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Running head: Depression disorder 1

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Depression disorder

Screening, Diagnosis and Treatment of Depression Disorder

August 6, 2019

Screening, Diagnosis and Treatment of Depression Disorder

           Depression is a mental disorder that has both social and health effects to individuals worldwide. Reports from the WHO suggest that depressive disorders form a significant percentage of the total number of deaths reported in both developed and developing countries. Depressive disorders are also a major cause of disability (U.S. Department of Health, 2017). Depression is treatable. The commonly used treatments of depression include psychotherapy and drugs. Studies suggest that there are various effective strategies available for use to improve the depression symptoms such as the integration between specialist and primary health care. The severity of depression varies from patient to patient. DSM-5 is the commonly used diagnostic criteria used to differentiate depressive disorders from sadness (Gore & Widiger, 2013). The criterion was developed in the United States and has been used extensively in psychiatric research. The model stipulates the threshold that the signs and symptoms of depression must meet to justify a diagnosis. This research analyzes Eliza Doolittle’s psychosocial assessment and treatment plan.

Intake

Eliza Doolittle is an eighteen years old girl. Her residence at the time of the visit was a school dormitory where she lived with her friends. Eliza stated the reason for her visit was due to being sent home from school. The depressive symptoms that Eliza experienced were anxiety or stress and low self-esteem. Eliza is the only child in her family. Her father is Burt, and her mothers name is Joan. She denied being on any medication for mental health at this time. She also added that she had not encountered any stressful experiences in her life.

Eliza completed the DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure (CCM-1) for adults, which is a questionnaire with the various depressive symptoms. This questionnaire enables the healthcare professional to identify the depressive symptoms that Eliza might have had in the last two weeks before her visit. According to the DSM-5 diagnostic criteria, Eliza must have experienced at least five symptoms of depression in the same two weeks period. Eliza must have at least one of the following symptoms to warrant a diagnosis. These include: loss of pleasure in usual activities, loss of self-worth or suicidal, fatigue, weight loss, tiredness, inability to think correctly, loss of energy and loss of appetite.

Biopsychosocial Assessment

Eliza was identified as a Caucasian female who was a first-year college student studying engineering. Eliza’s parents live in a town, which is about two hours away from the health center. Eliza was sent to counseling because she was found with alcohol in the dormitory although she claimed she was not intoxicated. However, she said that she was drunk. Eliza said that she had been experiencing stress in school since things in college were not easy as they were in high school. She added that study requirements have been difficult in college. Eliza stated that making friends had been difficult for her since her high school friends either went to different colleges or pursued other things.

Eliza admitted that she had used substances such as alcohol, and marijuana, although she said that she has never overused any of the substances. The only type of addiction that Eliza has was online gaming. Besides, she denied having been previously hospitalized due to mental illness. Eliza has had traumatic experiences, although she stated that she was teased in high school. Eliza’s social relationships were questionable because she felt that her friends were misusing her on many occasions. However, she had a good relationship with her parents despite there being some strains between the parents. Her family rarely goes to church; therefore, she is not strictly spiritually aligned. Eliza denied having had suicidal or homicidal intentions.

Assessment of Eliza’s symptoms using the DSM-5 diagnostic criteria showed that Eliza had experienced five depressive symptoms in the last two weeks prior to her visit to counseling. The symptoms included little pleasure or interest in doing normal activities, anxiety, slight sleeping problems, lack of identity, and little enjoyment of social activities. The CCM-1 results show that Eliza has slight symptoms of depression, which if not managed, can easily become more severe if the causes are not well managed. According to the DSM-5 diagnostic criteria, the results suggest that Eliza has mild depression because she had experienced at least one diagnostic symptom that is a loss of pleasure in usual activities.

The initial treatment goals for Eliza would be directed towards improving the depressive symptoms that Eliza has experienced. The major depressive symptoms in Eliza’s life are the loss of interest in normal activities as well as anxiety. There is no standard treatment for mild depression. However, Eliza has several options available for her treatment. First, the symptoms of mild treatment can go away without being treated. The physician can allow Eliza to go and come back after two weeks to check whether the situation will have improved (Schwitzer & Rubin, 2014). This method is commonly referred to as watchful waiting. Secondly, the physician can advise Eliza to start doing exercises. Exercise has been identified as one of the effective methods of dealing with mild depression (Schwitzer & Rubin, 2014). The physician can decide to involve Eliza in a group class where they will be doing exercises together. Third, self-help is a method of treating mild depression where Eliza would think about her feelings by talking to a psychological therapist or a friend.

