BEE ENN COLLEGE OF NURSING, JAMMU

CASE
PRESENTATION
ON
DEPRESSION

SUBMITTED TO: SUBMITTED BY:

MRS. SHRADHA MALLA SUMREENA KHAN
ASSISTANT PROFESSOR M.Sc. (N) 1st Year
BEE ENN COLLEGE OF NURSING BEE ENN COLLEGE OF NURSING

SUBMITTED ON:
PSYCHIATRIC HISTORY TAKING
PRELIMINARY DATA

Name : Sanjay Kumar

Age : 36 Years
Sex : Male
Bed no. 05
Education : 7th
Marital status : Married
Occupational status : shopkeeper
Income : Rs 15000/ per month
Religion : Hindu
Address : Nagrota
Diagnosis : Current Episode Depression without psychotic
symptoms
Name of the informant : Mrs. Birla Devi
Relationship with the patient: wife
Stay with patient: since the patient is not well.
PRESENTING CHIEF COMPLAINTS:
According to patient:
neend nhi ati hai
mnn dhuki rehta hai
negative thoughts ate hain
dil bhaut ghabrata hai 3months
kisi kam mein man nhi lagta hai
baat karne ka mnn bhi nhi karta
hai bhaut rona ata hai
khana bhi nhi acha lagta hai, mnn karta hai bas maar jaon
According to informant [wife]
baat to bilkul karte hi nhi hai,
bhut gussa karta hai, 3months
jabardasti baat kro to ghurne lagte
hai, roote rehte hain kuch bhi keh doh
toh,
khaana peene bhi chod rakha hai aj kal toh, 3months
har samay marne ki baat karte hain.

HISTORY OF PRESENT ILLNESS:

The patient reports experiencing significant distress, describing difficulty sleeping and feeling
restless. They mention persistent negative thoughts and a deep sense of anxiety, stating that "dil
bhaut ghabrata hai." The patient also expresses a profound lack of interest in daily activities,
noting that they have no desire to engage in conversation or any tasks. Frequent episodes of
crying are reported, along with a noticeable loss of appetite. The patient also expresses feelings
of hopelessness, stating, "mnn karta hai bas maar jaon," indicating suicidal ideation. The
patient’s problem increased day by day and now he is having irritable mood, depressed mood,
anhedonia, hopelessness, helplessness. After about a month he brought for treatment and was
admitted on 01/07/2024 in Male Psychiatric Ward 5 in Govt. psychiatric hospital Jammu.

TREATMENT HISTORY:
 ECT: None
 Psychotherapy: None
 Family therapy: None
 Rehabilitation: None

PAST PSYCHIATRIC HISTORY:

There is no significant history of psychiatric history.

PAST MEDICAL AND SURGICAL HISTORY:

There is no past medical history regarding Hypertension, Diabetes, and any surgical procedure.
GENOGRAM:

INDEX-

- Male - Female
Death - Patient

S.NO FAMILY AGE OCCUPATION RELATION WITH HEALTH

MEMBER PATIENT STATUS
1 Sanjay Kumar 36 yr shopkeeper self Unhealthy
2 Birla Devi 34yr homemaker wife Healthy
3 Anshu 15 yr student son Healthy
4 Deepak Kumar 12 yr student son Healthy

PERSONAL HISTORY
PERINATAL HISTORY:
Patient was born with full term normal vaginal delivery cried at birth, no any complication after
delivery no any birth defect.
CHILDHOOD HISTORY:
 There is no any history of Behavior and Emotional problem. The relations with the friends and
siblings were healthy. Patient has also no history of any sleep disturbance, temper tantrum, bed
wetting, stammering and mannerism. Normal Developmental of all mile stones achieved
appropriately at time. No history of Infections during childhood.
EDUCATIONAL HISTORY
He started going school at the age of 5 year. There he was good in Academic performance. He
was good in extracurricular activities. Their Relationship with peer’s teachers was satisfactory.
No School phobia was present. He terminated from studies because of poor financial conditions.
PLAY HISTORY
He used to play all types of game.
Relationship with play mates was good.
PUBERTY HISTORY: There is no history of nocturnal emission, masturbation habit,
masturbation guilt
Occupational and Marital History: Mr Sanjay is a shopkeeper.
• Age of marriage: client got married at the age of 16 years.
• Type of marriage: Arrange marriage.
• Satisfaction in marital life: satisfied.
• Quality of marital relationship: good.
•
PREMORBID PERSONALITY
- Interpersonal relationship was introvert.
- Family and social relationship was maintained good.
- Predominant mood was fluctuating
- Interest and Use of leisure time in travelling god’s places.
- Reaction to stressful life events was delayed
- Attitude to self-others was self-confidence.
- Attitude to work and responsibility was accepting.
- Religious beliefs and normal attitude is positive belief in god.
HABITS:
HABITS PREMORBID CURRENT HABITS
Sleep Insomnia (2-3 hrs) Insomnia (3-4 HRS)
Elimination pattern Disturbed Bladder— Bowel— Disturbed- Bladder: 5-6 times as
increased 5-6 times per day before
Bowel: constipation 1 time on 2nd Day

