Case Study on Adolescent Depression

Case Study on Adolescent slackThis matter ingest concerns a teenage service user whom we shall refer to employ a pseudo name, Katie, to maintain confidentiality in line with the nursing tocology Council Code of Conduct (NMC, 2015). Katie suffers from a comorbidity of Type 1 Diabetes (T1D) and economic crisis, and the focus of fountain read is on the imprint component. Managing and treating picture has proved to be nearly(prenominal)times troublesome for both practitioners and patients due to its multi-dimensional aetiology which is attributed to a combination of biological, surroundal and individual(prenominal) factors. Its have-to doe with is equally challenging as it usually associated with poor unhealthiness control, adverse health outcomes and forest of sprightliness impairment (Andreoulakis, Hyphantis, Kandylis, Iacovides, 2012).The case study leave explore patho physiological and mental eyeshots in the aetiology of belief. The objective of the gaze is t o undertake a systematic enquiry (Hol let looseay, Wheeler, 2010). Using a true(a) sphere situation to gain a deeper understanding of the situation to filter out and solve a problem and improve the current situation (Aitken Marshall, 2007).The think of of Cognitive behaviour Therapy (CBT) is discussed as the hinderance that was prescribed for Katie. The rationale is that CBT is pertinent to the assessment outcomes and the symptoms extraditeed by Katie.The GP referral to the friendship rational health aggroup states that Katie is a 16-year-old enthusiastic teenager, who is in full-time education and enjoys extramural activities in school and in like manner enjoys socialising. Recently Katie was diagnosed with type 1 diabetes (T1D) and prescribed insulin eye therapy. Following this diagnosis, Katie became remarkably withdrawn from friends and family, with expressions of hopelessness and low self-esteem. She has lost come to group in the activities that she has been enjoying in her life. Her GP diagnosed notion. The condition has been getting worse and moody for three weeks, putting a signifi sack upt strain on her p atomic number 18nts, including devil siblings who live with her. The GP concluded the case warranted specialist attention and referred Kate to the Community Mental Health Team.Katies referral nones hinted that her first should be assessed further due to decline in quality in her noetic health. The assessment highlighted significant low symptoms such(prenominal)(prenominal) as poor sleeping patterns, weight loss, burdensomeness, constant whimsy of sadness ( issue form for Health and C are Excellence, 2016). Also, self- loathing, insomnia, lack of energy, irritable mood, material pains and a gloomy outlook on life including diminished pleasure in enjoyable activities were the contemporary (National found for Health and Care Excellence, 2016). The symptoms are probably to impact on the ability to cope, personal relations hips and the general quality of life (Pryjmachuk, 2011). To feel the severity of Katies mental health, the Registered treat Practitioner took the lead in completing a Patient Health Questionnaires (PHQ-9) with Katie. Katie scored as having major depression. This self-reporting bastard is full of life in aiding practitioners to conceptualise depression as it can be used to monitor, diagnose, and measure the severity of depression (Wu, 2014). The risk of harm is critical to the assessment of depression (NICE, 2016). Studies show that mental disorders are present in 90% of suicide cases in the UK, with depression found in 60% of the cases ( move for self-annihilation Research, 2012). Hence, Katie was assessed on the risk of self-harm. However, she did not state any thoughts or actions of self-harm or suicide attempts. Due to the severity and the diverse nature of her symptoms an appellative was ar backgroundd for Katie to see the team Psychiatrist. Katie agreed to the decision. T his led to the intervention discussed posterior in the essay.Katies symptoms include loss of appetite, and in that respect is substantial evidence that link eating disorders with depression, especially among teenage females (Allen, Crosby, Oddy, Byrne, 2013). As pointed out by Allen et al. (2013) feeding disorders can lead to over eating, which contributes to separate problems such as corpulency and type 2 diabetes, termination of appetite can lead to malnutrition, Loss of weight and fatigue. Eating problems also lead to stomach aches, cramps and constipation (Allen et al. 2013). writings also shows that depression is linked to nearly every some other physical and mental illness, as according to the joint report ( princely College of Psychiatrists and purplish College of familiar Practitioners, 2009). Also, there is sufficient of evidence that physical illness disturbs our feelings and thinking, just as social, and personal essay can cause ill health (Royal College of Psychiatrists and Royal College of General Practitioners, 2009). Also, other diseases