MAJOR DEPRESSIVE DISORDER

By: Group 1

AUTHORS:
Akiya, Asliah Bucaling, Charme Dale Carbonilla, Martin King Genon, Lerej ann joy Guillena, Hannah Jacinto, Jane Laurente, Kevin Paul Macapobre, Jeryl mae Pepito, Kathleen Talaroc, Reymund

OBJECTIVES:
Patient centered Within 1 hour and 30 minutes of case Presentation The patients case will be presented clearly and be fully understood by the fellow students. The patients case will be discussed clearly and hence proper medication and treatments will be reviewing the reinforced appropriately Patients needs and priorities will be identified and reflect interventions on the recommendations goaled for the patients soon recovery.

STUDENT CENTERED:
Within 1 hour and 30 minutes of case presentation: The presenters will be able to: Impart knowledge with regard to patient case for the learning group. Present the case clearly with validity. Assume responsibility for clients rights for confidentiality Observe proper behavior in accepting corrections and suggestions raised by both clinical instructors and fellow student.

CRITIQUE GROUP
Impart necessary corrections for the improvement of the study. Raised sensible questions regarding to the case study presented goaled for the enhancement of the learning as well as improvement of the case study.

DEFINITION OF TERMS:

Amygdala- The amygdala is a structure in the limbic system that is linked to emotions and aggression. The amygdala functions to control fear responses, the secretion of hormones, arousal and the formation of emotional memories Appropriate affect- Expressing a full range of normal emotion which makes sense in the current situation. Ectomorph- An individual having a lean, slightly muscular body build in which tissues derived from the embryonic ectoderm predominate. Euthymic Mood- Pertaining to a normal mood in which the range of emotions is neither depressed nor highly elevated. Evasive- Expressing a full range of normal emotion which makes sense in the current situation. Major Depressive Disorder- is a mental disorder characterized by an all-encompassing low mood accompanied by low selfesteem, and by loss of interest

or pleasure in normally enjoyable activities. Flat Affect- a severe reduction in emotional expressiveness. People with depression and schizophrenia often show flat affect. A person with schizophrenia may not show the signs of normal emotion, perhaps may speak in a monotonous voice, have diminished facial expressions, and appear extremely apathetic. Also known as blunted affect. HippocampusAn area buried deep in the forebrain that helps regulate emotion and memory. Functionally, the hippocampus is part of the olfactory cortex, that part of the cerebral cortex essential to the sense of smell. Hypothalamus - is a portion of the brain that contains a number of small nuclei with a variety of functions. One of the most important functions of the hypothalamus is to link the nervous system to the endocrine system via the pituitary gland(hypophysis).

Neurotransmitters- A chemical that is released from a nerve cell which thereby transmits an impulse from a nerve cell to another nerve, muscle, organ, or other tissue. A neurotransmitter is a messenger of neurologic information from one cell to another. Oedipal complex- a boy's feelings of desire for his mother and jealously and anger towards his father. Prefrontal Cortex- is the anterior part of the frontal lobes of the brain, lying in front of the motor and premotor areas. This brain region has been implicated in planning complex cognitive behaviors, personality expression, decision making and moderating correct social behavior. The basic activity of this brain region is considered to be orchestration of thoughts and actions in accordance with internal goals. Slouched Posture- Kyphosis is the extreme curvature of the upper back also known as a hunchback.

INTRODUCTION
Major Depressive Disorder Major depressive disorder is described as a disturbance of mood involving depression or loss of interest or pleasure in the usual activities and pastimes. There is evidence of interference in social and occupational functioning for at least 2 weeks. There is no history of manic behavior and the symptoms cannot be attributed to use of substances or a general medical condition. The following specifies may be used to further describe the depressive episode:

This following are the types of Major depressive disorder:

1. Single Episode or Recurrent 2. Mild, Moderate, or Severe 3. With Psychotic Features 4. With Catatonic Features 5. With Melancholic Features 6. Chronic 7. With Seasonal Pattern 8. With Postpartum Onset

Major Depressive Disorder is one of the four major mental illnesses. The other three are bipolar disorder (feelings of both depression and mania), schizophrenia, and schizoaffective (a combination of both bipolar and schizophrenia). Major Depressive Disorder is characterized by uncontrollable feelings of sadness. These feelings can lead to suicidal thoughts and suicide. Sufferers may even experience mania, hallucinations (both auditory and visual). The disorder lasts longer than six months and affects all aspects of the patient's life.