Eating pattern Decreased one meal a day 2 meals a day than before

Use of any drug or Absent Absent

alcohol

MENTAL STATUS EXAMINATION

(15 July 2024) at 12pm)
GENERAL APPEARANCE AND BEHAVIOUR
Appearance: Looking one’s age
Physical deformity: Absent
Facial expression: Anxious
Level of grooming: Normally dressed as per the season.
Level of cleanliness: inadequate Clean
Level of consciousness: Fully conscious
Mode of entry: Came willingly
Behaviour: preoccupied
Cooperativeness: cooperative
Eye to eye contact: not maintained
Psychomotor activity: Decreased
Rapport: Spontaneous
Gesturing: odd hand gestures like waveing of hands
Posturing: stooped
Other movements: normal
Other catatonic phenomena: Absent
Conversion and dissociative signs: Absent
Compulsive acts or rituals or habits: Absent
Hallucinatory behaviour: crying without reason
Inference: The individual appears anxious and preoccupied, with
decreased psychomotor activity and odd hand gestures. They
maintain inadequate cleanliness but are dressed seasonally
appropriate. Despite their anxious state and lack of eye contact, they
are cooperative and fully conscious. Their behavior, including
crying without a clear reason, suggests underlying emotional
distress.

SPEECH
Speech sample:
Nurse: Hello Sanjay, Kaise ho?
Patient: mai theek hu
Nurse: kaisa lgrha hai apko?
Patient: khas thik ni lgrha

Nurse: kya khaya subah?

Patient: Bread aur doodh

Nurse: kon kon rehta ghar pr?

Patient: mere 2 bete hain aur mei meri wife hain bss.

 Inference:
Initiation of the Speech was after I started to talk, with normal reaction time i.e.1-2 seconds.
when I finished my question, he answered immediately, with slow rate, and decreased volume
and low pitch tone. Fully relevant and fully coherent speech with no evidences of tangentially
and circumstantiality.

2. MOOD AND AFFECT:

Speech sample:
Nurse: Apko yahan kaise lgrha h?
Patient: ghar se dur kya acha lgega

Nurse: apka mood aj kaisa h?

Patient: Thoda sa thik hai but utna nhi.
Nurse: kya apko aksar udaasi mehsoos hoti h
Patient: haan

Subjective mood: mera mnn udas hai bhaut.

Affect: unhappy
Inference: Mood is congruent to Affect.
THOUGHT :
Stream and form of thought:
Que- kis qism ke khayal aate hain apko?
Ans- mrne ko dil krta mera, ajeeb si udasi rehti hai.
Qn: kya apko kbi aisa khayal aate hain jo ap dusru ko keh ni paate?
Ans: hota hai kafi br bhaut si batein ni keh pata
Content of thought:
Delusion-
Nurse: Kya apko lgta hai ke apko koi marna chahta hai?
Patient: No
Inference – no delusion of persecutions.
Nurse: Kya apko lgta hai ap kuch b kharid skte ho kuch b kr skte , apko lgta hai apke pas koi
shakti hai?
Patient :Nhi
Inference – no delusion of grandiosity.
Nurse: kya apko lgta hai ke dusre apka mazak bnate hain?
Patient :Nhi
Inference – no delusion of reference.
Nurse: kya apko lgta hai apko koi control krrha hai?
Patient: Nhi
Inference – no delusion of control.
Nurse: kya apko apki body ajeeb si sansani aksr feel hoti hai?
Patient : Nhi

Inference – no somatic delusion.

