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Depression Intervention with the Medically Fragile Krista Clark Intervention with Medically Fragile INTV2013 Cheryl Ramey October 5th, 2011 October 5th, 2011 10 Pages Introduction The following is meant to act as an overview of depression for use in the field of intervention with individuals who are medically fragile. The report focuses on how depression can cause an individual to become medically fragile, but it also includes information regarding depression and the elderly and depression in individuals with dementias which, as the population ages, will become more and more relevant to the field of deafblindness. Definition 1. 2. 3. 4. The act of being depressed The state of being depressed Sadness; gloom; dejection A condition of general emotional dejection and withdrawal; sadness greater and more prolonged than that warranted by any objective reason. Types and Descriptions Clinical Depression (Major Depressive Disorder) Most serious form of depression, exhibits more severe symptoms of depression and is more likely to foster suicidal tendencies Dysthmia A low-to-moderate level of depression that persists for at least two years, the symptoms of depression are usually not as severe. Bipolar Disorder (Manic Depression) A disorder which is characterized through both low and high mood swings, an individual with bipolar disorder can experience severe symptoms of depression. Seasonal Affective Disorder Disorder where an individual’s mood is affective by the weather and/or the time of year and how much sunlight they are getting. This disorder is usually effectively treated with light therapy. Postpartum Depression Depression which occurs in 13% of women as a result of a hormonal imbalance after child birth. Depression with Psychosis In some cases Clinical Depression can progress to the point where an individual can lose touch with reality and experience hallucinations or delusions. Catatonic Depression Another severe form of Clinical Depression which is characterized by disturbances in motor function. Statistics “Mood disorders are one of the most common mental illnesses in the general population. According to statistics Canada’s 2002 Mental Health and Well-Being Survey Canadian Community Health Survey (CCHS), Cycle 1.2), 5.3% of the Canadian population aged 15 years and over reported symptoms that met the criteria for a mood disorder in the previous 12 months, including 4.8% for major depression and 1.0% for bipolar disorder. Further, one in 7 adults (13.4%) identified symptoms that met the criteria for a mood disorder at some point during their lifetime, including 12.2% for depression and 2.4% for bipolar disorder. Studies have consistently documented higher rates of depression among women than among men: the female-to-male ratio averages 2:1” (Public Health Agency Canada) Additionally: 10-25% of women suffer from depression The rate of completed suicide in men is four times that of woman, though more women attempt it Symptoms and Physical Manifestations depressed mood (sad countenance) slowed reaction time loss of interest or pleasure in daily activities loss of interest or pleasure in work loss of interest or pleasure in hobbies and favourite activities changes in appetite or weight crying easily lack of motivation and/or energy sleep disturbances (insomnia or chronic oversleeping) noticeable changes in activity level (agitated or slowed down) feelings of worthlessness of guilt irritability, impatience, short temper difficulty concentrating or making decisions recurring thoughts of death or suicide hallucinations delusions avoiding family and friends short-term memory loss panic attacks muscle and joint pain constipation/intestinal problems frequent headaches lack of interest in sex poor abstract reasoning/inability to think clearly self-deprecatory manner, belligerence, defiance (especially in adolescents) lack of eye contact appearance of preoccupation pacing, hand wringing, pulling hair slowed body movements, even to the point of being motionless or catatonic psychomotor retardation or agitation (slowed speech, sighs, and long pauses) Causes Depression usually results from a combination of any of the following factors: imbalance of brain chemicals family history psychological or emotional vulnerability traumatic or stressful life events stress difficult or abusive relationships Steroids sleeping problems isolation alcoholism socio-economic factors (income, housing, prejudice) medical conditions: stroke, heart disease, obesity, Parkinson’s disease, epilepsy, arthritis, cancer, AIDS, COPD, dementia/Alzheimer’s, underactive thyroid, lupus, chronic pain use of certain medications: narcotics, benzodiazepines, progesterone and street drugs such as amphetamines. Diagnosis Diagnosis is usually centred around questions about symptoms and severity of symptoms that a doctor will ask. A doctor may also perform a physical and have additional blood tests to ensure that the symptoms experienced are not the result of an underlying medical condition. Treatments Treatment options for depression differ greatly depending on the severity of the depression, and in many cases a combination of different treatments is used. Medication Medications used to treat depression begin to work within 2-4 weeks of treatment. In some situations more than one type of medication may be needed to treat the depression. Common medications include: duloxetine, venlafaxine, desvelafavine, bupropion, trazadone, mirtazapine, moclobemide, phenelzine, amitriptyline, doxepin, nortriptyline. All medications have side effects which need to be considered before using them to treat depression. Herbals St. John’s Wort is a common herbal remedy, but herbal remedies still have side effects and may be dangerous when taken with other medications, so a physician should be consulted before beginning a herbal treatment for depression Psychotherapy A process of talking through the depression which may involve psychiatrists, psychologists, a family doctor, and/or friends and