SOCIAL FACTORS INCLUDES:

Stressful life events such as Death, Divorce, Isolation, Disappointment, Failure, and financial problem, in Early adverse experiences with inadequate parenting and physical and sexual abuse can lead to major depressive disorder,

Research has shown that depression is influenced by both biological and environmental factors. Studies show that first degree relatives of people with depression have a higher incidence of the illness, whether they are raised with this relative or not, supporting the influence of biological factors.

Situational factors, if nothing else, can exacerbate a depressive disorder in significant ways. Examples of these factors would include lack of a support system, stress, illness in self or loved one, legal difficulties, financial struggles, and job problems. These factors can be cyclical in that they can worsen the symptoms and act as symptoms themselves.

The prevalence of 12-month and lifetime DSM-IV MDD was 5.28% (95% confidence interval, 4.98-5.57) and 13.23% (95% confidence interval, 12.64-13.81), respectively. Being female; Native American; middle-aged; widowed, separated, or divorced; and low income increased risk, and being Asian, Hispanic, or black decreased risk (P<.05).

Women were significantly more likely to receive treatment than men. Both current and lifetime MDD were significantly associated with other specific psychiatric disorders, notably substance dependence, panic and generalized anxiety disorder, and several personality disorders.

I.PRELIMINARY IDENTIFICATION
Name: Miss. MDD Room Number: Ward 12 (female ward) Age: 19 Gender: Female Civil status: Single Date of Birth: January 5, 1992 Birth place: Danao, Cebu Province Cultural Group: Cebuano

Primary Language: Cebuano Religion: Roman Catholic Highest Educational Attainment: Undergraduate (stop during 1st year 1st sem) Occupation: N/A Usual Health care provider: Physician private doctor Reason for health Contact: MDD Date of Confinement: Source of History: 50% family Member 20% patient 30% Chart Attending Physician/s: DR. Coruna Impression/final Diagnosis: MDD w/ psychotic features

II.INFORMANTS:
Name: Father B Age: 57 y.o Intimacy: Functional Relationship Reliability: Very Reliable ( 90%)

INTERVIEWERS IMPRESSION AGAINST INFORMANT:

Interviewers impression against informant: On the course of the interview, informant showed willingness to answer all the questions ask by the Group. Moreover, he had been very cooperative and was honest with his answer. He even gives additional information about the patient,

III.CHIEF COMPLAINTS:
Dli na sya mukaon, ug mag.dupa dupa atubangan sa sto.nino as verbalized by the step father.

IV.PERSONAL IDENTIFICATION:

Ms. MDD stands 5 feet and 2 inches tall. She has black long hair. She has a fair complexion and thin body structure.

V.HISTORY OF PRESENT ILLNESS:

2 weeks Prior to Admission, patient was noted to have poor appetite panagsa nalang mo.kaon as verbalized by step father. Patient did not take a bath and was noted to be nag.hinoktuk ug dli dli mutingog pangutan.on. 1 week Prior to Admission, nagyaw yaw na sya ra isa sa iyang kaugalingon when asked. Patient will only answer madamay ramo. Father also noted patient having behavioral changes maluhod siya, mag dupa dupa atubangan sa Sto. Nino patient still refused to eat.

VI.HISTORY OF PAST ILLNESS:

Patient is a non hypertensive, non diabetic and non asthmatic. No previous hospitalization, no know food and drug allergies.

