Mechanism of Development and Pathophysiology of Major Depressive Disorder - Essay Example

? Tina’s Major Depression Disorder Task Introduction Major depression disorder is a mental disorder that affects a person’s brain and its normal functioning particularly when it comes to thought and emotions. It is more than a feel of sadness or feeling ‘down and blue’. Diagnosis of a patient suffering from depression disorder would articulate, sadness accompanied by several psycho physiological changes such as insomnia or irregular sleeping patterns, crying, suicidal thoughts, reduced desire to socialize with family and friends, loss of appetite and reduced reflex reaction especially in speech and movement. Melancholia or vital depression is slightly much narrower terms used by some people to refer to severe depression. Bipolar Depression is a medical term used to refer to a condition where Major Depression Disorder is witnessed in a patient with a history of episodes of mania. In this paper, I will talk more about Major depression disorder, its causes, effects treatment, and the multiaxial system and relate to the case study about Tina’s story. Causes and effects According to the biopychosocial model, depression is caused by biological, social and psychological factors. The diathesis stress model on the other hand, points out that depression results when a vulnerability that has been existing in an individual is activated by stressful life events and experiences. Depression is evident in women more than men and this development is attributed to the fact that women experience a lot of hormonal changes like for example during menstruation, pregnancy, miscarriage or puberty which are all instances where they have sharp mood swings. Some women experience premenstrual syndrome (PMS) known as dysphoric disorder (PMDD) which is associated with changes in hormone levels that occur around ovulation and before menstruation begins. In addition, most women experience an addition in stress because of home and work responsibilities; where they are abused, have to look after the children, the elderly and relationship strains. This is not evident to all women as some actually find a way to cope with the stress situation. In men with stress, the reaction is quite different from that in women, having difficulty in sleeping, behaving recklessly, getting angry and sometimes abusive. They then tend to turn to drugs or abuse alcohol to tame the situation. Some become work addicts to try to destruct themselves from the impending situation or just try to ignore it. Depression in children on the other hand, is likely to continue through to their adulthood, causing a more severe form of depression as they grow up. A child suffering from depression is likely to pretend to be sick for example not wanting to go to school, be clingy to their parents or a figure that they idolize. They are mostly negative and irritable always getting into trouble, like in school for example. Because these signs are similar to normal, mood swings in children as they grow up, it may be difficult to diagnose them with depression. Before they get to puberty, both boys and girls are most likely to get into depression due to the hormonal influences, in girls more than boys are. Teen years are tough because they tend to develop quickly forming identity of their own, dealing with gender issues and sexuality. They want to be making independent decisions without their parents guide and experience new adventures that the world around them may be offering. Depression in adolescence often comes with other disorders as anxiety, drug and substance addiction, or eating disorders. It may also end up leading to suicidal thoughts (National Institute of Mental health, 2011). Diagnosis and Treatment Like any other condition that affects the body, the earlier it is detected, the more efficient the treatment will be. When one visits a doctor or mental specialist, a test is conducted to find out whether the patient is suffering from any other disorder that may be the cause of the stress like viruses; a physical exam to rule out the main cause through a lab test or an interview. If there is no medical condition, that may be causing the problem, there is a need for psychological evaluation. A mental health professional will then discuss any history of mental disorder to get complete details of stress and find a better solution. The most common treatments are psychotherapy and medication once the patient has been diagnosed with Major Depression Disorder. Medication includes Antidepressants, which work on brain chemicals, neurotransmitters serotonin and norepinephrine, while the neurotransmitter dopamine is affected by other antidepressants. These chemicals are involved in regulating mood as has been proved by scientists but the exact way in which they work is still not clear. Tricyclics are powerful antidepressants not used much because of their serious after effects. They may cause dizziness, weight gain, drowsiness, dry mouth and sometimes affect the heart for people with heart conditions. Other antidepressants are Monoamine Oxidize inhibitors (MAOIs) which are used for mild cases of depression. Not all antidepressants have an effect