Suicidal and homicidal ideas :

Nurse: kya apko kbi suicide ke khyal aate hain?
Patient: hnn mrne ko dil krta hai
Inference – He is having suicidal thoughts and thinks about suicidal attempts.
Obsession:
Nurse :Kya apke dimag mei koi ek hi khayal brb r aata hai jisko dil b krta hai krne ko?
Patient: nhi
Inference – He has no obsession.
Magical thinking :
Nurse: kya ap chamatkar mei yaqeen rkhte hain?
Patient: Nhi
Nurse :kya ap dharm pr yaqeen rkhte hain?
Patient :hnji
Nurse :kya apko kisi cheez ka drr hai?
Patient :Nhi
Nurse: kya apke dimag mei koi khayal chlte hain?
Patient :mrne ka khayal
Inference : Patient has suicidal thoughts and no other significant findings present.
PERCEPTIONS :
Hallucination-
Nurse : kya apko lgta hai ap ko koi awazein sunayi deti hain jo kisi aur ko nhi deti?
Patient: Nhi
Inference – No auditory hallucinations present.
Nurse : kya apko koi aksr tasweer ya koi cheez dhikhayi deti hain jo kisi aur ko nhi deti?
Patient: Nhi
Inference – No visual hallucinations present.
Nurse : kya apko lgta hai apko koi touch krta hai jbke wo cheez wahn pr hoti nhi?
Patient: Nhi
Inference – No tactile hallucinations present.
Nurse : kya apko kisi cheez ka taste mehsoos hota hai?
Patient: Nhi
Inference – No gustatory hallucinations present.
Nurse: kya apko aksr koi smell feel hoti hai?
Patient: Nhi
Inference – No olfactory hallucinations.
Illusion –
Nurse : kya apko kbi aksar cheezein kuch aur lgti hain?
Patient: Nhi
Inference – Patient has no illusion.
COGNITION:
I. Consciousness
He is conscious.
 II. Orientation
a. Time
Nurse :Aj date kya hai?
Patient: Aj 15 july hai
Nurse: Abi time kya hai?
Patient: 11: 20 am
b. Place
Nurse : kahan rehte ho?
Patient: Nagrota
Nurse : abi ap kahan ho?
Patient: Hospital. mei
c. Person
Nurse: ye kon hai apke sth?
Patient: wife
Inference –He is oriented to time, place and oriented to person.
ATTENTION AND CONCENTRATION:
Nurse -Repeat the digit forward and backwards.
Patient– forward-50,49,48,47,46,45
Nurse- Subtract 7 from 100 for 5 times
Patient – 93,86,
Inference: His attention and calculation is not good.
MEMORY:
 Immediate –
Nurse- ye 3 cheezein apko btani hai mjhe wapis?(mobile, ghoda, chaabhi)
Patient – mobile, ghoda, chaabhi
Inference –His immediate memory is intact.
 Recent –
Nurse- Raat ko khaya tha?
Pateint - Daal, chawal
Nurse : kya apne apni dawai khayi thi aj?
Patient-Yes
 Inference – His recent memory is intact as confirmed by his wife.

 Remote –
Nurse :Shadi ko kitne saal hue apke?
Patient :24 years
Nurse : Last koi function jo ghar pr hua ho?
Patient :Koi hua hi nhi.
Inference – His remote memory is intact.
INTELLIGENCE:
1. Educational status – 7th
2. Digit score-18+6=23
18-6=12
100/20=5
3. General knowledge
a. India ka PM kon hai?
Yaad nhi.
b. Hmara national bird kya hai?
Abhi yaad nhi a rha hai.
Inference – His intelligence is weak.
ABSTRACT THINKING :
 Proverb testing
Ques- Pet mei chuhe kudne ka kya matlab hai.?
Ans – bhaut bhukh lagna.
 Similarities between paired objects.
Ques- chidya aur hawayi jahaz mei kya ek samaan hai?
Ans –hawayi jahaz or chidiya dono hi udte hain..
 Dissimilarities between paired objects
Ques-- chidya aur hawayi jahaz mei kya alg hai?
Ans – chidya jandar hai aur jahaz bejaan.
Inference – Abstract thinking is intact.
JUDGEMENT
  Personal judgement
Ques- Yaha se discharge hone ke bad apka kya plan hai krne ka?
Ans- kuch toh karenge phle thk ho jayege
 Social judgement
Q ues- koi aapke ghar ayega to tm kya krogee?
Ans – bethtainge, baatein krenge, khana khilayege.
 Test judgement
Ques - aap kya karoge jab apke room me jaha aap bathe ho aag lag jayega to?
Ans- aag bhujaane ki koshish karenge.
Inference: Personal, Test judgement and social judgement was intact.