can trigger stress and onset depression, as is the case with Katie who got depressed after a diagnosis of diabetes. Oladeji Gureje (2013) suggest that patients can be caught in a vicious circle in which depression contributes to other present conditions and vice versa.Conceptualising the pathophysiology of depression is made complicated by the fact that while the majority of patients respond to pharmacological treatments such as antidepressants, some patients remain partially or wholly unresponsive to drugs (Cryan, Leonard, 2010).In these illustrations, there are individual differences in the manifestation of depression that cannot be communicate in current drug regimes. It follows that treatment for depression necessarily to be observed according to how each patients solvent to treatment(Andersson, Cuijpers, 2008).And this should provide guidance in formulating Katies carry off plan in th is study. However, there is research evidence that link depression for the maintenance of the homoeostasis and stress levels (Leonard, 2005 Cryan, Leonard, 2010). Stress is often well-defined as a state of real or perceived threat to homoeostasis (Leonard, 2005). The homoeostasis demonstrate function is to provide the all important(p) balance and stability in the tree trunk systems to enable cells to sustain life (Clancy, McVicar, 2011).Stress to the homoeostasis will activate stress response to provide the required body function balance (Leonard, 2005). Critically to the depression paradigm, the stress response mechanism is mediated by multiple responses that view the endocrine, nervous, and immune systems, which are collectively known as the hypothalamic-pituitary-adrenal axis (HPA) (Cryan, Leonard, 2010). Changes that travel by to the HPA and the immune system as a matter of chronic stress can trigger anxiety and depression (Leonard, 2005). Depression is also ascribed t o imbalances that fig out in the brain about serotonin, norepinephrine and dopamine (Charney, Feder Nestler, 2009).Evidence suggests that the physiological functions that are mediated by neurotransmitter serotonin include sleep, aggression, eating, sexual demeanor and mood (Nutt, Demyttenaere, Janka, Aarre, Bourin, Canonico, Stahl, 2007). All these symptoms are much dominant in almost depression cases, and indeed symptoms such as insomnia, loss of appetite undergo by Katie. Research also suggests that decrease production of serotonergic neurones that make serotonin has an impact on mood states and contributes to depression (Nutt et al. 2007). However, several lines of evidence suggest that neurotransmitter dopamine is touch on in motivation that drives to seek reward and pleasure, and it is believed low levels on this transmitter play a portion when depressed tidy sum cease to enjoy activities that they enjoyed in the past (Charney et al. 2009). Katie had been a vibrant r ecent and lost all the passion for passion when she was diagnosed with depression. Research suggests antidepressants play a role in improving neurotransmitter imbalances (Anderson, 2013). However, in the case of Katie, National make for for Health and Care Excellence, NICE (2017), recommends that antidepressants should be used in young muckle and children only after alternative therapies have been considered.The psychological impact of depression on the patient is touch on with the patients concepts of self, how they conceptualise their illness and the world around them (Barlow, 2014). It is quite critical as this impact on behaviour and treatment outcomes (Sanders Hill, 2014). Above all, an analysis of Katies symptoms and assessment suggest there are significant psychological issues. The symptoms that relate to behaviour include lack of motivation as shown by poor school work and lack of interest in social events that she enjoyed before. She is no longer taking responsibility for quotidian actions and routines. Katies do plan and treatment should aim to address this. There are also symptoms that relate to self. She mat up continuously sad about her present condition, resulting in emergency visits to her GP. In other words, Katie may have felt a loss of status and purpose, having become remarkably withdrawn from friends and family, she was not able to retain a sense of confidence in her the future. about of Katies psychological concerns can be addressed within the Community Mental Health Team working with other professionals and Katies Care-Coordinator, and also with Katies family. The punt of family and friends could be mobilised to give emotional, spiritual and financial assistance, with her family assuming an influential changing role and responsibilities when one person is ill (Washington Leaver, 2009). The motivation for Katies to participate in everyday activities could be initiated by working with the Occupational Therapy to engage in activ ities at the community centre.Sanders and Hill (2014) examined the psychological impact of depression, in so off the beaten track(predicate) as it is conceptualised by the