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Major Depressive Disorder Case Study

Edzarae Bell

Teresa Peck

April 2018
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Abstract

On April 4, 2018 I was on the psychiatric unit at Trumbull Memorial Hospital (TMH). The

patient was admitted with depressive disorder and bipolar. He no admissions prior to this one.

Throughout this paper I will be discussing my patient’s history along his psychiatric diagnosis,

and how he has progressed though out his treatment. I will also discuss the patient’s medications,

nursing diagnoses, his expected outcomes of care, and his plans for discharge. There were

stressors leading up to the admission to the psychiatric health floor. The symptoms of this

disorder can be shrugged off as just having a bad day or feeling blue. Education is a huge role in

understanding the disease process. As time progresses mental illness is taken more seriously, but

there is still a stigma on mental illness. With education society will understand that the people

diagnosed with mental illness are not just crazy, but they need help.
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Objective Data

My patient, DB, is a 28-year-old Caucasian male from Warren, Ohio. He was voluntary

admitted to TMH on March 30, 2018. This is his first admission here at Trumbull Memorial

Hospital. He realized that he had to stop self-medicating with alcohol and marijuana, and knew

if he didn’t get help it would end badly which is why he was brought to Trumbull. He had

recently been staying with a family member to try to help his situation with his wife and kids.

Axis I includes all psychological diagnostics, patient DB axis I is depression. axis II did

not have anything specific it was just noted “deferred.” Axis III includes general medical

conditions; acute medical conditions and physical disorder which DB is did not have any listed.

Axis IV includes psychosocial and environmental factors contributing to the disorder. Patient

DB’s axis IV included social and environment factors. Axis V consisted of a code for the level of

function of the patient, and the scale goes from 0-100. DB’s level of function for axis V is 0.

Patient came out from room at breakfast time and I noticed he had a kind of sad look on

his face. After he had breakfast I went to introduce myself and asked if we could sit and talk with

him. He agreed. I started the conversation with asking how he was feeling this morning, how he

had slept, how breakfast was. I was trying to build a rapport with him. When I asked him how he

was feeling he stated, “I am feeling better than when I got here.” I then asked why he was here,

he said he just knew if he didn’t get help it may not have been good. He stated “I felt myself

slipping.” I then asked if this was his first time seeking help and he explained that he had been in

a depression for about 6 months and had been using marijuana and alcohol to medicate. I
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acknowledged the fact that he made the right decision to come in to get help. He was able to hold

conversation appropriately.

Patient had a sad/ depressed facial expression and tone to voice. His voice was monotone.

He laughed at times throughout the conversation which was appropriate. Patient tended to look

down a lot during the conversation. DB stated he has a good coping skill that he likes art and

music, and it makes him happy to make music. He also said that going to groups has been helpful

to him.

Medication

DB is prescribed trileptal that is an anticonvulsant. This is prescribed for stabilizing his

mood, and he takes 300 mg twice a day. He is prescribed risperidone a antipsychotic for his

mania, 1 mg at bed and 0.5 mg daily. Also, patient is prescribed vistaril, an antihistamine for his

agitation. He takes 50 mg PRN every six hours. Patient is also prescribed trazadone an

antidepressant for insomnia. He is prescribed this 50 mg PRN, which he has used each night he

had been there.

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Psychiatric diagnoses and expected/common behaviors

According to Mayo Clinic, major depression disorder is very common and there about 3

million cases in the United States. Major depression disorder is defined as: the persistent feeling

of sadness or loss of interest that characterizes. This feeling has to be for two weeks all day every

day without any changes. Depression can affect any age group, but predominantly starts in the

twenties or thirties (Mayo Clinic, 2017). This patient was right in the middle of the age range.

There were probably signs of depression earlier, but family members and friends do not

recognize these signs as depression. Most people will think it is just one of those days and before

they know it’s been a month. Signs and symptoms are different for everyone. According the

National Institute of Mental Health, these are some of the symptoms of a person dealing with

depression: persistent sad, anxious, or “empty” mood, feelings of hopelessness, or pessimism,

irritability, feelings of guilt, worthlessness, or helplessness, loss of interests, weight changes, and

suicidal ideations (NIH, 2016).