INSIGHT:
Speech sample:
Nurse: Kya apko lgta h apko koi bemaari hai ya dimaagi bemaari hai?
Patient: Haan
Nurse: apko kya lgta h dawai se kch farak pdh rha h apko?
Patient: Haan
Nurse: apko kya lgta h apko yeh bemaari q h?
Patient: mjhe kch smj nhi aarha
Nurse: kya ap discharge hone k baad ghr pe dawai lege time se?
Patient: Haan, mai jb dawai leta hu toh mjhe theek lgta h

Inference: patient has 4/6 insight on the scale awareness of being sick nut due to something
unknown in himself.

DIAGNOSTIC FORMULATION:
Sanjay Kumar, a 45-year-old male diagnosed with depression, has been experiencing severe
symptoms for the past 3months. These include involuntary crying and dizziness, suicidal
ideation etc. Despite medication, his symptoms persist, affecting his daily life and causing
significant distress. His condition began insidiously. The patient exhibits anxiety and
sadness, with no evidence of substance abuse or significant past medical issues. His mental
status examination reveals full orientation and intact cognitive function and decreased
psychomotor activity. Despite these challenges, his insight is also impaired due to his illness.
 DEPRESSION
INTRODUCTION:

Depression is likely the oldest and still one of the most frequently diagnosed psychiatric
illnesses. It is a wide spread mental health problem affecting many people. Depression is a
syndrome consisting of low mood and loss of interest in usual activity accompanied by
psychomotor and cognitive manifestation and representing a deterioration from the individual’s
usual level of functioning.

DEFINITION:

A major depressive disorder occurs without a history of a manic, mixed, or hypomanic episode.
A major depressive episode must last at least 2 weeks, and typically a person with a diagnosis of
a major depressive episode also experiences at least four symptoms from a list that includes
changes in appetite and weight, changes in sleep and activity, lack of energy, feelings of guilt,
problems thinking and making decisions, and recurring thoughts of death or suicide.

INCIDENCE:

 Major depressive disorder (MDD) is one of the leading causes of disability in the
United States.
 In 2011, 6.6 percent of persons aged 18 or older (15.2 million persons) had at least one
major depressive episode in the past year (Substance Abuse and Mental Health
Services Administration [SAMHSA], 2012).
 Life time prevalence of depressive disorder is approximately 15%, closer to 10% in men
and 20% in women.
 During their lifetime, about 21 percent of women and 13 percent of men will become
clinically depressed. Research indicates that the incidence of depressive disorder is
higher in women than it is in men by almost 2 to 1.
 Poor socioeconomic conditions predispose people to mental disability.
 The gender difference is less pronounced between ages 44 and 65, but after the age of
65, women are again more likely than men to be depressed. Seasonal involvement i.e.
one in the spring (March, April, and May) and one in the fall (September, October, and
November). This pattern tends to parallel the seasonal pattern for suicide.

CLASSIFICATION OF DEPRESSIVE DISORDER [ACCORDING TO ICD-11]:

6A70.0 - Single episode depressive disorder, mild.

6A70.1 - Single episode depressive disorder, moderate, without psychotic symptoms.
6A70.2 - Single episode depressive disorder, moderate, with psychotic symptoms.
6A70.3 - Single episode depressive disorder, severe, without psychotic symptoms.
6A70.4 - Single episode depressive disorder, severe, with psychotic symptoms.
6A70.5 - Single episode depressive disorder, unspecified severity.
6A70.6 - Single episode depressive disorder, currently in partial remission.
6A70.7 - Single episode depressive disorder, currently in full remission.
6A70.Y - Other specified single episode depressive
disorder. 6A70.Z - Single episode depressive disorder,
unspecified.

ETIOLOGY:

Neurotransmitters

Although other neurotransmitters have also been implicated in the pathophysiology of

depression, disturbances in serotonin and nor epinephrine have been the most extensively
scrutinized. Cell bodies of origin for the serotonin pathways lie within the raphe nuclei located
in the brainstem. Those for nor epinephrine originate in the locus coeruleus. Projections for both
neurotransmitters extend throughout the forebrain, prefrontal cortex, cerebellum, and limbic
system.

