Depression is a chronic illness that impacts a person’s body, psychological state, and social contacts. This paper aims to examine the case of Majorie, a 75-year-old female, who had depression previously after the death of her daughter. The patient was hospitalised for the treatment since the antidepressant therapy did not improve her state. The purpose of this paper is to use a biopsychosocial theory to assess her mental and physical health and avoid further complications. The comprehensive evaluation is expected to provide the multidisciplinary team with sufficient information to choose relevant treatment options.
The attention will be paid to the connectedness between the mental and physical health of Majorie. By understanding this link, it will be possible to address the depressive symptoms and ensure a higher quality of life for the patient (Arthur et al., 2020). The paper will also discuss the required nursing and communication skills that are significant for effective care. More to the point, the roles of nurses, an interprofessional team, and the patient’s family will be examined regarding the improvement of Majorie’s health condition.
In terms of a biopsychosocial theory, it is critical to assess the biology, environment, and psychology of a patient (Pocklington, 2017). The interaction of these components should be considered to better understand how to overcome depression in the given patient. In terms of biology, Majorie suffers from weight loss and a lack of appetite, which is complicated by the refusal to see her grandchildren. For a person, the interaction with the family is one of the most important sources of success. It can be useful to encourage the family to communicate with her, explaining the role they play. The current lack of any interest in her life, including the unwillingness to change her clothes, points to the increased risk to her health (Pocklington, 2017; Ribeiro et al., 2018). Since this patient has previous depressive episodes and experience of electro-convulsive therapy (ECT), the care plan should be developed with the involvement of an interdisciplinary team.
The assessment of Majorie’s mental health can be performed using the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) as this model covers the basic health areas. In particular, fatigue or energy loss, weight loss, the reduced ability to think, and low interest in activities are relevant to this patient (Öğülmüş et al., 2020; Tsoi et al., 2017). These symptoms show that even though depression is a mental disorder, it also affects a person’s physical and social well-being. In addition, it is possible to suggest applying the Patient Health Questionnaire-9 (PHQ-9) which implies asking the patient about his or her feelings, concentration, speaking, and thoughts (Levis, Benedetti, & Thombs, 2019). The value of this inventory is associated with its specificity and sensitivity to patients, which allows avoiding generalisations and mistakes in diagnosing.
As for psychotherapeutic approaches to work with Majorie, cognitive-behavioural therapy (CBT) seems to be the most pertinent option. It helps in changing a patient’s thinking patterns to develop a positive view of life. The behaviours and beliefs of this patient should be adjusted to show her that her life can be valuable again, even without her husband. As stated by Ribeiro et al. (2018), hopelessness in patients with depression can lead to suicide ideation, which seems to be relevant in the case of Majorie. The use of CBT will identify negative thoughts and responses, which can be then tracked and addressed in a structured setting. The combination of cognitive and behavioural approaches will allow changing the behavioural responses of the patient to challenging situations and factors.
In geriatric patients, pharmacologic treatment should be selected with special attention, with minimum side effects. For Majorie, citalopram or sertraline can be chosen for their minimal potential of drug-drug interaction (Liu, Gerdtz, and Manias, 2016). At the same time, these antidepressants should be taken within 2-4 weeks, depending on the reaction of the patient. It is important to explain to the patient that she cannot stop using the medication without the assistance of care providers as it can lead to withdrawal syndrome. For this patient, the involvement of her family in the care process seems to be another useful intervention. If Majorie would understand that her life is still valuable and desired by her relatives, she would be more likely to reconsider her current perceptions. The family members should be preliminarily explained their role in the recovery of the patient.
To provide effective care, the team of professionals should properly communicate with Majorie, who may be resistant to answering their questions and therapeutic manipulations. The gap between the patient and health care providers, as well as between the care team members, can worsen the patient’s condition. It is not sufficient to access patients since they need to understand their diagnoses, the questions being asked, and the prescribed treatment. Ditton-Phare, Kelly, and Loughland (2017) state that the success of treatment largely depends on the extent to which patients understand their diseases. The patient can be unaware that her physical problems are caused by a psychiatric disorder. To ensure better treatment, nurses, physicians, and the care team members should effectively explain the care setting, the process of evaluation and therapies to Majorie.
In the case of Majorie, it is critical to practice interdisciplinary care as the contribution of various professionals is required. Primary care practitioners may lack education regarding the long-term treatment of patients with chronic depression (Vinciullo, 2019). Considering that this patient is an older adult, the consultation with a geriatrist can be useful to offer age-relevant care. For example, she may have hearing or sensory impairment (Leverton, 2019). The role of a psychiatrist is to access the symptoms, diagnose the patient, and assign pharmacologic treatment. The studies also show that the collaborative work of a psychiatrist and psychologist are beneficial to eliminate or reduce depressive symptoms. In addition, nurses who will provide services should be aware of all the symptoms and possible comorbidities of the patients. They are the main direct providers of care and the responsible persons who monitor and report any changes (Heslin and Young, 2018). Therefore, the cooperation of all these professionals is necessary for achieving the patient’s positive health outcomes.
Nursing skills compose an essential area that contributes to overcoming depression. First of all, the patient’s physical needs in hygiene, nutrition, and sleep should be met by nurses. Second, nurses should demonstrate robust communication skills to engage Majorie in conversation (Jeffrey, 2016; Orgeta, Brede and Livingston, 2017). This can be done by showing empathy to her challenges and listening carefully to her problems and thoughts. The observation of the patient’s behaviour in dynamics should be used to determine the methods of verbal and non-verbal communication. The third skill is related to educating the patient that her depression can be eased if she will talk about her emotions and views (Frost et al., 2019). The nurses play a great role in interacting with patients daily to help them in recognising negative patterns and learn to effectively change them.
To conclude, the case of Majorie needs to be assessed, diagnosed and treated comprehensively by the interdisciplinary team. The patient has weight loss, social isolation and depression, which should be assessed through DSM-5 and PHQ-9. It was identified that the consultations with the psychologist, psychiatrist, geriatrist and other professionals would be useful. The role of nurses is to encourage the patient to share her thoughts and explain that her condition can be improved. Further monitoring of the assigned CBT and medication should be conducted via a food chart and constant review of any physical and mental changes. The family should be considered as a source of support and hope, which are critical for Majorie.
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