until after around four to six weeks before their effect can be noticed, and taken fully as the doctor prescribes. One can easily opt to try another medication if one does not work, until the disorder is cured. Talk therapy or Psychotherapy also helps to deal with depression. There is cognitive behavioral Therapy and Interpersonal Therapy. Cognitive behavioral helps patients streamline negative thought patterns enabling them to interpret their interaction with people and their environment in a more positive way. It helps in the identification of the features that contributed to the depression in the first place and help in behavioral change to reduce depression. Interpersonal on the other hand, helps patients comprehend and resolve troubled relationships causing their depression or making it worse (National Institute of Mental health, 2011). Psychotherapy may only work effectively on mild depression cases, however, for severe depression cases, medication is the best treatment, sometimes even both. Finally, in severe cases of depression, Electroconvulsive therapy is applied to cure the patient who fails to respond to either Antidepressants or psychotherapy. In this type, electricity is passed through the brain for about one to two seconds to produce controlled seizure. This method is controversial in that it can cause memory loss and disorientation to the patient (Heaton, 2003). Multiaxial System The DSM (The Diagnostic and Statistical Manual of mental disorders) is the standard classification by caregivers in America in diagnosis and treatment as well as collecting and relaying correct public health. DSM consists of three components majorly, diagnostic classification, diagnostic criteria and descriptive text. It uses a Multiaxial System to assess and provide a comprehensive diagnosis that has a complete picture of not only the acute symptoms but also the entire factors that affect health. The multiaxial evaluation concept is that a patient is diagnosed in terms of different information systems that are of that individual’s highest clinical value. It allows diagnosis be referred to as a process of environmental adaptation to the environment psychologically, biologically and socially (Oken, 2000), and allows for a more comprehensive account of that individuals health. Axis I, also the Clinical Syndromes at the top level of the DSM represents acute symptoms of mental disorder that need treatment. This Axis’ diagnosis are the most popular, recognized widely and are classified according to V-codes by the medical industry (V-codes are codes that indicate conditions that are not attributed to some mental disorder but rather those that are a focus of the treatment. Such conditions may be occupational problems, interpersonal (history), or family stress). All psychiatric diagnoses are on this axis, except mental retardation and personality disorder reported on axis II. “This is the traditional "diagnosis" that brings the patient to psychiatric (or other mental health) attention. Up to a point in time before that happened, the patient had been functioning more or less adequately. Traditionally, one would say that the patient had been well and became sick” (Oken, 2000). Axis II, (Developmental disorders and Personality disorders) include diagnoses of mental retardation and personality disorder. The diagnoses made here are often hard to identify and are always noticed after a few visits to the physician. Axis II diagnosis is specific and should not be made when the patient is suffering from Axis I diagnosis. An example would be diagnosing a person with personality disorder when he/she is still suffering from depression, depression in this case does not allow a correct evaluation of an individual’s personality. In Axis III (Physical disorders and conditions), all physical diseases are mentioned for example HIV/AIDS, whether the disease symptoms witnessed are psychiatric disorder related or not. The medical stipulation of an individual is important to detect, manage and understand their mental disorder. Mental disorders and general medical conditions can be related in several ways where in some cases the individual’s health is a direct factor influencing their mental disorder. When a mental disorder is diagnosed to be a direct physiological result of the general medical condition, it should then be recorded on both axes I and III. Some general medical conditions may not directly have a relation to the mental disorder but have important implications in their treatment. An example of this is when the diagnosis on Axis I is arrhythmia, the choice of medication for the depressive disorder is influenced by the condition arrhythmia (National Institute of Mental Health, 2011). Axis IV (Psychosocial and Environmental Stressors) lists all stressors, past and present which have an impact on the patient at the time of evaluation. These stressors may include experiences from childhood to the present age. Some Psychological factors include Environmental deficiencies, Family or Interpersonal stressors, inadequate social support, and Negative life experiences in some events, divorce, unemployment. Axis V (Global assessment of Functioning) gives a broad evaluation of the individual’s