Case Study on Depression

Case:
Josie, 29 years old, recently got back from her first deployment

Winston Churchill called his depression 'The Black Dog'.

I think it’s more like a heavy black cloud that settles all around you. It feels like a lead sheet over your head and you can’t see through it. All you can see is blackness. I didn’t know what it was until a few months ago.

I reckon I was a pretty normal kid. I had ups and downs, but generally, I was OK. When I was 23, I was working in a dead end job and one day my boyfriend of two years walked out on me. No explanation just up and left. I was devastated. For the week after that, I barely got out of bed, I just couldn’t find the energy or the motivation to get up or do anything.
Luckily I had some good friends who looked after me and got me back on my feet. I left my job, joined the army, and things really looked up for a while.

But after I got back from the Middle East I started feeling horribly depressed. I don’t even know why – the deployment wasn’t difficult. I wasn’t really in danger and I didn’t see anything too awful or upsetting, but the adjustment coming home was harder than I expected. I just felt worse and worse, and all the things I used to enjoy seemed stupid and pointless.
I couldn’t be bothered doing anything, not even eating. I didn’t have any energy but I couldn’t sleep either. I managed to talk the doc on the base into giving me a few weeks off sick, but that didn’t do any good. I just stayed in bed and cried. Once I even thought about killing myself, but then I thought about what it would do to Mum and Dad.

While I was off sick, I saw an article about depression in a magazine. 'Beating the Blues', it was called. It was like they were writing about me – they described exactly what I was going through.
Except for the bit where they talked about treatment and getting over depression because I hadn’t done anything about that.
Although part of me didn’t believe it, another part of me wanted to give it a try. One thing was for sure – I didn’t want to feel like this any longer.
So I went back to the doc and asked if I could see the psych. He wasn’t enthusiastic. I think he thought I just wanted to get out of work. He then got me to fill out a questionnaire and my responses seemed to change his mind.

He gave me a prescription for an antidepressant and referred me to a civilian psychologist in town. The psychologist was good and the ADF paid all the bills. It was scary going into the psychologist’s office the first time; I didn’t know what to expect. But the psychologist was really nice. We talked about the problems I’d been having.
He said that depression can happen for lots of reasons: maybe some biological things, maybe some bad habits, maybe some life stress. But he said there were effective treatments. I remember leaving his office  that first day with more hope than I’d felt for ages.
We had about 15 sessions and I go back for regular 'check-ups'. From my perspective, I reckon I’m traveling well.

The GP said I could wean off the antidepressants next month. I also saw a mental health social worker who worked with the psychologist. She helped me sort out some practical things, like my accommodation and my relationship with my family … things that were getting in the way of me feeling better. But the most important thing for me was getting back
into doing the things I used to love.
I realised that if I sat around until I felt motivated it would never happen. So I forced myself to do things and the motivation gradually came back. I actually started enjoying myself. And with the psych’s help, I started to keep a diary of my thoughts. When I start to think negatively, I write down what I’m thinking, challenge it and come up with something more helpful.
It might sound simple, but it really helps. Now I’m looking forward to the future. I feel like the cloud has blown away.

For more information on depression,
visit: https://mtlhealth.blogspot.com/2019/04/depression.html

Factitious Disorder

Factitious Disorder

Factitious Disorders are characterized by physical or psychological symptoms that are intentionally produced or feigned in order to assume the sick role. The judgment that a particular symptom is intentionally produced is made both by direct evidence and by excluding other causes of the symptom.

Factitious Disorders are distinguished from acts of Malingering. In Malingering, the individual also produces the symptoms intentionally but has a goal that is obviously recognizable when the environmental circumstances are known.

Features

The essential features concerning factitious disorder are:

1.     the intentional production of physical or psychological signs or symptoms

2.     The motivation for the behavior is to assume the sick role

3.     External incentives for the behavior (e.g., economic gain, avoiding legal responsibility, or improving physical well-being, as in Malingering) are absent.

Individuals with Factitious Disorder usually present their history with dramatic flair but are extremely vague and inconsistent when questioned in greater detail. They may engage in pathological lying, in the manner that is intriguing to the listener, about any aspect of their history or symptoms (i.e., pseudologia fantastica).