patient, as grounded in the concept of self. They assert that the supposition of self is concerned with perceptions and awareness of being, the pattern of perceptions, which is also concerned with consequences for temperament and change (Sanders Hill, 2014). Also, a well-functioning self-characterised by assimilation and ability to respond to bare-assed experiences. However, a good self-process can become impeded by other impaired person -processes such as intrusive thoughts and any other perceptions that pose a threat and target the self (Sanders Hill, 2014). Threats to the self, which can be internal or external, can culminate in patterned restrictions on perceptions and response which is configured as depression expressed in symptoms such as pervasive feelings of negativity (Sanders and Hill, 2014). This conceptualisation encapsulates Katies perception of herself as Katie could electrostatic enjoy her life only if she could change her perception of herself. Katies intervention demand to focus on changing her perception of herself.Specifically, the Nursing process involves appellative of priorities as well as the determination of appropriate patient-specific outcomes and arbitration, thus square the urgency of the identified problem and prioritising the patients needs (Ackley, Ladwig, 2013). In other words, vernacular goal setting, along with symptom, pattern, recognition and triggers, will help prioritise interventions and determine which intervention is going to provide the greatest impact (Ackley, Ladwig, 2013). Heeramun-Aubeeluck, Luo, (2012) assert that collaborative circumspection, behavioural interventions, and psycho-education are helpful in encouraging patients to maintain treatment and enhance psychological well-being and quality of life. The intervention chosen fo r Katie in this case study is Cognitive Behaviour Therapy (CBT). CBT can be accessed by dint of referral to Improving Access to Psychological Therapies (IAPT). CBT is supported by NICE (2017), and also various government activity publications over the years have recommended the use of CBT such as No Health without Mental Health ( discussion section of Health, 2011) and Talking Therapies. CBT is concerned with how plenty think (cognition), how they feel (emotion) and how they act (behaviour) (Daniels, 2015). CBT is psychoeducational and focused on changing the way people conceptualise illness to influence their behaviour and carriage (Daniels, 2015). The objective of cognitive processing is to examine patients thoughts and help them to learn the skills of acknowledging interdict thoughts, often referred to as negative automatic thoughts (NATs). They will then be able to re-evaluate these reports using an objective framework, and this can involve using accession to gathering ev idence for the validity of ideas, such as proof against and for, surveys, or asking a trusted other (Grist, 2011). The rationale for CBT in this study is that its characteristics as a therapy would be helpful to address Katies symptoms and profile, as generally the symptoms that impact on her quality of life are of cognitive and behavioural nature.Equally important, a problem-solving approach will be adopted to complex body part and organise Katies nursing care and treatment. Katie will be involved in the whole process to empower her in her care plan by means of a person-centred approach and intervention that is evidence-based. Evidence-based interventions are practices or programs that have peer-reviewed, documented empirical evidence of effectualness. Evidence-based interventions use a continuum of activities, strategies, integrated policies, and services whose effectiveness has been verified or informed by research and evaluation (National Resources center field for Mental Health promotional material Youth Violence Prevention, 2017).Gulanick Myers (2016) contend that intervention is a basis for excellence in nursing practice, which includes correctly identifying living needs, as well as recognising potential needs or risk, planning, delivering care in own fashion to address actual and prospective needs as well as evaluating the effectiveness care. More importantly, nurses must be able to work autonomously with confidence with significant others, such as families, friends, and carers to reassure Katies needs are met, including self-care arrangement (Nursing and Midwifery Council, 2015). Besides, as the name suggests, CBT comprises obvious therapy approaches that the address either the cognitive or the behavioural aspects associated with mood disorders, including depression. In CBT cognitive and behavioural approaches can be used in combination or unilaterally (dobson Dozois, 2009).The behavioural perspective in CBT looks at the environment and behaviour of the patient. Depressive symptoms are attributed to a decrease in environmental reward, reinforcementof depressive reactions and avoiding alternative actions that facilitate good health (Hopko, Lejuez, Lepage, Hopko, McNeil, 2003). The