Treatment Planning

           APA offers a number of measures that help in the assessment of patients. The assessment measures should be administered form the first interview with the patient to help monitor the progress of the treatment (Weiner & Greene, 2017). DSM-5 Level 2 of assessing depression are used to measure the progress that Eliza would be taking during treatment. Eliza would require CCM-2 to measure her level of anxiety in the first seven days of treatment (Weiner & Greene, 2017). Eliza would be required to fill the CCM-2 questionnaire, which contains eight items whereby she would be needed to rate the severity of the depression in the last seven days. The physician then interprets the data and determines the level of depression of Eliza.

           Apart from the assessment provided by APA, Eliza can use online self-assessment tests to monitor her progress, especially with the issue of anxiety. Anxiety was the major problem that Eliza highlighted as a point of concern. She used to avoid anxious situations to manage her condition (Bot et al., 2017). Online assessments include questions similar to those of other assessments tests. The patient is required to give genuine information to be able to give genuine results. This process is helpful, especially if the patient has to travel for a long distance to see the physician.

           The findings of the assessment should be conveyed to Eliza in her native language. Diagnostic information should be provided in a language that Eliza understands best. The physician should maintain clear communication with Eliza (Gilligan et al., 2018). Clear and improved communication reduces the chances of adverse events by managing the anxiety of the patient. Although there is no standard way of communicating assessment results to Eliza or her family, the physician should be keen to avoid chaos. Communication failure can be disastrous (Gilligan et al., 2018). The physician should be able to tell the patient the situation is under control.  

           The objective of the physician is to guide the patient through the journey to a healthier state. The outcomes of the treatment are dependent on not only the prescription of the physician but also on Eliza’s willingness the get well and thereby follow the instructions. If the patient misses appointments or drops-out of the psychological therapies, it may be difficult for the physician to deliver the agreed-upon outcomes. However, patient follow-up helps keep the patient on track. Strategies, measures, and outcomes are achievable when the relationship between the Eliza and the clinician is maintained.

Referral

           Referrals are necessary when the clinician cannot offer the services needed by Eliza. The clinician can request the help of other professionals who can assist in the treatment process (Russomagno & Waldrop, 2019). If the needs of the client are outside the expertise of the clinician, a referral would be made. Examples of referrals in mental illnesses include psychological therapists, psychiatrists, family therapists, and mental health nurse. The referrals would be necessary for Eliza to help her understand her feelings. Therapists would allow her to cope with the symptoms of depression.

           The choice of referrals depends on the inherent condition that requires the expertize of other professionals. Eliza would require a psychological therapist who would enable her to understand the feelings that are depressing her (Russomagno & Waldrop, 2019). One can clearly see that Eliza feels that she is alright and doesn’t need any mental care. However, since the DSM-5 criteria showed that her experiences meet the criteria, it is necessary for her to get treatment. For this reason, a psychological therapist would help her understand the feelings and situations that make her depressed.

Conclusion  

Despite the overwhelming evidence on the prevalence of depression around the world, there are just a few studies that provide information on its treatment. Furthermore, treatment of mild depression is not sufficiently researched, although some studies propose various methods. However, there is one common feature in all depressive disorders; that is, the patient follows up. The therapeutic approach that was highlighted as a possible treatment plan requires the clinician to constantly follow-up the progress of Eliza. The study also pointed out the importance of referrals in the treatment of depression.

References

Bot, M., Middeldorp, C. M., De Geus, E. J. C., Lau, H. M., Sinke, M., Van Nieuwenhuizen, B., ... & Penninx, B. W. J. H. (2017). Validity of LIDAS (Lifetime Depression Assessment Self-report): a self-report online assessment of lifetime major depressive disorder. Psychological medicine47(2), 279-289. DOI: https://doi.org/10.1017/S0033291716002312

Gilligan, T., Coyle, N., Frankel, R. M., Berry, D. L., Bohlke, K., Epstein, R. M., ... & Nguyen, L. H. (2018). Patient-clinician communication: American Society of Clinical Oncology consensus guideline. Obstetrical & Gynecological Survey73(2), 96-97. doi: 10.1097/01.ogx.0000530053.40106.9b

Gore, W. L., & Widiger, T. A. (2013). The DSM-5 dimensional trait model and five-factor models of general personality. Journal of abnormal psychology122(3), 816. Doi: org/10.1037/a0032822

Russomagno, S., & Waldrop, J. (2019). Improving Postpartum Depression Screening and Referral in Pediatric Primary Care. Journal of Pediatric Health Care33(4), e19-e27. doi.org/10.1016/j.pedhc.2019.02.011

Schwitzer, A. M., & Rubin, L. C. (2014). Diagnosis and treatment planning skills: A popular culture approach (2nd ed.). Los Angeles, CA: Sage Publications. ISBN-13: 9781483349763 

U.S. Department of Health & Human Services, (2017). HIPAA for Professionals. Retrieved from https://www.hhs.gov/hipaa/for-professionals/index.html

Weiner, I. B., & Greene, R. L. (2017). Handbook of personality assessment. New York, NY: John Wiley & Sons.