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Case Study: Major Depressive Disorder

Valerie, age 25, is admitted to the psychiatric unit by her psychiatrist after stating that she no longer wanted to live. She has a long history of psychiatric problems, beginning at age 15, when she swallowed a handful of aspirin and acetaminophen.Valerie’s mother has a history of depression, and her father is very authoritarian. He ruled Valerie and her sister with an iron hand and rarely showed affection or gave positive feedback.

In college, Valerie met Bob, with whom she immediately fell in love. He was very affectionate and she felt she received some nurturing from him that she had not received from her parents. In the semester before graduation, Bob told her he was leaving to go to graduate school in another state, and that he was not ready to get married at this time. Valerie became hysterical and went into a deep depression.

After a few weeks she met Jack, with whom she immediately began a sexual relationship and became pregnant. Jack agreed to marry Valerie, and so they began a short, but extremely stormy, relationship. Six months after the birth of their baby boy, they began divorce proceedings, with a great deal of negative negotiations regarding custody and child support. The child is 4 years old now, and Valerie has had several “serious” relationships since her divorce, having just broken off from the most recent one this week. Ralph told her that she is just “too intense, draining him of all his energy.” She said he told her that she expects too much from their relationship—more than he has to give. She admits that she got serious really fast but that she really believes she loves him. She says to the admitting nurse, “What’s the matter with me? Why can’t I have normal relationships like other people? If it weren’t for my little boy, I wouldn’t even be here now.”

Provide 5 therapeutic responses/questions for  this client?        What type r your therapeutic responses? Define them.

Symptoms of Depression

Next to each of the behaviors listed below, write the letter that identifies the disorder in which the behavior is most prevalent. Choices are: a. Dysthmic Disorder, b. Major Depressive Disorder, and c. Transient Depression.

         1. Feeling the “blues” in response to everyday disappointments

         2. Gloomy and pessimistic outlook

         3. Feelings of total despair and hopelessness

         4. Physical movement may come to a standstill

         5. Feels at their best early in the morning and continually feels worse as the day progresses

         6. Able to carry out thoughts of self-destructive behavior

         7. Feels at their worst early in the morning and somewhat better as the day progress

Antidepressant Therapy

Please fill in the blanks and answer the questions in the spaces provided:

1.     What is the mechanism by which antidepressant medications achieve their desired effect (regardless of the different physiological processes by which this action is accomplished)?

2.     For what must a nurse be on the alert with a client who is receiving antidepressant medication?

3.     When should a nurse expect a client to begin showing signs of symptomatic relief after the initiation of antidepressant therapy?

4.   Give an example of a tricyclic antidepressant: ___________________________________________

Give an example of an MAOI:                                                                                                        

Give an example of an SSRI: _________________________________________________________

5.     Describe some common side effects and nursing implications for tricyclic antidepressants.

6.                                                is the most potentially life-threatening adverse effect of MAOIs. Symptoms for which the nurse must be on the alert and items the client must avoid consuming include:

7.     What must be done to prevent these symptoms from occurring? (Your answer must include some examples.)

SCIENCE
HEALTH SCIENCE
NURSING

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