Symptoms

Factitious disorder signs and symptoms may include:

·   Extensive knowledge of medical terms and diseases

·   Clever and convincing medical or psychological problems

·   Vague or inconsistent symptoms

·   Conditions that get worse for no apparent reason

·   Conditions that don't respond as expected to standard therapies

·   Seeking treatment from many different doctors or hospitals, which may include using a fake name

·   Reluctance to allow doctors to talk to family or friends or to other health care professionals

·   Frequent stays in the hospital

·   Eagerness to have frequent testing or risky operations

·   Many surgical scars or evidence of numerous procedures

·   Having a few visitors when hospitalized

Treatment

People with factitious disorder may be well aware of the risk of injury or even death as a result of self-harm or the treatment they seek, but they can't control their behaviors and they're unlikely to seek help. Even when confronted with objective proof — such as a videotape — that they're causing their illness, they often deny it and refuse psychiatric help.

Pain Disorder

Pain Disorder

Pain Disorder is characterized by pain as the predominant focus of clinical attention. In addition, psychological factors are judged to have an important role in its onset, severity, exacerbation, or maintenance.

This is not to be confused with Hypocondriasis which is the preoccupation with the fear of having, or the idea that one has, a serious disease based on the person's misinterpretation of bodily symptoms or bodily functions.

Features and Symptoms

The primary symptoms observed in a patient with pain disorder are:]

1.     The predominant focus of the clinical presentation and is of sufficient severity to warrant clinical attention

2.     The pain causes significant distress or impairment in social, occupational, or other important areas of functioning

3.     Psychological factors are judged to play a significant role in the onset, severity, exacerbation, or maintenance of the pain

4.     The pain is not intentionally produced or feigned as in Factitious Disorder

5.     Pain Disorder is not diagnosed if the pain is better accounted for by a Mood, Anxiety, or Psychotic Disorder

Examples of impairment resulting from the pain include inability to work or attend school, frequent use of the health care system, the pain becoming a major focus of the individual's life, substantial use of medications, and relational problems such as marital discord and disruption of the family's normal lifestyle.

Diagnosis

The main problem in diagnosis is that pain disorder can only be considered as the patients condition if the medical and laboratory results for the symptoms turn out to be normal but the patient still has prevalent complaints for the pain. Even then, the condition may not be that of Pain Disorder but maybe mis-diagnosed as other similar mental illnesses like somatization disorder, conversion disorder or psychotic disorder. It is also possible that pain disorder prevails with other mental illnesses which makes the diagnosis even more troublesome and tedious.

Treatments

Depending on whether the pain is acute or chronic, management may involve one or more of the following: pharmacological treatment (medication); psychotherapy(individual or group); family, behavioral, physical; hypnosis, and/or occupational therapy. Antidepressants may be prescribed along with psychotherapy for fast and effective results. Pain and sleep medication is also closely linked so sleep medication is also a good option.

Social Anxiety Disorder

Social Anxiety Disorder

The persistent fear of social or performance situations in which embarrassment may occur is a key feature of social anxiety disorder or social phobia. Exposure to the social or performance situation almost invariably provokes an immediate anxiety response. In extreme cases panic attacks, anxiety attacks and/or losing consciousness can be observed.

Symptoms

The diagnosis is appropriate only if the avoidance, fear, or anxious anticipation of encountering the social or performance situation interferes significantly with the person's daily routine, occupational functioning, or social life, or if the person is markedly distressed about having the phobia for at least 6 months.

Individuals with Social Phobia experience concerns about the embarrassment and are afraid that others will judge them to be anxious, weak, "crazy," or stupid. They may fear public speaking because of concern that others will notice their trembling hands or voice or they may experience extreme anxiety when conversing with others because of fear that they will appear inarticulate.

They may avoid eating, drinking, or writing in public because of a fear of being embarrassed by having others see their hands shake.