AREAS OF THE BRAIN AFFECTED:

Areas of the brain affected by depression and the symptoms that they mediate include the
following:

• Hippocampus: Memory impairments, feelings of worthlessness, hopelessness, and guilt

• Amygdala: Anhedonia, anxiety, reduced motivation

• Hypothalamus: Increased or decreased sleep and appetite, decreased energy and libido

• Other limbic structures: Emotional alterations

• Frontal cortex: Depressed mood, problems concentrating

• Cerebellum: Psychomotor retardation/agitation

MEDICATIONS AND THEIR EFFECTS ON THE BRAIN

 All medications that increase serotonin, norepinephrine, or both can improve the emotional
and vegetative symptoms of depression.
 Medications that produce these effects include those that block the pre synaptic reuptake of
the neurotransmitters or block receptors at nerve endings (tricyclics, SSRIs, SNRIs) and
those that inhibit monoamine oxidase, an enzyme that is involved in the metabolism of the
monoamines serotonin, norepinephrine, and dopamine (MAOIs).
 Side effects of these medications relate to their specific neurotransmitter receptor-blocking
action. Tricyclic and tetracyclic drugs (e.g., imipramine, amitriptyline, mirtazapine) block
reuptake and/or receptors for serotonin, norepinephrine, acetylcholine, and histamine. SSRIs
are selective serotonin reuptake inhibitors
 Others, such as bupropion, venlafaxine, and duloxetine block serotonin and norepinephrine
reuptake and also are weak inhibitors of dopamine.
 Blockade of norepinephrine reuptake results in side effects of tremors, cardiac arrhythmias,
sexual dysfunction, and hypertension.
 Blockade of serotonin reuptake results in side effects of GI disturbances, increased agitation,
and sexual dysfunction.
 Blockade of dopamine reuptake results in side effects of psychomotor activation.
 Blockade of acetylcholine reuptake results in dry mouth, blurred vision, constipation, and
urinary retention.
 Blockade of histamine reuptake results in sedation, weight gain, and hypotension.

TYPES OF DEPRESSIVE DISORDERS

Major Depressive Disorder

MDD is characterized by depressed mood or loss of interest or pleasure in usual activities.

Evidence will show impaired social and occupational functioning that has existed for at least 2
weeks, no history of manic behavior, and symptoms that cannot be attributed to use of
substances or a general medical condition.

Persistent Depressive Disorder (Dysthymia)

Characteristics of dysthymia are similar to, if somewhat milder than, those ascribed to MDD.
Individuals with this mood disturbance describe their mood as sad or “down in the dumps.”
There is no evidence of psychotic symptoms. The essential feature is a chronically depressed
mood (or possibly an irritable mood in children or adolescents) for most of the day, more days
than not, for at least 2 years (1 year for children and adolescents). The diagnosis is identified as
early onset (occurring before age 21 years) or late onset (occurring at age 21 years or older).
Premenstrual Dysphoric Disorder

The essential features of premenstrual dysphoric disorder include markedly depressed mood,
excessive anxiety, mood swings, and decreased interest in activities during the week prior to
menses, improving shortly after the onset of menstruation, and becoming minimal or absent in
the week post menses.

Substance/Medication-Induced Depressive Disorder

The symptoms associated with a substance/ medication-induced depressive disorder are

considered to be the direct result of physiological effects of a substance (e.g., a drug of abuse, a
medication, or toxin exposure), and they cause clinically significant distress or impairment in
social, occupational, or other important areas of functioning

Depressive Disorder Due to Another Medical Condition

This disorder is characterized by symptoms associated with a major depressive episode that are
the direct physiological consequence of another medical condition (APA, 2013).

Predisposing Factors

Biological Theories: A genetic link has been suggested in numerous studies; however, a
definitive mode of genetic transmission has yet to be demonstrated. Twin Studies Twin studies
suggest a strong genetic factor in the etiology of affective illness. It most often found in first
degree relative.

Family Studies

An increased risk of depressive disorder in individuals with positive family history is quite
compelling.

Biochemical Influences

Biogenic Amines

Deficiency of the neurotransmitter’s norepinephrine, serotonin, and dopamine, at functionally

important receptor sites in the brain and dysregulation of acetylcholine and GABA.

Neuroendocrine Disturbances

Neuroendocrine disturbances may play a role in the pathogenesis or persistence of depressive

illness. Hypothalamic-Pituitary-Adrenocortical Axis. In clients who are depressed, the normal
system of hormonal inhibition fails, resulting in a hypersecretion of cortisol.
Hypothalamic-Pituitary-Thyroid Axis Thyrotropin-releasing factor (TRF) from the
hypothalamus stimulates the release of thyroid-stimulating hormone (TSH) from the anterior
pituitary gland. In turn, TSH stimulates the thyroid gland. Diminished TSH response to
administered TRF is observed in approximately 25 percent of depressed persons.

