Case Study of Mrs. B: Communication Techniques, Major Depressive Episode with Psychotic Features, Nursing Interventions for Appetite and Sleep

This case study discusses the communication techniques used by nurses to interview Mrs. B, who suffers from major depressive disorder with psychotic features. It also covers nursing interventions for appetite and sleep, and references for further reading.

Running head: CASE STUDY OF MRS. B
Case study of Mrs. B
Name of the student:
Name of the university
Author note:

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CASE STUDY OF MRS. B
Reflection on the communication technique:
Effective communication in patient centric care is crucial for providing competent patient
centric care (inpatient interview, 2018). In the video of the Inpatient Interview” in Module 6, I
have observed a few techniques of nursing for interviewing Mrs B. (inpatient interview, 2018). I
have observed the due to mental condition the communication of the patient was impaired and
therefore nurse for assessing necessary data involved her in conversation by giving her
recognition. The recognition acknowledges a patient’s behavior and highlights an overt
compliment, which provides the patient with a sense of comfort. I have observed that the nurse
showing active listening skills while communicating with the patient. According to Kaiser et al.
(2015), the verbal cues of nurses encourage the patient to continue talking and highlight the
interest of nurse. I have observed the clarification and summarizing skills while interviewing the
patient. These are a useful technique for nursing which made the patient feel wanted and worthy.
In my opinion, the techniques were demonstrated well since the patient complimented the nurse
that he is nice which in turn indicate that the patient was comfortable in the interview with the
nurse. Moreover, environment is crucial for interviewing patient and interviewer ensured that the
environment was pleasant without any distraction, which enabled interviewer to obtain necessary
data through communication.
Features of a major depressive episode with psychotic features:
Psychotic depression or major depressive disorder with psychotic features is a serious
illness in which a person suffers from a combination of the depression of mood along with
psychosis (Siu et al., 2016). Wagner et al. (2013), stated major depressive disorder
characterized, the loss of contact with the reality manifesting itself as the nihilistic type,

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delusions with false belief, false perception, hallucination, suicidal attempt more commonly for
elder patient (Australian commission on safety and quality of the health care, 2018). Mrs.
B has the false belief that she is going to die and strong wish of death resulted in probable feeling
of unworthiness. These symptoms often regarded as the major depressive disorder where patient
often have a period of increase depressed mood and tearfulness, social isolation, sleeping too
much, sense of worthlessness (Greenberg et al., 2015). These delusions and hallucinations
seem real to the patient and consequently, it implants a tendency of self-harm. Therefore, the
patient with the major depressive disorder with psychotic features needs immediate clinical
attention in order to prevent self-harm and provide quality of life.
Communication skills can nurse used to response to the situation of Mrs. B:
Acutely mentally ill patient present their beliefs and convictions in such a way that
challenges the normal social interaction (Gartlehner et al., 2015). Therefore, strategic
interpersonal communication skills are crucial for caring mentally ill patient, which
involves active listening, identification and problem solving approach. As observed in this
case study, Mrs. B was suffering from the major depressive disorder with psychotic features with
false beliefs and delusions, which resulted in the loss of appetite and hopelessness. In this
context, in order to solve issues nurses can show the expression of empathy through the activity
of reflective listening where she will feel comfortable. The communication skills also involve the
development of discrepancy between the goals of the patient and their current behavior and
beliefs(Bashshur et al., 2016). Further communication involves body orientation, maintaining,
eye contact, use of open question, use of short sentence, slow pace of speech and attention.
Moreover, response based spontaneous approach without being judgmental to the patient while

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providing care provide security to the patient with cognitive impairment. This will help her to
overcome her delusions and false belief of dying and this, in turn, help her to cope up with the
current depression (Bashshur et al., 2016). The nurses can show compassion and respect to the
patient by avoiding any argument and direct conformations since she vulnerable in nature due to
the mental illness (Carrión et al., 2015). The patient is made to feel they are capable of
achieving the change and therefore avoiding any confrontation will provide her a sense of
comfort, which in turn enhance her healing process.
Reason of appetite of patient and nursing interventions:
Appetite loss and weight changes are common but variable diagnosis marker in major
depressive disorder. In many cases, some depressed patients manifested with the increases of the
appetite while other exhibit loss of appetite (Carrión et al., 2015). According to Ngandu et al.
(2015), many of the brain regions are implicated in the appetite response to the food during the
episode of depression. In this case study, Mrs. B was suffering from a reoccurrence of the major
depressive disorder with psychotic features with false beliefs and delusions which resulted in the
loss of appetite due to discontinuing the antidepressant and antipsychotic medications (Carrión
et al., 2015). In such cases, the effective nursing intervention will be persuasion for consuming
meals in order to prevent physical weakness and supervision of her consumption adequate diet. It
also involves adequate fluid intake if the patient refuses to eat adequate food containing proteins,
zinc, selenium, calcium, chromium and other trace elements can prevent against depression and
improve depression symptoms (Bashshur et al., 2016). Adding vitamins, Omega 3 supplements
in form of tablets in diet as these are effective mood elevator and reducing malnutrition .Other
nursing interventions can be engaging her in leisure activities such as walking, gardening,