Diagnosis

DSM-5 criteria for social anxiety disorder include:

• Persistent, intense fear or anxiety about specific social situations because you believe you may be judged, embarrassed or humiliated
• Avoidance of anxiety-producing social situations or enduring them with intense fear or anxiety
• Excessive anxiety that's out of proportion to the situation
• Anxiety or distress that interferes with your daily living
• Fear or anxiety that is not better explained by a medical condition, medication or substance abuse

Treatment

Treatment depends on how much social anxiety disorder affects your ability to function in daily life. The two most common types of treatment for social anxiety disorder are psychotherapy (also called psychological counseling or talk therapy) or medications or both.

Generalized Anxiety Disorder

 Generalized Anxiety Disorder

Generalized Anxiety Disorder is characterized by at least 6 months of persistent
and excessive anxiety and worry. It is found with combination with panickattacks, agoraphobia, obsessive compulsive disorder etc.

Symptoms 

While a number of different diagnoses constitute anxiety disorders, the symptoms of generalized anxiety disorder (GAD) will often include the following:

• restlessness, and a feeling of being "on-edge"
• uncontrollable feelings of worry
• increased irritability
• concentration difficulties
• sleep difficulties, such as problems in falling or staying asleep

A Panic Attack is a discrete period in which there is the sudden onset of intense
apprehension, fearfulness, or terror, often associated with feelings of impending doom.
During these attacks, symptoms such as shortness of breath, palpitations, chest pain or
discomfort, choking or smothering sensations, and fear of "going crazy" or losing control
are present.
Agoraphobia is anxiety about, or avoidance of, places or situations from which
escape might be difficult (or embarrassing) or in which help may not be available in the
event of having a Panic Attack or panic-like symptoms.
Many symptoms of other kinds of anxiety disorders can be observed in GAD.

Causes

The causes of anxiety disorders are complicated. Many might occur at once, some may lead to others, and some might not lead to an anxiety disorder unless another is present.
Possible causes include:

• environmental stressors, such as difficulties at work, relationship problems, or family issues
• genetics, as people who have family members with an anxiety disorder are more likely to experience one themselves
• medical factors, such as the symptoms of a different disease, the effects of a medication, or the stress of an intensive surgery or prolonged recovery
• brain chemistry, as psychologists define many anxiety disorders as misalignments of hormones and electrical signals in the brain
• withdrawal from an illicit substance, the effects of which might intensify the impact of other possible causes

Treatment

There are several exercises and actions to help a person cope with milder, more focused, or shorter-term anxiety disorders, including:

• Stress management: Learning to manage stress can help limit potential triggers. Organize any upcoming pressures and deadlines, compile lists to make daunting tasks more manageable, and commit to taking time off from study or work.
• Relaxation techniques: Simple activities can help soothe the mental and physical signs of anxiety. These techniques include meditation, deep breathing exercises, long baths, resting in the dark, and yoga.
• Exercises to replace negative thoughts with positive ones
• Support network: Talk with familiar people who are supportive, such as a family member or friend. Support group services may also be available in the local area and online.
• Counseling:  A standard way of treating anxiety is psychological counseling. This can include cognitive-behavioral therapy (CBT), psychotherapy, or a combination of therapies.
•  Medication:  A person can support anxiety management with several types of medication. Medicines that might control some of the physical and mental symptoms include anti-depressants, benzodiazepines, tricyclics, and beta-blockers.

Schizophrenia

Schizophrenia 

Schizophrenia is a psychotic disorder. Psychotic disorders describe  prominent hallucinations that the individual realizes are hallucinatory experiences.

Schizophrenia is a disturbance that lasts for at least 6 months and includes at least 1 month of active-phase symptoms (i.e., two [or more] of the following: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms). Some may have heard of this disorder as there has been some popular movies based on it like Russell Crowe’s A Beautiful Mind.

Symptoms

The essential features of Schizophrenia are a mixture of characteristic signs and symptoms (both positive and negative) that have been present for a significant portion of time during a 1-month period (or for a shorter time if successfully treated), with some signs of the disorder persisting for at least 6 months.

