour of the patient. Depressive symptoms are attributed to a decrease in environmental reward, reinforcementof depressive reactions and avoiding alternative actions that facilitate good health (Hopko, Lejuez, Lepage, Hopko, McNeil, 2003). The behavioural perspective to depression underpinned by the works o f Lewisohn (1974), who concluded that the pleasure obtained through interaction with ones environment increases the likelihood of a rewarding behaviour. Further, change in the environment could result in deficient response-contingent positive reinforcement (RCPR) which directly contributes to depression (Dobson Dozois, 2009). Dobson Dozois, (2009) highlights Response-Contingent affirmative Reinforcement as positive or pleasurable effects deriving from the behaviour of a person within their environment and the likelihood of increasing such conduct. Behavioural Activation therapy has proved to be useful in addressing deficient RCPR and improving mood and thoughts. This treatment focuses on availing activities that support environmental reinforcement (Hopko et al. 2003). twain the cognitive and the behavioural components of treatment would benefit Katie. Sheldon (2011) contends that CBT is a therapeutic approach that involves talks and conferences. In this therapy, the patients are involved in discussions, and they express their feelings, behaviours and thoughts to a CBT professional during the initial assessment (Sheldon, 2011). Kassel (2016)asserts the value of CBT as a therapy that teaches individuals how to think and react to certain stressful situations appropriately and can be used for some crossways a range of disorders including phobias, schizophrenia, depression, eating disorders, anxiety disorders, and relationship difficulties. When embarking on CBT interventions, the therapist uses information collected from an interview the patient in this case, it would be with Katie and guides her through a description of the CBT model of depression as it applies to her profile and symptoms (Kassel, 2016). Also, general models of how thoughts, moods, behaviours, and physical sensations interact are discussed, enabling identification of a model as it relates to the patients life. some(prenominal) lines of evidence suggest that CBT is one of the most effective t reatments when anxiety and depression present as the primary symptoms (Royal College of Psychiatrists, 2009). Further, CBT helps to make sense of a profound problem by breaking it down into smaller bits (Kassel, 2016). The National Centre for Biotechnology Information (2012) highlights that a combination therapy consisting of medical drugs and CBT has been establishing to be more efficient when that when medical specialty is used alone in patients with more severe, recurrent or chronic forms of depression in the acute treatment phase. However, as highlighted by RCP (2009) CBT does not a quick fix, and if the patient is feeling depressed, it will be difficult to concentrate on getting them propel. Further, CBT courses can last for six weeks to sixths months depending on the type of problem, and how motivated the patient is on engaging. CBT offers some significant advantages as an alternative therapy. Given all that has been mentioned so far, it is evident that CBT has considerable influence on the disease burden of depression as the treatment is safe and cheap (RCP, 2009). Also, it can administer as a self-help programme. CBT is now also delivered online, however, the quality of these trails is not always right wing (Andersson, Cuijpers, 2008). RCP (2009) notes that some research suggests that CBT may be better than antidepressant at preventing depression relapses. However, it is necessary for the patient to keep practising their CBT skills, even after they are feeling betterCONCLUSIONThe two dominant approaches to conceptualising and treating depression that is the physiological perspective and psychological perspective, offer plausible concepts in understanding the aetiology of depression, yet the patient may attach different conceptualization of the illness, which results from the idea of the self. The idea of the self is quite critical in treatment outcomes in so far as it mediates changes in cognition and behaviour. However, it has not yet been clearly established how the perspectives interact to cause depression symptoms. This case study highlights that when treating depression, it is essential to carefully monitor the response to treatment as some people will not respond to available therapies. Further, as some people dont respond to treatment, there is a herd of research that needs to be done to understand how antidepressants work in different people entirely. Finally, cognitive behavioural therapy has numerous benefits for patients, including, decreased psychological distress, ameliorate pain management, increasing self-efficacy, execute the sources of action required to manage prospective situations, better quality of life and function.ReferencesAckley, B. J., Ladwig, G. B. (2013). Nursing diagnosis handbook An evidence-based guide to planning care (10th ed.). St. Louis, Mocapital of the United Kingdom Elsevier MosbyAllen, K. L., Crosby, R. D., Oddy, W. H., Byrne, S. M. (2013). 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