In the article Early parental loss and depression history: Associations with recent life

stress in major depressive disorder states “the possibility that persons who have

experienced early adversity or who have a history of depression may be sensitized to

stress.” With that being said I do believe that after getting the information of his mother

committing suicide when he was a young age. Also, he realizes that may be the root of his

depression which may indicate he needs to work through this to move on.

Precipitating stressors and behaviors

Patient is originally from Warren, Ohio, but currently lives with a family member

because he removed himself from his immediate family to work on himself. He has a wife and 5
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kids. He says he was in the navy about 3 years ago. Patient states that one of his kids is from an

old relationship and does not currently live with his family which could be a stressor to him. He

also stated that his mother committed suicide when he was younger and he believes that is the

stem of his depression.

Nursing care provided and milieu activities attended

There was a nurse assigned to him to watch him and give him the nursing interventions

needed throughout his hospital stay. She would also provide his medication and watch for any

adverse effects. DB did participate in the morning groups and was calm and cooperative during

the groups. I think these groups really help him to focus on himself and what he finds enjoyable.

Group would help him with coping mechanisms such as writing his music when he starts feeling

upset to help him calm down. Also identifying the triggers that he tends to dwell on so he can

learn how to either face the trigger and move on or remove himself from the environment.

Ethnic, Spiritual, and Cultural Influences

Patient touched a little on his spiritual beliefs. He talked about how his wife is catholic

and how he does enjoy the specific religion. However, he does not enjoy the church she attends

so therefore does not attend many services with her. He does read the bible on his own time and

plans to do more readings moving forward because he enjoys reading about the lord.

Outcomes related to care

In his chart it stated that when he came in appeared to be very sad. He states he feels a lot

better and is excited to get discharged to get back to his family. I asked him about his anxiety,

depression, suicidal thoughts, and homicidal thoughts. Patient denied all symptoms. Patient made

a statement during are conversation about not taking good care of himself prior to coming here.
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So to see after a few days of being at TMH he had been taking better care of himself is as far as

ADLs go is an improvement.

Plans for discharge

DB is not quite ready for discharge yet. We did talk somewhat about his plans for when

he leaves. He plans to be med complaint so that he doesn’t have as many low moments. He

plans to go back to his primary home with his wife and kids. His wife did agree to go to

counseling with him to help their marriage and household. He also he plans to do that through

the pastor who married them since they had pre-marital counseling with the pastor. Patient states

he also wants to stop self-medicating with street drugs and alcohol.

Prioritizing Nursing diagnoses

1. Self care deficit R/T anergia AEB persistent insomnia and inability to complete ADLs

2. Ineffective coping related to substance use as evidence by patient stating, “I have been

self-medicating with marijuana and alcohol.”

3. Impaired social interaction R/T anergia AEB avoids contact with others and lacks eye

contact.

Nursing Diagnoses

 Spiritual Distress R/T death of mother AEB expresses feelings of helplessness

 Disturbed thought processes R/T overwhelming life circumstances AEB easily distracted

 Knowledge deficient R/T substance use as evidence by not utilizing resources.

Conclusion

After meeting DB and having a moderately in depth conversation about a variety of

topics I do believe he can have a better outcome of his mental illness. He was able to
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identify to me points that could have enhanced the depression symptoms. He is willing to

modify in any way he can to better himself for his family. He is also willing to be

medication compliant and seek spiritual methods to help as well. These all play a big part

in managing and trying to recover for this mental illness.

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References

Depression (major depressive disorder). (2017, August 16). Retrieved April 8, 2018, from
https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007

Depression. (n.d.). Retrieved April 8, 2018, from

https://www.nimh.nih.gov/health/topics/depression/index.shtml

Slavich, G. M., Monroe, S. M., & Gotlib, I. H. (2011). Early parental loss and depression
history: Associations with recent life stress in major depressive disorder. Journal of
Psychiatric Research,45(9), 1146-1152. doi:10.1016/j.jpsychires.2011.03.004