ability to cope with their current life situation and can be used as a measure of need for hospital admission. Information from this axis helps to plan treatment measure its impact, and predict the outcome of the treatment. Here the doctor rates the person’s rate of functioning, both presently, and the level of the highest within the past few months. It helps understand how the above four axes affect his patients and the type of changes that may start happening. GARF scale (Global assessment of Functioning) is used to show an overall diagnosis of the family of individual and is rated as GARF of 81-100 Overall, which shows that the individuals’ rate of functioning is satisfactory. The atmosphere in the family is appropriate, general feeling of warmth, caring and love. GARF of 61-80 Overall indicates that the functioning of the patient is somewhat unsatisfactory, warm feelings are shared within the family but there is still a bit of tension. Sexual activity in adults may have arguments or sometimes reduced. There are evident instances of emotional blocking and tension frequently. In GARF of 41-60 Overall, the relationship is clearly not functioning well in the family or among loved ones. Anger and emotional complications take shape and interfere with the normal happiness. In GARF of 21-40 Overall, there is serious dysfunctional relationship between the units involved. Frequent distancing or evident hostility is quite evident leading to painful moments within the time that may have been set aside for enjoyment. In GARF of 1-20, there is little or no time to consider each other’s emotional needs particularly in relationships. There is no sense of attachment, concern, commitment for one another at all (Berman). Tina’s Case In the case Study about Tina’s Story, we get to know about her life ever since she was a child. Tina has been undergoing through several challenges in an attempt to find happiness. In the story, we find out that the start of her problems is in her childhood, when her father left her family, blaming herself for this action. She then gets married to Joe straight out of high school, having so many expectations for the two of them only to find out that her plans are to fall to pieces. In her attempt to work harder on her work to make their life better, working for two companies, Tina neglects her Joe often finding her tired from work then to sleep. Since she could not sexually satisfy her husband, let alone spend more time with him, Joe leaves Tina for another woman, making her more depressed. She feels that if Joe had left her for some other woman, it must be because she was not good enough either just like the time her father left. Tina has no one to talk to and finds herself depressed and crying most of the time. Tina’s friends start neglecting her because they are tired of her constant whining and want for sympathy. Her sister on the other hand, the only other person she would feel better talking to committed suicide four years back, after depression from her broken relationship. These entire events lead her to feel low and worthless, disrupting most of her daily routines like going to the gym or even showing up for work. She finds herself getting little or no sleep at all, losing appetite, and even having suicidal thoughts. There is no history of treatment she had had in her past; hence, the symptoms show that she definitely has bipolar depression. Symptoms like feeling hopeless, sad, physical and mental sluggishness, appetite loss, sleep problems, feeling of worthlessness, guilt, thoughts of suicide are all signs that she possesses. She is at the point where failure to seek a psychiatric diagnosis may lead to actual suicide. Tina is at the depressive phase of bipolar disorder where suicide is a major factor. Medication alone is not effective in her case; hence, therapy, lifestyle changes and social support especially from her friends is necessary. An experienced psychiatrist helping her to complete her prescription as prescribed should closely monitor medication. A combination of talk therapy and medication would be Ideal for Tina and closely monitor her progress and treatment of her condition. Conclusion Major depressive disorder is curable and like and other illness, the earlier someone is diagnosed with it, the more the chances of being cured. If not closely monitored, it can lead to depression and in Tina’s case; there is need for social support and love. It is also important that curing of this disorder is not easy and takes time. There are always setbacks but the symptoms can be put under control with the right medication and therapy. References Agam, G, Everall, I. P., Belmaker, R. H. (2002). The postmortem brain in psychiatric research Norwell: Springer. Heaton, J. (2003). Major Depressive Disorder: What are the Facts? AIIPsych online. Retrieved on November 26, 2011 from: National Institute of Mental Health. (2011). Depression. Retrieved on November 26, 2011 from: Oken, D. (2000). Multiaxial Diagnosis and the Psychosomatic Model of Disease. Psychosomatic Medicine, Journal of Biobehavioral medicine Vol. 62(2). Smith, M. & Segal, J. (2011). Understanding Bipolar Disorder. Helpguide.org. Retrieved on November 26, 2011 from: Read More