NURS 6501 PSYCHOLOGICAL DISORDERS MODULE 6
Primary Diagnosis: Depression
- Describe the pathophysiology of the primary diagnosis in your own words. What are the patient’s risk factors for this diagnosis?
| Pathophysiology of Primary Diagnosis |
| · Depression has been primarily being associated with low brain 5‐hydroxytryptophan (5-HT) levels and altered 5‐HT receptors, such as upregulated 5‐HT2 and downregulated 5‐HT1A receptors causing mood alterations (Tian et al., 2022).
· Alterations in dopamine, glutamate, noradrenaline and GABA neurotransmitters and their receptors have been associated with synaptic plasticity and altered neurogenesis resulting in symptoms of major depression.
· In addition, stress has been associated with high cortisol levels that inhibit 5‐HT1 neurotransmission increasing risk of depression.
· High cortisol levels have also been associated with inflammatory cytokines such as interleukins that alter synaptic connections resulting in depression-like-behavior. |
| Causes |
Risk Factors (genetic/ethnic/physical) |
| · Neurodegenerative diseases such as dementia.
· Genetic alterations in serotonin 5-HT receptors (Remes et al., 2021).
· Poor nutrition resulting in anemia
· Thyroid diseases
· Cushing disease
· Pregnancy and post-partum state. |
· Family history of depression especially in a first degree relative.
· Medical conditions such as cancer and diabetes (Remes et al., 2021).
· Female gender.
· Psychological stress
· Grief and loss
· Alcohol and substance use. |
- What are the patient’s signs and symptoms for this diagnosis? How does the diagnosis impact other body systems and what are the possible complications?
| Signs and Symptoms – Common presentation |
How does the diagnosis impact each body system? Complications? |
| · Depressed mood
· Insomnia or hypersomnia
· Anhedonia
· Loss of concentration
· Increased or reduced appetite (Christensen et al., 2020)
· Weight gain or loss
· Fatigue and lack of energy.
· Feeling guilty or worthless
· Suicidal ideations |
· The diagnosis has been associated with an increased risk of comorbid alcohol and substance use.
· Depression has higher risks of relapse thus increasing morbidity rates (Fernandes et al., 2023).
· The diagnosis has been associated with an increased rate of suicide hence increasing their morbidity and mortality.
· Depression has an impact in a patient’s social life leading to failed friendships and marriage further worsening the prognosis.
· Obesity can co-occur increasing the patient’s risk for cardiovascular diseases. |
- What are other potential diagnosis that present in a similar way to this diagnosis (differentials)?
| · Central nervous system diseases such as Parkinson’s and dementia.
· Endocrine diseases such as hyperthyroidism, hypothyroidism, and Cushing’s disease (Menezes et al., 2022).
· Schizophrenia and schizoaffective disorders.
· Medical conditions such as syphilis and HIV.
· Alcohol and substance use intoxication.
· Anxiety disorders |
- What diagnostic tests or labs would you order to rule out the differentials for this patient or confirm the primary diagnosis?
| · Thyroid function tests.
· Complete blood count.
· Rapid plasma reagin (RPR).
· HIV test.
· Dexamethasone suppression tests (Menezes et al., 2022).
· Blood alcohol level and toxicology screen.
· Urea, electrolytes, and creatinine (UECs).
· Brain magnetic resonant imaging (MRI). |
- What treatment options would you consider? Include possible referrals and medications.
| a) Pharmacotherapy using antidepressants such as:
· Selective serotonin receptor inhibitors such as fluoxetine.
· Serotonin-Noradrenaline receptor inhibitors such as venlafaxine (Karrouri et al., 2021).
· Tricyclic antidepressants such as amitriptyline.
· Monoamine oxidase inhibitors such as phenelzine.
b) Psychotherapy methods such as:
· Cognitive-behavioral therapy (Karrouri et al., 2021)
· Interpersonal therapy
· Problem-solving therapy
· Behavioral activation
c) Electroconvulsive therapy in patients who:
· Have failed drug response.
· Have high risk of suicide (Karrouri et al., 2021).
· Need high antidepressant response. |
References
Christensen, M. C., Wong, C. M. J., &Baune, B. T. (2020). Symptoms of Major Depressive Disorder and Their Impact on Psychosocial Functioning in the Different Phases of the Disease: Do the Perspectives of Patients and Healthcare Providers Differ?. Frontiers in psychiatry, 11, 280.
https://doi.org/10.3389/fpsyt.2020.00280
Fernandes, M. D. S. V., Mendonça, C. R., da Silva, T. M. V., Noll, P. R. E. S., de Abreu, L. C., & Noll, M. (2023). Relationship between depression and quality of life among students: a systematic review and meta-analysis.
Scientific reports,
13(1), 6715. https://doi.org/10.1038/s41598-023-33584-3
