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In this essay, a discussion will be done on the biological, psychological as well as social factors of the “Bio-psychosocial Model” that contribute to Chole’s condition. Moreover, in the second section of the essay, a “Person-Centred Approach” will be taken to take suitable interventions for severe depression of Chole. In the third section of the essay, an analytical overview will be provided of the effectiveness of intervention strategies. Moreover, in the last section, the analysis will be done on any possible ethical as well as legal issues in the treatment. The client is Chole who has been diagnosed with 1st episode of severe depression by the GP. She has a language barrier and can only speak in her native language. She used to visit the UK to meet her children occasionally with her husband. In India, some robbers burgled their home and at the hit moment, her husband was killed.
In this section, the “Bio-psychosocial Model” by George Engel (1980) will be used to represent a formulation for Chole. The factors that have contributed to this condition of the patient will be evaluated. The biological factors, psychological factors or emotional factors that have contributed to severe depression condition include:
Biological factor:
Chole is an older adultand depression is quite common among elderly people. As per data, globally, it is assessed that 5.7% older adults suffer from depression (Who, 2021).
There can be several factors, which might have contributed to her psychological state. Firstly, hormonal changes can cause depression and menopausal women are more prone to develop depression. As per the findings of Cai et al(2021), the decline in the oestrogen level contributes to emotional changes including irritability, fatigue, and even sadness. Furthermore, a low level of oestrogen is associated with sleep disturbances or insomnia and which results in depression. Women who have a higher BMI, pharyngeal abnormalities, and higher waist circumference are likely to have depression. Another possible cause of this depression might be a change in neurotransmitter levels. According to Yagishita (2020), imbalanced serotonin and dopamine levels are bly associated with depression; hence, it might be a possible cause of severe depression.
Psychological factors:
The sudden death of her husband in front of her eyes might be a possible cause of her depression. Chole used to live with her husband in India and after her husband’s demise; she was forced to stay alone. As per the findings of Djelantik et al (2020), losing someone very close can cause depression and the loss of her most loved ones might be a possible psychological factor contributing to severe depression. The researchers have claimed that PGD or “Prolonged Grief Disorder” symptoms are expected in trauma-exposed grieving adults and this is closely related to symptoms of PTSD as well as depression.
Social factors:
Chole lives alone after her husband demised and due to the language barrier she cannot properly communicate with others in English (Freedman and Nicolle, 2020). The study has shown that social isolation, loneliness, as well as social vulnerability are familiar problems among older adults and have significant health consequences.
Moreover, as she has come to the UK with her children she does not know anyone personally with whom she can share her feelings and thoughts. Most times, she stays alone. Before the demise of her husband, she used to live with him in India and could communicate in her native language with neighbours and close ones. Therefore, the language barrier and lack of communication with others except children might be a possible cause of this severe depression.
A PCC or “Person-Centred Approach” helps take biological, psychological, as well as social interventions for Chole.
Biological:
As per the evidence, there can be two possible physical or physiological conditions, which can cause depression. Menopause or reduction in oestrogen levels and altered neurotransmitter levels can be another possible cause.Oestrogen therapy has been found to be beneficial for treating depression as per the findings of Shea et al. (2020). However, it has to be done based on the actual reason for depression; otherwise, this therapy will not work to relieve the depression. Medications such as anti-depressants that contain Citalopram, fluoxetine, paroxetine, and sertraline known as “Selective serotonin reuptake inhibitors (SSRIs)” can be used (Ungvari et al. 2019). She was suggested mirtazapine and promethazine medicationsfor her depression.The possible risk factor or slide effect of taking long-term SSRI treatment is sleep disturbances and a rapid weight gain and that in turn can significantly enhance the chances of Diabetes and CVDs (Piché et al. 2020). In this regard, the role of the doctor is to select a medicine dose appropriate for Chole and her mental condition. The role of the nurse is to provide support if the patient shows any unusual behaviour such as seizures or something (Zheng et al. 2019). The dietician can help the patient to do physical exercise and taking a balanced diet can help in mitigating these possible negative impacts of prolonged talking of medicines.
Psychological:
Psychotherapy is a possible intervention that is useful in treating psychological disorders like depression. Hence, other than anti-depressants and oestrogen therapy as the treatment for depression, Chole can do regular physical activities because as per NHS, depression can elevate the neurotransmitter levels in the brain and might feel better and happier (Cuijpers et al. 2020). Moreover, as per NICE guidelines, people with mild to moderate depression can exercise for 45 to 1 hour, thrice a week to elevate their mood by balancing the neurotransmitter levels in the body (Nhs, 2022). As per the findings of Kouloutbani et al. (2022), physical exercise does not contribute majorly to elevating mood in depression and with any existing physical problem doing physical activities might not be a good option.
She can attend counselling with a psychologist to help her cope with the depression she has been going through.
The therapist at first used cognitive behavioural therapy (CBT) to help Chole to identify her core beliefs, as well as address her negative thoughts to adjust her behaviour accordingly (Karyotaki et al. 2021). Based on the diagnosis she underwent psychotherapy which is commonly used to treat mental disorders.
Social:
Later on, Chole will receive Interpersonal therapy (IPT) can be used as an effective intervention strategy for depression. It helps in improving interpersonal connections as well as relationships that Chole needs the most to become more socialise(Havsteen-Franklin et al. 2021). As Chole stays with her children in the UK and she has some serious communication barriers. The IPT can help to take such strategies that can improve interpersonal relationships. The reason Chole received this IPT as a social intervention is to build b attachments with her children.
