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?

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NURS 6501 PSYCHOLOGICAL DISORDERS MODULE 6

Primary Diagnosis:  ­­­­­­­­­­Depression

  1. 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.

 

  1. 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.

 

  1. 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

 

  1. 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).

 

  1. 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

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