Physiological Influences:

Medication Side Effects

A number of drugs, either alone or in combination with other medications, can produce a
depressive syndrome. Most common among these drugs are those that have a direct effect on the
central nervous system (CNS). Examples of these include the anxiolytics, antipsychotics and
sedative-hypnotics. Certain antihypertensive medications, such as propranolol and reserpine,
have been known to produce depressive symptoms.

Neurological Disorders

These are true mood disorders, and antidepressant drug therapy may be indicated. Brain tumors,
particularly in the area of the temporal lobe, often cause symptoms of depression. Agitated
depression may be part of the clinical picture associated with Alzheimer’s disease, Parkinson’s
disease, and Huntington’s disease.

Electrolyte Disturbances

Excessive levels of sodium bicarbonate or calcium can produce symptoms of depression, as can
deficits in magnesium and sodium.

Hormonal Disturbances

Depression is associated with dysfunction of the adrenal cortex and is commonly observed in
both Addison’s disease and Cushing’s syndrome. Other endocrine conditions that may result in
symptoms of depression include hypoparathyroidism, hyperparathyroidism, hypothyroidism, and
hyperthyroidism. An imbalance of the hormones estrogen and progesterone has been implicated
in the predisposition to premenstrual dysphoric disorder.

Nutritional Deficiencies

Deficiencies in vitamin B1 (thiamine), vitamin B6 (pyridoxine), vitamin B12, niacin, vitamin C,

iron, folic acid, zinc, calcium, and potassium may produce symptoms of depression

Postpartum Depression

The severity of depression in the postpartum period varies from a feeling of the “blues,” to
moderate depression, to psychotic depression or melancholia. Of women who give birth,
approximately 50 to 85 percent experience the “blues” following delivery. The incidence of
moderate depression is 10 to 20 percent. Severe, or psychotic, depression occurs rarely, in about
1 or 2 out of 1,000 postpartum women. Symptoms of the “maternity blues” include tear- fullness,
despondency, anxiety, and subjectively impaired concentration appearing in the early
puerperium. The symptoms usually begin within 48 hours of delivery, peak at about 3 to 5 days,
and last approximately 2 weeks.

CLINICAL MANIFESTATION OF DEPRESSION

Book picture Patient picture

Depressed mood Present
Depressive cognition Present
Suicidal thoughts Present
Decreased psychomotor activity Present
Some psychotic features Absent
Somatic symptoms Present
 Decrease appetite or weight
 Early morning awakening diurnal
variation, with depression being worst in
the morning
 Psychomotor agitation or retardation
 Pervasive lack of interest and lack
of reactivity to pleasurable stimuli
Other features
 Difficulty in thinking and concentration Present
 Subjective poor memory Present
 Menstrual and sexual disturbances NA
 Physical symptoms such as fatigue, aching Present
discomfort, constipation, etc.

INVESTIGATIONS AND DIAGNOSIS:

Book picture Patient picture

1. Psychological test –beck depression Not done
inventory. Not done
2. Hamilton rating scale Done
3. Dexamethasone suppression test Not done
4. Toxicology screening Done
5. Based on ICD-10 criteria Done

MEDICAL MANAGEMENT:

Book picture Patient picture

 Citalopram 20-40mg/dl
SSRIs Fluoxetine 20-80 mg/dl
Sertaline 25-200mg/dl Given
Amitriptyline 50-300 mg/dl
TCAs Clomipramine 25-250mg/dl Given
Imipramine 30-300mg/dl
Doxepine 25-300 mg/dl
MAOIs Isocarboxazid 20-60 mg/dl
Phenelzine 45-90mg/dl
Heterocyclines bupropion 200-450mg/dl
Maprotilline 25-225mg/dl
SNRIs Desvenlafaxine 50–400
Duloxetine 40–60
Venlafaxine 75–375
Antianxiety drugs – Betacap Given

SOMATIC AND PSYCHOLOGICAL THERAPIES:

Book pictures Patient pictures

 Electroconvulsive therapy (ECT) Not done
 Repetitive transcranial magnetic
stimulation (RTMs)
 group therapy
 behavior therapy Done
 cognitive therapy
 family therapy
 supportive psychotherapy
Assessment:

1. Identified the client’s behavior like self directed violence .

2. Identified the type of disturbance the patient is experiencing i.e loss of intrest in eating,
lack of sleep, aggression and irritability, suicidal ideas, decreased psychomotor activities.
3. Asked the patient about feelings while thought alterations are evident like suicidal
ideations.
4. Assessed for ability to perform daily activity, i.e. sleep pattern and less interaction with
others.
5. Assessed disturbed communication process related to depressive cognition as evidenced
by being unable to interact with other, and withdrawn.
6. Assessed personal hygiene i.e Self-care deficit related as evidenced by poor personal
hygiene.

APPLICATION OF NURSING THEORY: Dorothea E. Orem's Self-Care Deficit Nursing

Theory:

Dorothea E. Orem's selfcare deficit nursing theory, also known as the Orem Model of Nursing, is
a nursing theory that explains how nurses can support patients. The theory was developed
between 1959 and 2001 and is often used in rehabilitation and primary care settings. It's
considered a grand nursing theory, meaning it covers a broad scope with general concepts that
apply to all nursing situations.

It suggests that patients should take care of themselves as much as possible. Nurses help by
supporting patients in becoming more independent, which aids their recovery and boosts
their confidence. It includes:

1. Self-Care: Refers to the activities individuals undertake to maintain their health and
well- being. This includes practices like hygiene, nutrition, and managing health conditions.

2. Self-Care Deficit: Occurs when an individual is unable to perform necessary self-care

activities due to limitations, which may be physical, mental, or situational. This deficit creates
a need for nursing intervention.

3. Nursing Systems: Define the role of nurses in assisting patients who have self-care deficits.
Nurses provide support through:
- Wholly Compensatory: Nurses take over all self-care activities for the patient.
- Partly Compensatory: Nurses assist the patient in performing some self-care activities.
- Supportive-Educative: Nurses help patients develop the skills and knowledge needed
to manage their own self-care.

To apply Orem’s SelfCare Deficit Nursing Theory for Sanjay Kumar,36 years old male
patient with Depression:
1. Assessment of Self-Care Deficits:

-Physical Self-Care: Determined Mr. Sanjay is struggling with personal hygiene, grooming,
and maintaining a healthy diet due to symptoms like low energy, fatigue, or lack of motivation.

Emotional Self-Care: Assessed Mr. Sanjay is engaging in activities that support his mental
health, such as social interactions, hobbies, or relaxation techniques.
Medication Management: Checked Mr. Sanjay is adhering to his prescribed medication and
managing any side effects.

SELF CARE SELF CARE DEMANDS NURSING AGENCY

2. Identifying Needs:
- Daily Living Activities: Identified specific areas where Mr. Sanjay needs assistance, such as
cooking meals, bathing, or managing household tasks.
-Support Systems: Determined Mr. Sanjay has a support network and if he is utilizing it
effectively, or if he needs additional support from caregivers or mental health professionals.

3. Nursing Interventions:
- Compensatory Actions: Assisted Mr. Sanjay with tasks he is unable to perform due to
depression, such as providing meals, helping with personal hygiene, or managing household
chores.
- Assistive Measures: Offer reminders and encouragement for taking medication, attending
therapy sessions, and engaging in daily activities. Help him establish a structured routine to
provide stability.
- Educational Support: Educated Mr. Sanjay about the importance of self-care, coping
strategies for managing depression, and techniques for improving mood. Encourage him to set
small, manageable goals and celebrate progress.
4. Monitoring and Evaluation: - Regularly reviewed Mr. Sanjay’s progress in managing self-
care tasks and adjust interventions as needed. Provide ongoing support and encouragement to
foster independence and improve his ability to manage his self-care.

By addressing these areas, the goal is to help Mr. Sanjay improve his ability to manage his self-
care, support his recovery from depression, and enhance his overall quality of life.