VII.ALLERGIES:

Client had no noted food, drugs or other allergies

VIII.MEDICATIONS:
Flouoxetine 2Omg 1 cap OD Risperidone 2mg 1 tab HS Biperiden 2mg 1 tab OD sentraline 50mg 1 tab OD w/out flouxetine

IX.FAMILY HISTORY:
Have a family member with psychiatric illness (mother side) Step Father is a owner of a small carinderia Occupation: 1st year college 1st semester. Alcohol: drinks alcohol occasionally. Cigarette: yes Drug/Allergies: NO

X.PERSONALITY:

Ms. MDD loves to be alone rather than to join other clients during games and therapy sessions. She rarely interacts with others.

XI.Psychosexual: Not assessed.

XII.CURRENT SOCIAL SITUATION:

hilomon pero dghan ug amiga labing Non alcoholic, non smoker Condition on admission: Calm, non cooperative, conscious

XIII. ASSETS:
As the group had observed, client has the ability to make comics and draw different kind of cartoon character. XIV. Dreams, Fantasies, and Value system: Client loves to cook foods. She also wants to finish her studies and graduate with a degree and to become an Architect or fashion designer someday.

XIV. DREAMS, FANTASIES, AND VALUE SYSTEM:

Client loves to cook foods. She also wants to finish her studies and graduate with a degree and to become an Architect or fashion designer someday.

ANAMNESIS

Father MDD and Mother MDD had given 3 children yet they were not married at all. Their youngest child which was Ms. MDD was being adopted by her fathers elder brother/Ms. MDDs uncle when she was still 7 moths old. According to her stepfather, Ms. MDD was given birth in full term pregnancy; its method of delivery was NSVD through a manghihilot. Mother MDD gave birth to a healthy baby girl which was Ms. MDD.

During infancy and early childhood, Ms. MDD wasnt able to be with her mother because she was already being adopted by her stepfather at 7months. Shes being taken cared well by her stepfather; she had given with a proper nutrition and was given with enough sleep. She started to walk at 1 yr old with first words spoken of papa and mama. She had her bowel and bladder control at the age of 1 yr. old.

In her middle adult childhood times, her usual playmates are her classmates and neighborhood friends. When she commit mistakes her father wont physically hurt her but instead her father would just properly scold her. She had experience cough, colds, mumps, fever, and chicken pox during childhood but she havent experience any serious illnesses before.

Her onset of puberty was at the age of 13. The first achievement that she had receive was service award when she was still in2nd year high school. She also loves to play badminton and volleyball together with her friends, and on the other hand she spends most of the time watching television and making sketch. At this age she had already experience any romantic involvements, she had her first boyfriend when she was still in 3rd year high school.

SPIRITUAL ASSESSMENT

MS. MDD emphasized the importance of religion in his life. She wishes to go to heaven if she dies. But the patient verbalized bsin dli nko ma.ad2 ug langit tungod sa akong sala or violations. In spiritual beliefs, for her it is a big factor that could influence her on how to live in goodwill with fear of God. Her family serves as her source of hope, in stressful time.

CULTURAL ASSESSMENT

MS. MDD has been experience treated to a quack Doctor for her mental disorder. She never used Herbal medicines. Her step father always brings MS.MDD and members of the family to the hospital if the quack doctor cannot heal their condition.

PROGRESS NOTES

October 20, 2011 Subjective: Patient has no subjective complaints seen always sitting in near the door. Wants to go home, fair appetite. Poor hygiene noted. Objectives: Examined awake, conscious, unresponsive patient are not respond to examiners questions. Depressed mood with appropriate affect. Has no taken a bath other parameter cannot be assume done due to unresponsiveness. Assessment: MDD w/ Psychotic features. Plan: cont. Medications, ensure proper hygiene

October 21, 2011 Subjective: Patient still does not respond. Has taken a bath. Poor appetite able to sleep poor hygiene Objectives: examined awake, conscious, unresponsive, does not respond to examiner question. Depressed mind with appropriate affect. Other parameters cannot be assessed due to unresponsiveness. Assessment: MDD w/ psychotic features Plan: Cont. Medications, Ensure proper hygiene.

