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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
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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:
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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
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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
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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:
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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
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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
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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
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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/>