NURSING DIAGNOSIS:

1. High risk of self-directed violence related to depressed mood directed inward on the
self as evidenced by anhedonia and hopelessness.
2. Imbalance nutrition less than body requirement related to depressed mood lack of
appetite or lack of interest in food as evidence by weight loss.
3. Disturbed sleep and rest related to depressed mood and depressive cognition as
evidenced by difficulty in falling as sleep, early morning awakening.
4. Disturbed communication process related to depressive cognition as evidenced by
being unable to interact with other, and withdrawn.
5. Self-care deficit related to depressed mood as evidenced by poor personal hygiene.
6. Social isolation related to depressed mood as manifested by lack of interest in talking
and spending time with others.
Psychoeducation:

1. High Risk of Self-Directed Violence:

Create a Safety Plan: Identify warning signs, coping strategies, and contacts you can reach out
to when feeling overwhelmed. Keep emergency numbers handy.
Seek Professional Support: Regularly consult a mental health professional, such as a therapist
or psychiatrist, to discuss feelings and develop coping mechanisms.
Stay Connected: Reach out to trusted friends or family members when feeling low. Having
someone to talk to can make a significant difference.
2. Imbalanced Nutrition:

Eat Regularly: Try to maintain a routine of regular meals. Even if you don’t have an appetite,
eating small portions can help keep your energy up.
Choose Nutritious Foods: Focus on balanced meals with fruits, vegetables, lean proteins, and
whole grains. Avoid excessive sugar and caffeine, which can impact mood and energy levels.
Stay Hydrated: Drink plenty of water throughout the day. Dehydration can exacerbate feelings
of fatigue and low energy.

3. Disturbed Sleep and Rest:

Establish a Sleep Routine: Go to bed and wake up at the same time every day, even on
weekends. This helps regulate your body’s internal clock.
Create a Relaxing Bedtime Ritual: Engage in calming activities before bed, such as reading,
taking a warm bath, or practicing deep breathing exercises.
Limit Screen Time: Avoid screens (phones, computers, TV) at least an hour before bedtime, as
blue light can interfere with sleep patterns.

4. Disturbed Communication:

Practice Open Communication: Share your feelings and thoughts with others, even if it feels
difficult. Honest communication can help reduce misunderstandings and feelings of isolation.
Seek Support Groups: Joining a support group, either in person or online, can provide a safe
space to share experiences and connect with others facing similar challenges.
Use Creative Outlets: Writing, drawing, or other creative activities can be effective ways
to express emotions that are hard to put into words.

5. Self-Care Deficit:
Set Small Goals: Break down self-care tasks into small, manageable steps. For example, start
with brushing your teeth, then move on to washing your face, and so on.
Create a Routine: Establish a daily routine that includes time for personal hygiene, dressing,
and grooming. Routines can provide a sense of normalcy and control.
Reward Yourself: Recognize and reward yourself for completing self-care tasks. Positive
reinforcement can boost motivation.
6. Social Isolation:

Stay Connected: Make an effort to reach out to friends and family, even if it’s just a quick
call or message. Social connections are vital for emotional support.
Join Activities: Engage in activities or hobbies that interest you. Participating in group activities
can help reduce feelings of loneliness.
Volunteer: Helping others can provide a sense of purpose and can be a way to connect with the
community.

CONCLUSION: Depression is one of leading cause of death burden globally and in low and
middle income countries, depressive disorder accounted for nearly one third of the total days
caused by mental and substance use disorder. It is projected to be the second leading cause of
disease burden globally and third leading cause of disease burden in limits by 2030.Between
2005 and 2015 the no of people living with depression worldwide increased by an estimated
18.4%and there is increasing disability associated with depression. (Mathers et.al2015)

As per NMHS (2015-16)in India one in 20 people over 18 yr of age have ever suffered (at least
once in their life time )from depression amounting to a total of over 45 million person with
depression in 2015.

Several studies conducted in India have documented that 17-46%of patient attending primary
health centers suffer from CMDs, depression was the commonest disorder a recent study
reported a prevalence of 30.3%for depression among outpatient attendees in a secondary
hospital in Delhi .( Kochli C.el al 2013).
BIBLIOGRAPHY:

Book sources:

 StuartW.G, Principle and practice of psychiatric nursing, 1st edition, Elsevier publication,
p:344-375
 Ahuja N, Textbook of psychiatry, 7th ed, Jaypee Brothers , p. 54-76
 ICD-10 classification of mental and behavioral disorders
 Sreevani RA . Guide to mental health and psychiatric nursing. 3rd ed. Jaypee Brothers,
Medical Publishers; New Delhi. p.169-173.
 Sadock. K. Synopsis of psychiatric behavioural sciences& clinical psychology, 10th ed.
Wolter Kluwers, p. 341-347.
 Townsend MC. Psychiatric mental health nursing, 7th ed. Jaypee publishers, p.459-463.