No unmet needs have been identified in the nursing intervention of Chole. All of the physical needs, mental need as well as social needs of the service users have been addressed.
Chole’sview:
“Following undergoing psychotherapy, I am feeling much better now. The doctor has suggested walking in the afternoon for one hour thrice a week. However, until now I have not been able to meet this instruction as I get severe pain in my knees at night after I finish walking. I have told him about this pain and he has suggested some tests. Coming to my mood, I feel much better now and happier than before. Previously, whenever I used to wake up in the morning I used to feel sad and not get any energy to do any work. Now, every morning I make breakfast for my children”. This interprets, that following undergoing the therapies and medication as suggested by the doctors, she is feeling much better now and these are some signs of her recovery. “Nevertheless, sometimes I miss my husband and I still feel I could not save him. Furthermore, I still face difficulties in communicating with the neighbours. I feel ashamed to talk with others in my society and afraid of being judged by others”. This means, she still needs to continue with her treatment as she is not completely cured and still needs some help in socialization.
Doctor’s view:
I have noticed that before undergoing psychotherapy my mother never used to talk with me until I ask her. However, with more passing time she tries to communicate with me and make me understand how she feels. She makes breakfast every day and tries hard to accept the reality of our father.
What has worked well?
Most probably, the medication that the doctor suggested worked well for Chole. “Selective serotonin reuptake inhibitors (SSRIs)” medications have been suggested for Chole. These medicines are useful in elevating serotonin levels in the brain. Moreover, this medication blocks the uptake of serotonin into the neurones and that is the reason, there is more serotonin available, which can improve the signal transmission across neurones (Chu and Wadhwa, 2022). Although initially, the patient might experience some side effects like insomnia, restlessness, agitation and dizziness and even occasional nausea, diarrhoea, and vomiting and Chole has been experiencing such issues as well in the initial phase of the treatment. However, presently no such side effects have been observed.
Current risk and mitigation strategies
There is a low risk of malnutrition as she has already been suggested to eat a balanced diet. Moreover, there is a higher risk that she might have developed osteoporosis. Many factors have possibly contributed to this condition. Menopausal women are at a high risk of developing osteoporosis due to lower levels of oestrogen, which acts as a protective factor in non-menopausal women. In this regard, a calcium and vitamin D supplement can be provided (Fistarol et al. 2019).Higher social isolation due to the language barrier can be mitigated by helping her learn English.
“The Mental Healthcare Act 2017 (MHCA 2017)” considers the rights provided to the patients who suffer from mental health disorders. Under this act all the legal as well as ethical responsibilities in the case of mental health professionals and government (Nhs, 2022). This act ensures the proper diagnosis, treatment, and care for all vulnerable mental health patients. People detained under this Mental Health Act who need urgent mental health care and are at risk of self-harm sometimes needed to stay in the hospital for treatment. Section 5(2) gives the right to the doctor to detain any mental health patient in a healthcare institution for three days and within this time duration, doctors assess whether any further detention will be required or not. Moreover, Section 5(4) provides the right to the nurse to detain a mental health patient in the hospital for approximately 6 hours (Nhs, 2022). None of these is applicable for Chole as she was not in such a severe mental condition and her family members, carer, and her GP are mainly responsible for taking care of her condition. However, her family members stated that she occasionally showed extreme agitation and anger and so she might need to be retained in future for that, her family members and carers took permission from the doctor. On the other hand, under this act, the patient might not give consent and he or she might be treated against their will as well (Athira, 2021). The rationale behind this rule is that some severely ill mental health patients do not have sufficient ability to make an informed decision about their care and treatment.However, that is judged under MHA or “Mental Health Act” 1983 (service.gov.uk, 2022). Therefore, in future, if Chole needs to be detained her family members will have to take permission for that and that can avoid any future ethical or legal issues. However, if Chole is detained without taking permission from the doctor or nurse that could be a possible legal and ethical consequence. The children can appoint an “approved mental health professional (AMHP)” who has specialised training for providing help as well as assistance to the mental health patients treated under the Mental Health act (Leah, 2020). One of the major functions of this AMHP is to help in assessing if a person needs to be detained as part of the treatment. Therefore AMPH might be applicable for Chole if the frequency of agitation or extreme anger rises significantly in the future.
The focus of this essay was to report the outlining of the assessment and care plan necessary for Chole, the patient who was diagnosed with severe depression following the demise of her husband. Three major factors such as biological, psychological, as well as social factors have been identified as the possible contributing factors to severe depression. Based on the identified factors some intervention strategies have been suggested. “Selective serotonin reuptake inhibitors (SSRIs)” have been prescribed which are useful in elevating serotonin levels in the brain. Moreover, the doctor has suggested some physical exercises; however, Chole has experienced pain in the joint. Later she was diagnosed with osteoporosis and for that, calcium and vitamin D supplement was prescribed. Moreover, it has been found that one of the major side effects of SSRIs is unnecessary weight gain that in turn could possibly give rise to CVDs and Diabetes. As part of PCC and multi-professional involvement, a balanced diet has been proposed to manage weight effectively. In the end, the possible legal and ethical issues were analysed and no possible issues could be identified.
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