family depending on the nature and severity of depression. Electroconvulsive Therapy (ECT) ECT is the most effective treatment in severe case where the individual does not respond to medications or other treatments, and may also be used to treat individuals who have Depression with Psychosis. Additional Treaments Psychoeducation Self-help organizations Light therapies: controlled exposure to artificial sunlight Physical activity and sports: helps relieve anxiety, increase appetite, aid sleep, improves mood and self-esteem, and naturally releases endorphins Suicide Warning Signs Signs of depression Repeated expressions of hopelessness, helplessness, or desperation Behaviour that is out of character (outgoing to withdrawn; polite to withdrawn; compliant to rebellious; well-behaved to “acting out”) A sudden and unexpected change in attitude Giving away possessions Making preparations for death (Making a will; taking out life insurance) Making remarks related to death or expressing the intent to commit suicide Depression and being Medically Fragile In-class definition of medically fragile: has a serious, ongoing illness or a chronic condition that has lasted or is anticipated to last at least 12 months or has required at least on month of hospitalization, and that requires daily, ongoing medical treatments and monitoring by appropriately trained personnel which may include parents or other family members, and requires the routine use of a medical device or of assistive technology to compensate for the loss of usefulness of a body function needed to participate in activities of daily living, and lives with ongoing threat to his or her continued well-being. (ARD/IEP Supplement Form for Medically Fragile ARDSUPMF) According to the in-class definition of ‘medically fragile’ there are four circumstances in which an individual with depression can be considered medically fragile. The first circumstance is that the individual is a danger to themselves because they live with an ongoing threat to their continued well-being. Individuals who are suicidal require monitoring by trained personnel and may either be hospitalized or put in a residential treatment center until the individual is no longer a danger to themselves or others. The second is that they are unable to perform activities of daily living. If an individual’s depression is so severe that they are no longer capable of taking care of themselves they may also be hospitalized and monitored until the treatments are effective. The third is if they are experiencing psychotic symptoms which make them a danger to themselves and/or others. Hallucinations and delusions that can be experienced by individuals with depression are another cause for them to be hospitalized and monitored until the treatments become effective in order to keep them safe and ensure that they are not ongoing threat to their lives. The fourth is if their depression causes them to refuse to eat or become unable to eat through catatonia. Refusal to eat may be seen in individuals who have dementia and depression, in both circumstances the individual may require a feeding tube in order to sustain their life. Additionally, having Dysthymia (mild depression) can affect an individual’s overall health over an extended period of time and puts them at higher risk for developing symptoms of severe depression. Dysthymia can also lead to heart disease or general heart problems due to the strain that the emotions place on the heart, this can be especially dangerous to someone who is already considered at risk or who is medically fragile. Conclusion Depression can affect the vulnerable population with which we work in many ways. The isolation experienced by the population puts them at greater risk to experience symptoms of depression, it is important when working with individuals to always be objectively monitoring them subconsciously and knowing how to recognize the warning signs of depression and suicide. References Article Links Suicide Prevention Strategy pushed by federal Liberals http://www.cbc.ca/news/politics/story/2011/10/04/pol-suicide-prevention.html Dealing with the Depths of Depression http://psychcentral.com/lib/2006/dealing-with-the-depths-of-depression/ Seasonal Affective Disorder http://psychcentral.com/library/depression_sad.htm Practical Geriatrics: The Diagnosis and Treatment of Depression with Dementia http://ps.psychiatryonline.org/cgi/content/full/50/9/1151 “Tube Feeding” – Right or Wrong: The Medical, Legal and Ethical Issues http://www.thedoctorwillseeyounow.com/content/aging/art2071.html Weight Loss in the Dementia Patient http://www.alzbrain.org/pdf/handouts/2023.%20%20WEIGHT%20LOSS%20IN%20THE %20DEMENTIA%20PATIENT.pdf Video Links What is Depression? (Depression #1) http://www.youtube.com/watch?v=IeZCmqePLzM Sign Symptoms and Treatment of Depression http://www.youtube.com/watch?v=mlNCavst2EU Depression in the Nursing Home http://www.youtube.com/watch?v=F5Lzq33NcwI Segment on Elderly Depression http://www.youtube.com/watch?v=uDQaQD4hBxg Works Cited Body and Health Canda. 1996-2011. MediResource. 28 September 2011 <http://bodyandhealth.canada.com/channel_condition_info_details.asp?channel_ id=1053&disease_id=438relation_id=28250> Centre for Addiction and Mental Health. 2009. 1 October 2011 <http://www.camh.net/ about_Addiction_Mental_Health/Mental_Health_Information/depression_mhfs.ht ml> "depression." Dictionary.com Unabridged. Random House, Inc. 05 Oct. 2011. <Dictionary.com http://dictionary.reference.com/browse/depression>. Healing from Depression. 2010. 1 October 2011 <http://www.healingfromdepression. com/hospitalization> Medscape Reference. 1994-2011. 1 October 2011 <http://emedicine.medscape.com/ article/805459overview#aw2aab6co11> PubMed Health. 2011. 1 October 2011. <http://www.ncbi.nlm.nih.gov/pubmedhealth/ PMH0001941/> WebMD. 2005-2011. 1 October 2011 <http://www.webmd.com/depression/ hospitalization-needed> What is Catatonic Depression? 2011. LIVESTRONG. 1 October 2011. <http://www. livestrong.com/article/14427-what-is-catatonic-depression/>