October 22, 2012 Subjective: Patient still unresponsive and depressed. Poor hygiene noted. No measles. Objective: examined awake, conscious, unresponsive patient depressed more with appropriate affect. Has not yet taken a bath poor hygiene. Other parameter cannot be assessed. Assessment: MDD with psychotic features Plan: cont. medications ensure proper hygiene.

October 23, 2011 Subjective: Patient still unresponsive has not taken a bath. Poor hygiene noted. Wants to go home. Refused medications. Objectives: Examined. Awake, conscious, unresponsive patient, seen sitting near the door wearing white shirt, white shorts without slippers does not respond to the question asked by the examiner. Depressed mood with appropriate affect other parameter cannot be assessed. Assessment: MDD with psychotic features. Plan: Cont. medications. Ensure proper hygiene.

October 24, 2011 Subjective Patient still unresponsive has not taken a bath. Poor hygiene noted. Wants to go home. Patient still refused medications. Objectives: examined awake, conscious, unresponsive patient. Sees sitting near the door wearing white shirt, white shorts without slippers. Does not respond to questions assessed by examiner depressed mood with appropriate affect. Other parameters cannot be assessed. Assessment: MDD with psychotic features Plan: Cont. medication, ensure proper hygiene.

October 25, 2011 Subjective: Patient still unresponsive, poor hygiene noted. Has not taken a bath wants to go home patient still refused medications Objectives: Examined awake, conscious, unresponsive patient. Always sitting near the door. Poorly groomed does not respond to question asked by examiner. Depressed mood with appropriate affect. Other parameters cannot be assessed. Assessment: MDD w/ Psychotic features Plan: cont. medications, Ensure proper hygiene.

October 26, 2011 Subjective: patient still unresponsive. Refused med, Poor hygiene. Objectives: Examine awake, conscious, unresponsive patient, always sitting near the door, poorly groomed does not respond to question asked by examiner. Depressed mood with appropriate affect other parameters cannot be assessed. Assessment: MDD w/ Psychotic features Plan: Cont. medication, Ensure proper hygiene.

October 28, 2011 Subjective: Patient still unresponsive refused medications, poor hygiene. Has not taken a bath, wants to go Home. Objectives: Examined patient awake, conscious, unresponsive patient was sitting near the door when ask patient does not respond. Poor hygiene, refused medication. Assessment: MDD w/ Psychotic features Plan. Cont. medications, Ensure proper Hygiene.

October 30, 2011 Subjective: Patient still unresponsive was not taken a bath, poor hygiene noted, wants to go home, patient still refused medications. Objective: Examined Awake, conscious, unresponsive patient always sitting near the door. Does not respond to questions asked by examiner. Depressed mood with appropriate affect other parameters cannot be assessed. Assessment: MDD w/ Psychotic features Plan: Cont. Medication, Ensure proper hygiene.

November 1, 2011 Subjective: patient gives a thumbs up when asked how she is. She shahes her head no. When asked if she has taken a bath. Objective: Examined patient awake, conscious, with poorly groomed appearance she only responds by nodding and shahing her head no. other parameters cannot be assessed. Assessment: MDD w/ psychotic features Plan: Cont. Medications, Ensure proper hygiene.

November 3, 2011 Subjective: patient signals ok when asked how she is. Objective: Examined patient awake, conscious, with poorly groomed appearance wearing a white shirt and shorts. She only responds to questions by shahing her head. Other parameters cannot be assessed Assessment: MDD w/ psychotic features Plan: Cont. Medications, Ensure Proper hygiene.