behavioural perspective to depression underpinned by the works of Lewisohn (1974), who concluded that the pleasure obtained through action with ones environment increases the likelihood of a rewarding behaviour. Further, change in the environment could result in deficient response-contingent positive reinforcement (RCPR) which directly contributes to depression (Dobson Dozois, 2009). Dobson Dozois, (2009) highlights Response-Contingent Positive Reinforcement as positive or pleasurable effect deriving from the behaviour of a person within their environment and the likelihood of increase such conduct. behavioural Activation therapy has proved to be profitable in addressing deficient RCPR and improving mood and thoughts. This treatment focuses on availing activities that support environmental reinforcement (Hopko et al. 2003). Both the cognitive and the behavioural components of treatment would advantage Katie. Sheldon (2011) contends that CBT is a therapeutic approach that involves talks and conferences. In this therapy, the patients are involved in discussions, and they express their feelings, behaviours and thoughts to a CBT professional during the initial assessment (Sheldon, 2011). Kassel (2016)asserts the value of CBT as a therapy that teaches individuals how to think and react to certain stressful situations appropriately and can be used for some across a range of disorders including phobias, schizophrenia, depression, eating disorders, anxiety disorders, and relationship difficulties. When embarking on CBT interventions, the therapist uses information self-collected from an interview the patient in this case, it would be with Katie and guides her through a explanation of the CBT model of depression as it applies to her profile and symptoms (Kassel, 2016). Also, general models of how thoughts, moods, behaviours, and physical sensations interact are discussed, enabling identification of a model as it relates to the patients life.several(prenominal) lines of evidence suggest that CBT is one of the most effective treatments when anxiety and depression present as the primeval symptoms (Royal College of Psychiatrists, 2009). Further, CBT helps to make sense of a weighed down problem by breaking it down into smaller bits (Kassel, 2016). The National Centre for bioengineering Information (2012) highlights that a combination therapy consisting of medical drugs and CBT has been establishing to be more than efficient when that when medication is used alone in patients with more severe, perennial or chronic forms of depression in the acute treatment phase. However, as highlighted by RCP (2009) CBT does not a quick fix, and if the patient is feeling depressed, it will be difficult to co ncentrate on getting them motivated. Further, CBT courses can support for six weeks to sixths months depending on the type of problem, and how motivated the patient is on engaging. CBT offers some significant advantages as an alternative therapy. Given all that has been mentioned so far, it is diaphanous that CBT has considerable influence on the disease burden of depression as the treatment is safe and cheap (RCP, 2009). Also, it can administer as a self-help programme. CBT is now also delivered online, however, the quality of these trails is not always right (Andersson, Cuijpers, 2008). RCP (2009) notes that some research suggests that CBT may be better than antidepressant at preventing depression relapses. However, it is necessary for the patient to keep practising their CBT skills, even after they are feeling betterCONCLUSIONThe two dominant approaches to conceptualising and treating depression that is the physiological perspective and psychological perspective, offer plausib le concepts in understanding the aetiology of depression, to date the patient may attach different conceptualization of the illness, which results from the idea of the self. The idea of the self is quite critical in treatment outcomes in so far as it mediates changes in cognition and behaviour. However, it has not yet been distinctly established how the perspectives interact to cause depression symptoms. This case study highlights that when treating depression, it is essential to carefully monitor the response to treatment as some people will not respond to available therapies. Further, as some people dont respond to treatment, there is a lot of research that needs to be done to understand how antidepressants work in different people entirely. Finally, cognitive behavioural therapy has numerous benefits for patients, including, decreased psychological distress, improved pain management, increasing self-efficacy, execute the sources of action required to manage prospective situatio ns, better quality of life and function.ReferencesAckley, B. J., Ladwig, G. B. (2013). Nursing diagnosis handbook An evidence-based guide to planning care (10th ed.). St. Louis, MoLondon Elsevier MosbyAllen, K. L., Crosby, R. D., Oddy, W. H., Byrne, S. M. (2013). 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