University Nursing Case Study: Mary's Depression and Treatment Options

This case study examines the mental health of Mary, a 41-year-old woman experiencing depression. It explores the correlation between mental and physical health, diagnosing Mary with recurrent major depressive disorder based on DSM-IV and ICD-10 criteria. The study delves into treatment options, including antidepressant medications like SSRIs and cognitive behavioral therapy, highlighting the significance of personal recovery. It emphasizes the implications for nursing practice, such as building therapeutic relationships and promoting healthy behaviors. The analysis underscores the importance of understanding the link between mental and physical well-being to improve the quality of life for individuals with mental illness. The case study also addresses the role of nurses in patient care, medication compliance, and lifestyle choices, providing a holistic approach to mental health treatment.

Running head: CASE STUDY NURSING
Case study nursing
Name of the student:
Name of the University:
Author’s note

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Introduction
Mental health and physical health have correlation with each other; poor physical
health contributes to risk of mental health issues. Similarly, mental health problems
negatively influence physical health, personality and overall quality of life of an individual
(Kemp and Quintana 2013, pp288-296.). This essay develops the understanding of mental
health and its relationship with physical health through the analysis of the case study of Mary,
a 41 year old woman, who has been suffering from moments of despair when she feel tearful
and tend to develop symptoms of depression. Her feeling of worthlessness and hopelessness
has affected her overall appearance, normal sleep time and completion of simple activities in
daily life. The purpose of the essay is to give insight regarding understanding of mental
illness with support from Mary’s case and find the importance of personal recovery for Mary.
The next section discusses about the mental health needs of Mary and proposes the best and
treatment options for her recovery. It also gives an insight into the implications of the
information for the practice of health professionals.
Mental health and Mental illness
The examination of the Mary’s case study has mainly revealed the problem of
feelings of despair, low motivating in daily activities, and feelings of worthlessness, sleep
difficulty and a history of depression. All this symptoms is an indication of major depression
in patient. This is because the symptoms are similar to the DSM-IV criteria for major
depressive disorder (MDD) (DSM-IV Criteria for Major Depressive Disorder (MDD) 2017).
According to the DSM-IV criteria, a person having depressed mood for more than two weeks,
impaired social and occupational functioning and presence of at least five specific symptoms
every day are regarded as suffering from MDD (DSM-IV Criteria for Major Depressive
Disorder (MDD) 2017). These symptoms include depressed mood, little pleasure in activities,

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weight loss or appetite change, modified sleep and activity patterns, tiredness, feelings of
worthlessness, poor concentration and suicidal thoughts (Uher et al. 2015, pp. 459-471)
Similar to this specification of DSM-IV, Mary was also found to experience low moods,
feelings of worthlessness and hopelessness, little interest in activities like eating and dressing,
loss of sleep and poor personal hygiene. Hence, she also had at least five of the nine
symptoms of depression and the only symptom that was not present in her included suicidal
thoughts (Uher et al. 2015, pp. 459-471).
Based on the frequency or persistence of symptoms in Mary, it is found that Mary
developed low moods more frequently and she also experience moments of low mood.
However, however her condition can be classified as recurrent MDD because she was
admitted to the hospital for depression earlier too and she has started experiencing low mood
again. In case of recurrent depression, relapses of depressive symptoms occur in affected
individuals after phases of normal moods (van der Velden et al. 2015, pp.26-39). According
to the severity of depression, the ICD classified depression into four categories which
includes mild depressive episode, moderate depressive episode, severe depressive episode
without or without psychotic symptoms (ICD-10 Version: 2016 2017). According to the ICD-
10 classification, it can be said that Mary’s depression is under F32.1 category of moderate
depression. This is because she has four or more symptoms of depression but she does not
develop suicidal thoughts. If she has suicidal thoughts, then her condition would be described
as severed depressive disorder. Hence, it is clear that Mary is suffering from moderate
depression.
Relationship between mental health and physical health
There are numerous links between mental health and physical health conditions and
both have an impact on quality of living, health outcomes and demand of care. WHO (2016)