November 5, 2011 Subjective: Patient gives a thumb ups when asked how she is. Objective: Examined patient, awake, conscious, with poorly groomed appearance wearing a white short and shirt. She has a flat affect. Assessment: MDD w/ psychotic features. Plan: Cont. Medications, Ensure Proper hygiene

November 9, 2011 Subjective: patient only looks the direction of the examiner when asked question Objectives: Examined patient awake, with poorly groomed appearance, wearing a white shirt and shorts. She is kneeling on the floor facings the windows and only looks in the direction of her examiner a few seconds when asked. Other parameters cannot be assessed> Assessment: MDD w/ psychotic features. Plan: Cont. Medications, Ensure proper hygiene.

November 11, 2011 Subjective: patient is responsive. Objective: Examined awake with poorly groomed appearance, wearing a white shirt and shorts. She only focuses briefly in the direction of the examiner when asked. Other parameters cannot be assessed. Assessment: MDD w/ Psychotic features Plan: Cont. Medications, Ensure Proper hygiene.

November 13, 2011 Subjective: Patient is responsive. Objective: Examined awake, unresponsive to question, with poorly groomed appearance, wearing a white short and shirts. She is crawling on the floor and only briefly looks in the direction of the examiner when asked questions. Other parameters cannot be assesses. Assessment: MDD with Psychotic features. Plan: Cont. medications. Ensure proper hygiene.

November 15, 2011 Patient MS.MDD, 19 years old. Patient female admitted on October 19, 2011 for MDD w/ psychotic features. Patient is always sitting near the door and is usually unresponsive to questions she has poor hygiene. Please do MSE. Progress notes every 2 days.

DSM IV TR

PSYCHODYNAMICS

Psychodynamics is the systematized study and theory of the psychological forces that underlie human behaviour, emphasizing the interplay between unconscious and conscious motivation and the functional significance of emotion.

Major depressive disorder is a mental disorder characterized by an allencompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activitiesfeeling of guilt, difficulty in concentrating, loss of appetite, and thoughts of death or suicide.The most common time of onset is between the ages of 20 and 30 years, with a later peak between 30 and 40 years.(http://www.wikipedia.com)

The patient is a female adolescent with no known relative who has the same illness as her. During adolescent stage teenagers are more prone to rebellious acts regardless of gender. Ms. MDD was starting to make some decisions in her own in which she was trying to leave her childhood years and formally enter the world of an independent individual. During her college years she was starting to go out with her friends and sometimes came home late at night that may lead Ms. MDD to exposed such stressor.

When she was 7 months Ms. MDD was raised by her uncle in her father side and treats her as a real daughter because her parents was not able to get married, she called her uncle as a papa and they have a strong relationship as a father and daughter she dont have any conflicts towards the family members of her uncle. Diathesisstress model is a psychological theory that explainsbehavior as a result of both biological and genetic vulnerabilityThis model thus assumes that the onset of a certain disorder may result from a combination of one's biological disposition towards the given disorder and stressful events that bring about the onset to such disorder.(http://www.wikipedia.com)

Ms. MDD is an introvert type of person who is quiet and more often relates in the inner world of ideas and thoughts rather than expressing. During her high school year (3rd year) when she enter in her first intimate relationship that last for about 4 months.She dont have any close friends or best friend she just hanging out with her classmates that she consider as friends with different personality without knowing them better.

The psychodynamic understanding of depression defined by Sigmund Freud and expanded by Karl Abraham is known as the classic view of depression. That theory involves four key points: (1) disturbances in the infant mother relationship during the oral phase (the first 10 to 18 months of life) predispose to subsequent vulnerability to depression; (2) depression can be linked to real or imagined object loss; (3) introjection of the departed objects is a defense mechanism invoked to deal with the distress connected with the object's loss; and (4) because the lost object is regarded with a mixture of love and hate, feelings of anger are directed inward at the self. (Kaplans and Saddocks)

