Report and Case-Study on Depression

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Table of Contents

1. 2. 3. 4. 5. 6. 7. 8.

03 Summary --------------------------------------------------------------------------------------------------Acknowledgement ---------------------------------------------------------------------------------------04 Definition and Classification of Depression -------------------------------------------------------- 05 Natural History ------------------------------------------------------------------------------------------ 05 --Depression in Young people ------------------------------------------------------------------------------06 07 Case-Study ---------------------------------------------------------------------------------------------------Treatment of Depression ---------------------------------------------------------------------------------08-09

Conclusion ------------------------------------------------------------------------------------------------ 10 ----

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Executive Summary Depression is a common mental disorder that presents with depressed mood and/or loss of interest. It is mainly due to adverse life events, disease or medications. It affects important mental and social functions, which depending on the severity might substantially impair a patients abilities to carry out simple daily activities. Fifteen per cent of patient will commit suicide if not treated depression is responsible for 850,000 death every year. Some estimates show that depression will be the second leading illness by the year 2020. Depression accounted for 6% of the global in the year 2011. Depression affects 315% of the general population; 0.45% of cases are severe. It affects mainly adults, women, and low-income groups. In young people, the prevalence of depression is 0.6% in preschool children; 2% in schoolchildren; and 48% in adolescents. Children of both sexes are equally affected, but in adolescents, females are affected twice as often as males. The symptoms may include behavioural problems, social isolation and difficulties at school; thus depression is frequently misdiagnosed as growing pains. Depression in adolescents is risk factor for depression and bipolar disorder during adulthood; drug or alcohol abuse; and suicide. Suicide is one of the major causes of adolescent mortality. Depressed patients incur higher medical costs, perform worse at work and have a higher level of absenteeism than those who are not depressed. In the general population, depression is often undiagnosed or misdiagnosed and even more frequently untreated. In general, fewer than 40% of cases are diagnosed at the primary care level; fewer than 40% of these are treated; and around 40% of treated patients take their medicines as indicated. Assuming 100% treatment efficacy, the effectiveness of health systems in managing depression at the population level is less than 6.4%. There are three main forms of treatment for depression: (1) Counselling and/or psychotherapy; (2) Electroconvulsive therapy (ECT); and (3) Antidepressant medications.

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Acknowledgement I would like to express my special thanks to Almighty Allah and my teacher Mr Rehan Shakoor who gave me the golden opportunity to make this wonderful report on Case Study which also helped me in doing a lot of Research and I came to know about so many new things. I am really thankful to him.

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1. DEFINITION AND CLASSIFICATIONS Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration. It usually occurs as a result of adverse life events, such as: losses of a significant person, object, relationship or health, but can also occur due to no apparent cause. These problems can become chronic or recurrent and lead to substantial impairments in an individual's ability to take care of his or her every day responsibilities. Currently, depression is included in the category of mood disorders, which is divided into bipolar depression, unipolar depression and dysthymic disorders. The relationship between psychological stress, adverse life events, and the onset of depressive episodes remains unclear. Certainly, adverse life events can contribute to depression, but depression itself can also be the source of stressful experiences. The most common clinical classification for mood disorders divides them into three groups: (1) Depressive disorders; (2) Bipolar disorders; and (3) Depression associated with medical illness or alcohol and substance abuse.

2. NATURAL HISTORY Depression, as a disorder, usually starts in early adulthood, with likely recurrences. An episode may be characterized by sadness, indifference or apathy, or irritability. The symptoms include distributed sleep patterns and appetite and weight-loss, fatigue, impaired concentration and decision-making, feelings of shame or guilt, and thoughts of death or dying. A small proportion of patients will experience psychotic symptoms. The duration of an untreated crisis ranges from 9 months to several years. Fifty to sixty per cent of patients will have at least one more episode in their lifetime. The nature of depression is such that affected persons are unlikely to realize that they are depressed and therefore unlikely to seek help for themselves. They are also incapable of appropriately taking their treatment as directed by health care professionals. Major depression is diagnosed when depressed mood or lack of ability to enjoy or experience pleasure has been present for more than 2 weeks and is associated with at least five of the following symptoms: loss of interest, fatigue or loss of energy,
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feelings of worthlessness or excessive guilt, decreased concentration, significant weight loss or gain, and recurrent suicidal ideation.