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CASE STUDY OF MRS. B
listening to music, and reflective listen, engagement in social activities, exercises, and
motivational session (Gartlehner et al., 2015). These sessions will boost the self-esteem of the
patient, provide her with a sense of worthiness and increase her food intake. Moreover, electro
exclusive therapy is proved to be effective and safe to cure depression and loss of appetite
(Gartlehner et al., 2015).
Intervention for managing sleeping pattern:
Depression is a common but destructive disease that destabilizes the mental and physical
well being of the patient (Greenberg et al., 2015). As observed in this case study, Mrs. B was
experiencing the reoccurrence of major depressive disorder with the psychotic features and
behavioral disturbance. She was exhibiting the disturbed sleeping pattern which is another
symptoms of major depressive disorder. In such cases, in order to assist her to sleep, increase of
sleeping hygiene with a combination of the psychotherapy along and antidepressant prove to be
effective in managing the sleeping patient. According to Gartlehner et al. (2015)., electro
exclusive therapy is proved effective and safe therapy if the patient has dementia and coexistence
depression (Paul & Paul, 2017). However, the mental health worker must monitor the
effectiveness of the therapy. Cognitive behavioral therapy is also effective for eliminating the
negative thoughts of the patient and replace with the positive thoughts (Carrión et al., 2015). It
will manage the behavioral issue of the patient and improve the sleeping pattern. Warm shower
before sleeping , limited napping during the day is effective for good sleeping pattern. Other
novel treatment of choice can be exercise, yoga, meditation, relaxations techniques, music, and
light therapy during sleep is effective for reducing depression (Gartlehner et al., 2015).

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References :
Australian commission on safety and quality of the health care, (2018). REDUCING
INAPPROPRIATE USE OF ANTIPSYCHOTICS in people with behavioural and
psychological symptoms of dementia (BPSD). Retrieved
from :www.safetyandquality.gov.au and cognitivecare.gov.au
Bashshur, R. L., Shannon, G. W., Bashshur, N., & Yellowlees, P. M. (2016). The
empirical evidence for telemedicine interventions in mental
disorders. Telemedicine and e-Health, 22(2), 87-113.
Carrión, S., Cabré, M., Monteis, R., Roca, M., Palomera, E., Serra-Prat, M., ... & Clavé,
P. (2015). Oropharyngeal dysphagia is a prevalent risk factor for malnutrition in a
cohort of older patients admitted with an acute disease to a general
hospital. Clinical nutrition, 34(3), 436-442.
Gartlehner, G., Gaynes, B. N., Amick, H. R., Asher, G., Morgan, L. C., Coker-
Schwimmer, E., ... & Bann, C. (2015). Nonpharmacological versus
pharmacological treatments for adult patients with major depressive disorder.
Greenberg, P. E., Fournier, A. A., Sisitsky, T., Pike, C. T., & Kessler, R. C. (2015). The
economic burden of adults with major depressive disorder in the United States
(2005 and 2010). The Journal of clinical psychiatry, 76(2), 155-162.

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inpatient interview. (2018). Retrieved from
https://download.www21.filehosting.org/4cf415270d653d49dd45a2b84bdf3924/mrs
%20b%20video.mp4\
Kaiser, R. H., Andrews-Hanna, J. R., Wager, T. D., & Pizzagalli, D. A. (2015). Large-
scale network dysfunction in major depressive disorder: a meta-analysis of resting-
state functional connectivity. JAMA psychiatry, 72(6), 603-611.
Ngandu, T., Lehtisalo, J., Solomon, A., Levälahti, E., Ahtiluoto, S., Antikainen, R., ... &
Lindström, J. (2015). A 2 year multidomain intervention of diet, exercise,
cognitive training, and vascular risk monitoring versus control to prevent cognitive
decline in at-risk elderly people (FINGER): a randomised controlled trial. The
Lancet, 385(9984), 2255-2263.
Paul, S., & Paul, D. (2017). Cognitive-behavioral therapy. In Social Work Theory and
Methods (pp. 78-93). Routledge.
Siu, A. L., Bibbins-Domingo, K., Grossman, D. C., Baumann, L. C., Davidson, K. W.,
Ebell, M., ... & Krist, A. H. (2016). Screening for depression in adults: US
Preventive Services Task Force recommendation statement. Jama, 315(4), 380-
387.
Wagner, G. S., McClintock, S. M., Rosenquist, P. B., & McCall,W. V. (2013). Major
Depressive Disorder with Psychotic Features May Lead to MisDiagnosis of

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Dementia: A Case Report and Review of the Literature. Journal of Psychiatric
Practice, 17(6), 432–438. doi:10.1097/01.pra.0000407968.57475.ab.