The positive symptoms appear to reflect an excess or distortion of normal functions, whereas the negative symptoms appear to reflect a diminution or loss of normal functions. The positive symptoms include distortions or exaggerations of inferential thinking (delusions), perception(hallucinations), language and communication (disorganized speech), and behavioural monitoring (grossly disorganized or catatonic behavior). Negative symptoms include restrictions in the range and intensity of emotional expression (affective flattening), in the fluency and productivity of thought and speech (alogia), and in the initiation of goal-directed behavior (avolition).

Causes

Genetic inheritance

If there is no history of schizophrenia in a family, the chances of developing it are less than 1 percent. However, that risk rises to 10 percent if a parent was diagnosed.

Chemical imbalance in the brain

Experts believe that an imbalance of dopamine, a neurotransmitter, is involved in the onset of schizophrenia. Other neurotransmitters, such as serotonin, may also be involved.

Family relationships

There is no evidence to prove or even indicate that family relationships might cause schizophrenia, however, some patients with the illness believe family tension triggers relapses.

Environmental factors

Although there is no definite proof, many suspect trauma before birth and viral infections may contribute to the development of the disease.

Stressful experiences often precede the emergence of schizophrenia. Before any acute symptoms are apparent, people with schizophrenia habitually become bad-tempered, anxious, and unfocused. This can trigger relationship problems, divorce, and unemployment.

Drug induced schizophrenia

Marijuana and LSD are known to cause schizophrenia relapses. Additionally, for people with a predisposition to a psychotic illness such as schizophrenia, usage of cannabis may trigger the first episode.

Treatment

Treatment can help relieve many of the symptoms of schizophrenia. However, the majority of patients with the disorder have to cope with the symptoms for life.

Psychiatrists say the most effective treatment for schizophrenia patients is usually a combination of:

• medication
• psychological counseling
• self-help resources

Anti-psychosis drugs have transformed schizophrenia treatment. Thanks to them, the majority of patients are able to live in the community, rather than stay in a hospital. The patient must continue taking medication even when symptoms are gone. Otherwise they will come back.

Diagnosis

Certain tests will be ordered to rule out other illnesses and conditions that may trigger schizophrenia-like symptoms, such as:

• Blood tests - in cases where drug use may be a factor a blood test may be ordered. Blood tests are also done to exclude physical causes of illness.
• Imaging studies - to rule out tumors and problems in the structure of the brain.
• Psychological evaluation - a specialist will assess the patient's mental state by asking about thoughts, moods, hallucinations, suicidal traits, violent tendencies, or potential for violence, as well as observing their demeanor and appearance.

The patient must:

• Have at least two of the following typical symptoms:
• delusions
• disorganized or catatonic behavior
• disorganized speech
• hallucinations
• negative symptoms that are present for much of the time during the last 4 weeks
• Experience considerable impairment in the ability to attend school, carry out their work duties, or carry out everyday tasks.
• Have symptoms that persist for 6 months or more.

Depression

Depression

Let's start with the most well-known word, Depression.

Depression is a mood disorder which includes disorders that have a disturbance in mood as

the predominant feature. In depressive disorders, there is a noticeable loss in interest in all activities for at least 2 weeks or more.  In children and adolescents, the mood may be irritable rather than sad.

 

Symptoms

There are major changes in appetite or weight, sleep (insomnia or hypersomnia), and psychomotor activity; decreased energy; feelings of worthlessness or guilt; difficulty thinking, concentrating, or making decisions. It's not just feeling blue. It's actually forgetting how to come back from a self-induced sadness. Decreased energy, tiredness, and fatigue are common. There may be thoughts of death, suicidal ideation, or suicide attempts.

Causes 

The causes of depression are not fully understood. Depression is likely to be due to a complex combination of factors that include

• genetics
• biological - changes in neurotransmitter levels
• environmental
• psychological and social (psychosocial)
• Culture can influence the experience and communication of symptoms of depression.

Treatment 

Depression is a treatable mental illness. There are three components to the management of depression:

1. Support from close ones

2. Psychotherapy

     In psychotherapy, the patient is sent to a psychiatrist for talking things through and resolving         emotional issues so as to get the patient to feel guilt-free.

3. Drug treatment

    This course of treatment is usually paired with psychotherapy sessions for faster and efficient relief. There have been many drugs developed to treat all kinds of depression.

4. Exercise and outdoor activities