3. DEPRESSION IN YOUNG PEOPLE Depression in young people may be expressed differently from that in adults, with manifest behavioural disorders (e.g. irritability, verbal aggression and misconduct), substance abuse and/or concurrent psychiatric problems. Between the ages of 6 and 12 years, the most common signs and symptoms are complaints, school difficulties, fatigue, boredom/apathy, disturbed eating, lack of motivation, decreased concentration and anxiety. It is common for young, schoolchildren to present with irritability, restlessness and hyperactivity. Between the ages of 12 and 18 years, the most common signs and symptoms are suicidal thoughts, hopelessness, social isolation, drug or alcohol use, overeating and oversleeping, and rage. Risk factors for suicide in young people are: previous suicide attempts; a close family member who has committed suicide; past psychiatric hospitalization; recent loss of a significant figure (through death, divorce or separation); social isolation; drug or alcohol abuse; exposure to violence in the home or the social environment; and handguns in the home. Early warnings for suicide are talking about it, preoccupation with death and dying, giving away special possessions, and making arrangements to take care of unfinished business.

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4. CASE-STUDY Leena is a 16 year-old, white female admitted to Hospital in March, 2000 because of active suicidal ideations manifested by holding a knife to her arm that morning. This was accompanied by thoughts of hanging herself by wrapping a telephone cord around her neck. Leena has a history of suicidal ideation and has tried to cut herself in the past, but reported that the knife would not penetrate her skin. She was concerned that she would not be able to stop herself again. Leena reported depression for the past 2 years and an obsession with death since 8 th grade. She is an overweight female who appeared sad, making poor eye contact and demonstrating poor social skills. Her affect was flat and apathetic. Leena reported difficulty sleeping, low energy, irritable mood and trouble with her appetite. She also reported significant feelings of worthlessness, helplessness and hopelessness. In addition to the above symptoms, Leena spoke about her imaginary friends, which she had since 6 years of age. She normally acts and argues with TV characters, she knows that they are not real, but she spends time with her imaginary friends rather than real ones. She reported just before a week of her admission in hospital she heard the voice to get out of the bed and to feel better. One of the reason for development of depression in Leena is that her parents are divorced. Her mother is a victim of domestic violence, and her father is an alcoholic. So as per research Children with at least one depressed parent have a three times greater risk of development of depression in child.

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5. TREATMENTS FOR DEPRESSION Introduction There are many treatment options for depression - and new treatments (particularly Medications) appear regularly. However, treatments vary in the benefits they may Bring clearly, selecting the most appropriate treatment is important. Continuing Research means that evidence on how well a treatment works is constantly evolving. Depression can be treated with medication and without medication. In this report only selected non-medication treatments are discussed keeping in view the case-study of Leena presented before. Psychological treatments There are a variety of psychological treatments for depression. Depression psychological therapy may be the sole or major treatment (without medication being used). Some of the main ones include: Mindfulness therapy Cognitive Behaviour Therapy (CBT) Interpersonal Therapy (IPT) Psychotherapies Narrative Therapy. The therapies may be an alternative to medication (in some cases of non-melancholic Depression) or offered in combination with medication (when appropriately timed, this may be in any type of depression). As always, a thorough assessment of the person is needed in order to decide on the best approach. Mindfulness Therapy Mindfulness is a form of self-awareness training taken from Buddhist mindfulness meditation. It has been adapted for use in treatment of depression, especially preventing relapse and for assisting with mood regulation. It has been described as a state of being in the present, accepting things for what they are. Fact Sheet Cognitive Behaviour Therapy (CBT) CBT aims to show people how the negative thinking patterns affect their mood and how to challenge the negative thoughts. It is based on the understanding that thinking negatively is a habit, and, like any other unhelpful habit, it can be changed. Interpersonal Therapy (IPT) IPT is a time-limited psychotherapy that focuses on the interpersonal context and on building interpersonal skills. It aims to change the person's interpersonal behavior by fostering adaptation to current interpersonal roles and situations. The underlying assumption with IPT is that depression and interpersonal problems are interrelated.
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Fact Sheet Psychotherapies Psychotherapy is an extended treatment (possibly for years) in which a particular relationship is developed between the therapist and patient. This relationship is important in exploring aspects of the person's past in great depth and understanding Narrative Therapy Narrative Therapy is a form of counseling based on understanding the 'stories' that people use to describe their lives. The therapist listens to how people describe their problems as stories and helps the person to consider how their stories may restrict or limit them in overcoming their difficulties. Narrative Therapy differs from many therapies in that the focus is on identifying people's strengths and the positives - particularly regarding situations mastered in the past. Self-help & alternative therapies There are a wide range of self-help measures and alternate therapies that can be useful for some types of depression, either alone or in conjunction with physical treatments. Self-help and alternative therapies that may be useful for depression include: Meditation Relaxation Good nutrition Alcohol and drug avoidance Exercise Yoga Massage therapy Acupuncture.

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6. CONCLUSION As discussed above, the problem of depression is increasing day by day not only in adults but also in young children and this is concern for parents as well. They need to take care of their children and should take appropriate action / medication in case the symptoms of depression in their children.

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