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has defined that without mental health, overall health and well-being of an individual is not
possible. The relation between mental and physical health is particularly more apparent in
chronic conditions (WHO 2016). Poor mental health increases the risk of chronic physical
illness in patients, whereas people with chronic physical conditions are vulnerable to
developing poor mental health. For instance, the study by Kemp and Quintana (2013,
pp.1238-1334) showed increased association between depression and cardiovascular disorder.
It was found that depression increased the risk for developing CVD by 1.5 fold, whereas
patients with both CVD and depression had three fold risk of developing cardiac events. In
this case, heart rate variability was found to influence mental and physical well-being. It is
recommended that for patients like Mary with mental illness, increasing physical activity,
mediation and dietary changes should be considered along with conventional treatment to
promote recovery
In case of Mary too, it can be said that presence of depressive mood is likely to affect
her physical health too. This is because in the presence of altered mood and lack of
motivation, she may not full attention to her nutritional and personal needs. Inability to
complete activities like eating and maintain personal hygiene will increase the risk of
physical illness in patient. Chronic fatigue and physical aches and pain become common for
patients with depression. Secondly, poor personal hygiene and nutritional intake make the
susceptible to diseases too (Coventry et al., 2015). Research has explained that individuals
with mental illness have shorter life than general population because mental health related
factors like unhealthy lifestyles, disparities in health care access and affect of psychotropic
medications increases the risk of physical morbidity (Correll et al. 2015). Evidence has
proved that antipsychotics increase risk of physical illness such as diabetes, obesity, renal
disease and other issues in mentally ill patients (Correll et al. 2015). To find treatment
options for people living with either mental illness or physical health conditions, the most

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critical aspect for the health care professional will be to find the link between body and mind.
This understanding will help to develop effective strategies to improve the quality of life of
people living with mental illness and physical health conditions (Rogers and Pilgrim 2014).
Hence, clinicians can minimize adverse outcome for Mary by analysing the link between
treatment and patient specific risk factors.
Understanding the personal recovery for Mary
Personal recovery is defined as the systematic process of modifying an individual’s
attitude, values, feelings and goals towards illness and being satisfied and hopeful even
within the limitations of illness (Unger 2017). In case of Mary, whose quality of life has been
seriously affected by altered moods and feelings of hopelessness in life, focusing on personal
recovery is most important. This is because clinical recovery can just address the physical
symptoms of patients, however patient’s thoughts and feelings towards illness cannot be
changed unless personal recovery related values are developed in them. Hence, recovery can
be facilitated in Mary only changing her attitude towards mental illness and developing new
purpose in life. This will help her to cope with her current issues as well as find strategies to
tackle such issues in life (Drake and Whitley 2014). This will eventually help her to gain
back the lost confidence and approach her illness with a positive towards life (Angermeyer et
al. 2013).
WHO (2016) has defined that mental health is the state of well-being in which a
person is capable of coping with stressors of life and working productivity to contribute to the
community. The development of major depression is evident from the symptoms of low
mood, feelings of worthlessness, sleep disturbance and history of depression. The presence of
these symptoms has affected Mary’s capability to manage life stressors and work
productively. Although she has a supportive husband and no history of drug use, she finds it a

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challenge to manage not just her work but also simple activities in life. In such situation,
personal recovery should be facilitated in Mary by providing an environment that supports
her in adapting healthy lifestyles. Hope, identity and personal responsibility will be the key
elements of personal recovery in patient and this will enable Mary to live a life beyond illness
(Lin et al. 2013). This action is related to the recovery model of mental illness because
inculcation of personal recovery values in patients supports them to take control in their life
as well as on mental illness (Jacob 2015). For Mary, her personal recovery will add a new
meaning to her life. It will make her control her moments of despair and develop resilience
particular during emotional distress. The role of psychotherapist will be crucial in teaching
Mary self-management strategies will help her to develop hope, optimism, control and
responsibility towards life (Owen and Hilsenroth, 2014, p. 280).
Mental health needs
As Mary is having recurrent symptoms of depression, the main health care priority is
to address altered mood in patients and change development of negative thoughts in patient.
She would require both pharmacological as well as cognitive behavioural therapies to address
the problem of altered moods and low pleasure in daily life activities. The best
pharmacological treatment option for Mary includes providing antidepressant medications
initially to stabilize her mood (Lara et al. 2013, pp.2111-2117). The initial antidepressant
medication that is suitable for Mary includes selective serotonin reuptake inhibitors (SSRIs)
as it prevents neurotransmitters form being reabsorbed into the nerve cells (Kemp et al.,
2014). However, the limitation of antidepressant treatment is that many side-effects develop
in patients which further increases the relapse rate and health risk in patients. Many patients
like Mary also develop remission and continue to suffer from residual symptoms (Fishbain et
al. 2014, pp.1522-1539). Mary had also taken Citalopram antidepressant in the past, but her