Ms. MDD family is belong to low socio economic status they have a small business outside their house that contributes to their daily income. They live in a squatter area near the public market. Poverty is associated with increased risk of mental health problem in general, stressful life events are strongly associated with the onset of major depressive episodeslack of social support may increase the likelihood that life stress will lead to depression, or the absence of social support may constitute a form of strain that leads to depression directly. (http://www.wikipedia.com)

DISCHARGE PLAN
MEDICATIONS DOSAGE NURSING INTERVETION

Biperidine

20mg/tab OD

Watch out for possible side effects: Blurred vision ( avoid driving in activities that require alertness and visual acuity). Nausea (try frequent small meals). Dry mouth (suck sugarless lozenges or ice chips) Painful/difficult urination (empty bladder immediately before each dose). Constipation (maintain adequate fluid intake and

MEDICATIONS

DOSAGE

NURSING INTERVENITION Take this drug exactly has prescribed. Manage manifestation of psychotic disorder.

Flouxetine

20mg/ tab 1 Tab OD

Tell patient to avoid taking drug in the afternoon because fluoxetine commonly causes nervousness and insomnia. Drug may cause dizziness or drowsiness. Warn patient to avoid driving and other hazardous activities that require alertness and good psychomotor coordination until CNS effects of drug are known.

MEDICATIONS

DOSAGE

NURSING Tell patient to consult doctor before taking other prescription or OTC drugs.

Sentraline

50mg 1 tab OD w/out flouxcitine

Monitor patients mental status carefully. Stay alert for mood changes and indications of suicidal ideation, especially in child or adolescent. Evaluate neurologic status regularly. Institute safety measures, as appropriate to prevent injury.

MEDICATIONS

DOSAGE

NURSING INTERVENTION Monitor temperature.watch for fever and other signs or symptoms of infection. Advise patient to take once a day, either in morning or night, with or without food. Instruct patient to mix oral concentrate with 4 oz of recommender liquid only. Advise her to swallow diluted drug immediately after mixing. Tell patient using oral concentrate that drug contains alcohol.

MEDICATIONS Risperidone

DOSAGE 2mg 1 tab HS

NURSING INTERVENTION Obtain baseline blood pressure measurements before starting therapy, and monitor pressure regularly. Watch for orthostatic hypotension, especially during initial dosage adjustment. Monitor patient for tardive dyskinesia, which may occur after prolonged use. It may not appear until months or years later and may disappear spontaneously or persist for life, despite ending

EXCERCISE
Exploration of daily activities like stretching, active range of motion and walking exercises whenever she can. Teach and demonstrate to the client ROM exercise that promotes wellness until to the full recovery of the patient. Instruct client to avoid strenuous activity.

THERAPY
Encourage client to involve self on activities/therapies: DANCE THERAPY MUSIC THERAPY ART THERAPY Psychosexual rehabilitation program or a mental health support group for clients and families.

A combination of psychotherapy and medications is considered the most effective treatment for depressive disorder. Behavior therapy seeks to increase the frequency of the clients positively reinforcement interactions w/ the environment and to decrease negative interactions. Cognitive therapy focuses on how the person thinks about the self, others, and the future and interprets his or her experience. Interpersonal therapy focuses on difficulties in relationships, such as grief reactions, role disputes, and role transitions.

HEALTH TEACHINGS
SUICIDE Evaluate client for suicide. Ask patient about the advantages and disadvantages of suicide. Advice client or family members avoid stress activity. Evaluate the clients access to means of suicide. Teach about the importance of maintaining with the community and participating is supportive organizations and care.

Self care and proper nutrition. Encourage client to perform independently as many activities as possible. Provide positive reinforcement for independent accomplishments. (Independent accomplishment and positive reinforcement enhance self-esteem and promote repetition of desirable behaviors.

A patients support system may come from several sources, including the family, a professional residential or day program provider, shelter operators, friends or roommates, churches and synagogues, and others. Because many patients live with their families, the following discussion frequently uses the term family. However, this should not be taken to imply that families ought to be the primary support system.