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depressive symptoms relapsed again. Research evidence shows that such challenges in
antidepressant therapy can be addressed by means of optimization of dosage and duration of
the therapy and switching strategies like discontinuation of ineffective drugs and initiation of
new drugs. In some patients like Mary, addition of a second anti-depressant also addresses
symptoms of depression (Al-Harbi 2012).
As pharmacological treatment for depression is associated with many side-effects and
risk of disease in patients, focusing on non-drug strategies is particularly important for Mary.
The best treatment options for bringing behavioural change in Mary would include
antidepressant medications with cognitive therapy to promote recovery in patient. Research
on the effect of cognitive therapy with antidepressant medications has proved that such
strategies increase the rate of recovery from MDD compared to use of antidepressant
medications alone (Hollon et al. 2014, pp. 1157-1164). Cognitive behavioural therapy is
based on the assumption that mood of a person has direct relation with thought patterns and
the therapist supports the patient to recognize negative thoughts and replace them with valid
and positive thought patterns (Yoshimura et al. 2013, pp.487-493). Hence, combining
cognitive therapy with antidepressant therapy is likely to enhance treatment response.
Another study also suggest that mindfulness based cognitive therapy can reduce risk of
relapse in patient compared with conventional treatment (Kuyken et al. 2015) As Mary has
mainly recurrent major depression, this intervention would be most useful for her to endure
positive outcomes, prevent relapse of depressive symptoms and improve the quality of life
(Samaan et al. 2016, p.22).
Implications for nursing practice
For a nurse providing care to patients like Mary, knowledge about mental illness and
their link with physical health and social determinants of health can have useful practice

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implications. While prioritising care and recovery of patient like Mary, the main care plan of
nurse will be to develop a therapeutic relationship with patients based on trust and promote
effective coping skills to empower Mary to overcome negative feelings. The nurse will also
play a critical role in promoting positive health behaviour in patients such compliance with
medication and healthy lifestyle (Ekers et al. 2013, pp.14-22). Mentally ill patients are most
likely to discontinue medications and nurse must observe them and motivate them to adapt
healthy lifestyle choices. In many patients with depression, smoking and consumption of
alcohol further deteriorates their condition (Braithwaite et al. 2016, pp.566-572). In such
situations, nurses also have the responsibility to encourage people to withdraw from alcohol
and drugs (Ekers et al. 2013, pp.14-22). However, Mary has no history of smoking, alcohol
or drug use. Therefore, the area of lifestyle choices where the nurse needs to closely work
with Mary includes increasing physical activity, personal development and diet changes in
patient. In short, it can be said that collaborative care by nurse will promote recovery and
mental health and well-being in Mary (Zimmermann et al. 2016, pp.101-111).
Conclusion
Thus, from the analysis of Mary’s case scenario, it is understood that mind and body
plays a key role in the health and well-being of an individualThe critical evaluation of Mary’s
symptoms and issues in life summarized that according to DSM-IV criteria, recurrent major
depression was a major health issue for Mary. The essay also established link between mental
health and physical health by stating that poor mental health increases the risk of physical
illness and in increase in risk of depression in patients with chronic disease. As mind and
body are linked together, the essay also highlighted why adapting personal recovery model is
important for Mary. To address and treat Mary, the combination of cognitive behaviour
therapy as well as antidepressant therapy was proposed as this is likely to address all

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challenges in treatment too. This knowledge will also have useful implications for nursing
practice and delivering effective care to mentally ill patients. The future recommendation to
improve nursing skills in caring for mentally ill patient is that nurses must change their
attitude towards such patient and engage in empathetic and close relationship with them to
understand their social as well physical health needs to treat them

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