OPD
Remind client of post consultation schedule with psychiatrist/physician pertaining to location, time and day of consultation. Encourage the client to report on the physician if adverse effects of medications are severe.

DIET
Consume and maintain a well balanced diet such as fruits and vegetables. Adequate intake of fluid. Since Saturated fats, cholesterol and trans fatty acids serve no health benefit, it is recommended that intake be reduced to the lowest level possible needed to acquire a nutritionally adequate diet.

SPIRITUAL

Encourage the client to keep faith in GOD and PRAY.

RECOMMENDATIONS

This Recommendation is intended for the improvement and betterment not only of this research but also for our patients, his family, and to the society. TO THE PATIENTS FAMILY: We would like to propose to the family to provide further emotional support to the patient and to focus on giving her more attention than he was given before. This is for the patient to feel more loved plus this would also serve as a monitoring on the patients behavior and improvement. .

TO THE HEALTHCARE RESEARCHERS: As Healthcare providers, we would like to recommend further researchers on the treatment of this disease; a specific treatment that is. Also, we advise to maintain the clients identity as confidential. TO OTHER STUDENT RESEARCHERS: If by chance we missed to place other informations, we are open to your ideas and add ons with regards to this topic

Prognosis

Document

Onset of illness (if acute or Chronic)

Acute: Good Chronic: Poor

An untreated episode of depression can last to 60% of people who have an episode of depression will have another. After a second episode of depression, there is a 70% chance of recurrence.

Precipitating factors ( if present or absent)

Present: Fair Absent: Poor

Poverty and social isolation are associated with increased risk of mental health problems in general. Child abuse (physical, emotional, sexual, or neglect) is also associated with increased risk of developing depressive disorders later in life. Such a link has good face validity given that it is during the years of development that a child is learning how to become a social being. Abuse of the child by the caregiver is bound to distort the developing personality and create a much greater risk for depression and many other debilitating mental and emotional states. Disturbances in family functioning, such as parental (particularly maternal) depression, severe marital conflict or divorce, death of a parent, or other disturbances in parenting are additional risk factors.
)

Family support (if strong/weak/poor/absent)

Strong: Good Weak: Fair Poor: Poor Absent: Poor

Abuse of the child by the caregiver is bound to distort the developing personality and create a much greater risk for depression and many other debilitating mental and emotional states. Disturbances in family functioning, such as parental (particularly maternal) depression, severe marital conflict or divorce, death of a parent, or other disturbances in parenting are additional risk factors.

Depressive feature (if present/absent)

Present: Good Absent: Poor

Clients with depression have difficulty fulfilling roles and responsibilities. They have problems going to work or school; when there, they same unable to carry out their responsibilities. In addition to the inability to fulfill roles, clients become even more convicted of their worthlessness for being unable to meet life responsibilities.

Mood and Affect (if appropriat e/inappro priate)

Appropriate: Good Inappropriate: Poor

Client with depression may describe as hopeless, helpless, down or anxious. They also may say they are burden to others or are a failure at life, or they may make other similar statements. They are easily frustrated, are angry at themselves and can be angry at others. They experience anhedonia, losing any sense of pleasure from activities they formerly enjoyed.

Willingness to take Meds

Poor

They often cannot make decisions or choices because of their extreme apathy or their negative belief that it doesnt matter anyway

BIBLIOGRAPHY

Psychiatric Mental Health nursing 7th ed., by Louise Rebraca Shives Psychiatric Mental Health Nursing 3rd ed., Sheila L. Videbeck Mental Health Nursing by Mary Townsend Nursing Diagnoses in psychiatric Nursing - Care plan and psychotropic Medications by Mary C. Townsend. Nursing care Plans by Doenges, Moorhouse and Murr Kaplan and Sadocks synopsis of psychiatry 10th ed. By Sadock and Sadock. Mental Health and psychiatric Nursing Compilation By Madale www.Wikipedia.com