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Part 1: Case Formulation

Medical History & Currenting Symptoms

Case formulation explanation

Mei, a twenty-two-year-old Vietnamese immigrant student, was presented under new care after the referral of her general practitioner, who has been treating her for the last ten years. Mei was diagnosed with first-degree depression and was prescribed Pristiq (50 mg) for her symptoms regulation. The primary evaluation of her condition revealed that she had been experiencing a recurrence and worsening case of depressive symptoms. Mei reported that she has been suffering from depressive symptoms for the last five months after enrolling in the bachelor's architecture program. She experienced worsening symptoms and faced difficulty attending lectures or completing her homework. Mei's social and domestic history suggests that she has been residing in stressful or traumatic situations due to a series of stressors. The family's struggle with financial constraints and her parents' extensive pressure on Mei to shoulder the domestic responsibilities enhanced expectations regarding her academic and professional progress and the situation of domestic abuse from her mother. Mei did not feel psychologically secure and comfortable after moving to Australia due to losing contact with her grandparents. The only reliant family member for Mei was her younger brother, which could not improve the situation of psychological distress for her.

The one incident depressive disorder refers to one primary incident of major depressive disorder, distinctive from the individuals experiencing the episodes for an extended period (Moriarty et al., 2021). The prescription of Pristiq (50 mg) is an anti-depressant that belongs to the class of serotonin-norepinephrine reuptake inhibitors (SNRI). It helps manage major depressive disorder (Elias et al., 2022). The administration of Pristiq assists in enhancing the neurotic absorption of norepinephrine and serotonin in the brain, which stimulates a better and positive attitude in Mei (Elias et al., 2022). The regulated and pharmacologically enhanced mood in case of major depressive disorders can further help improve energy levels and prevent the prevalence of fatigue in the individual. However, prolonged exposure to the medication can lead to addiction and side effects like headache, vomiting, nausea, excessive sweating, dry mouth, reduced will to eat, and more psychological symptoms. (Thom et a., 2019). An aspect of Mei’s life that might have further deteriorated her psychological health is the lack of any close individual to share or express her distress. To efficiently overcome and prevent any adverse complications in psychiatric disorders is prominently influenced by early diagnosis and the ability of the individual to trust in someone and express feelings (Holz et al., 2020)

The current symptoms displayed by Mei imply that her depressive disorder is getting worse with the increment in her fatigue, lack of appetite, and a significant increase in her sleeping routine, which signify prominent weakness and lethargy (Thom et al., 2019). A significant implication of her deteriorated psychological health was her suicidal ideation. The incidence of suicidal ideation is primarily observed among individuals suffering from major depressive disorder (Hong et al., 2022). The lack of support within the family setting and negligence towards the situations experienced by Mei has caused the feeling of dejection, which gave rise to her emotional overwhelm and a negative thinking pattern with significantly deteriorating self-confidence (McKay et al., 2021). Her mother’s abusive behaviour also acted as a psychiatric stressor leading to trauma-induced psychological issues. Lack of emotional support, a secure domestic environment, exposure to discrimination within her university, and the burden of her family responsibilities led to the progression and worsening of her major depressive disorder (Micco et al., 2019).

Part 2: Treatment Plan

The clinical assessment of Mei reveals that she was experiencing a worsening case of major depressive disorder. The implementation of clinical treatment methodologies in the regulation or management of psychological symptoms; is considered essential for maintaining the patients' overall well-being (Lawn et al., 2020). Deteriorated psychological health and chronic psychiatric disorders like major depressive disorder lead to prolonged damage to the health even while considering physical health damages (Hodes & Vostanis, 2019). The case of Mei provides extensive evidence regarding her rapidly deteriorating condition of major depressive disorder. The significantly enhanced fatigue, excessive sleep, no leisure activities, poor self-worth or lack of self-confidence, suicidal tendencies, lack of trust, and reluctance to get comfortable with new surroundings (Dhanakotti & Rajendran, 2020). Critical evaluation of the case study of Mei provides a deeper understanding of detecting her primary healthcare requirements and helps form effective treatment strategies.

The induction therapy method considered for treating and managing major depressive disorder symptoms in Mei was the administration of the anti-depressant Pristiq (50 mg). The standard pharmacological agents considered in the initial stages of MDD treatment are serotonin-norepinephrine reuptake inhibitors (SNRI) or selective serotonin reuptake inhibitors (SSRI) (Rink et al., 2022). The application of comprehensive incorporation of both pharmacological and psychotherapy methodologies is found to be significantly beneficial in treating major depressive disorder (Tanguay-Sela et al., 2022). While considering the scenario of Mei, the primary areas of concern influencing her situation are the abusive household environment, her lack of sense of security, and to efficiently help her in building motivation regarding life. Psychotherapy measures that can be adapted for providing patient-specific care to Mei comprise different components considering her areas of concern for psychological and physiological well-being (Tanguay-Sela et al., 2022).

Psychotherapy interventions employed in psychotherapy for Mei are cognitive behaviour therapy and interpersonal therapy. Cognitive behaviour therapy (CBT) is a psychotherapy intervention aiming to understand and modify the psychological triggers, negative thinking patterns, and responses to the triggers (Stallard, 2022). CBT focuses on modifying the thought processes and helping form positive perspectives about life along with the development of motivation to enhance the quality of life (Stallard, 2022). Interpersonal therapy is another psychotherapy intervention that is found to be effective as it stimulates and focuses on building interpersonal behaviour among patients with depressive disorders. The integration of interpersonal therapy (IPT) for Mei would benefit her in overcoming the psychological distress caused due to the disruptive and abusive domestic environment (Karrouri et al., 2021). Before her psychotherapy intervention and treatment commencement, it is essential to apply assessment tools and evaluate the severity and type of her psychological disorder. The use of tools like DSM-5, Beck's Depression Inventory, and the Center for Epidemiology Studies Depression Scale; are prominently employed tools for efficient assessment of her psychological disorder along with the estimation of the severity of her psychological symptoms (Luo et al., 2020). Most assessment tools used for psychological evaluation follow the self-evaluation approach, which is beneficial in providing adequate information regarding her psychological condition to Mei and motivating her to improve her health.

The integration of IPT in Mei’s treatment can be done for a shorter period to help her express herself, build better communication, and build trust or faith in others (Murphy et al., 2021). The therapy sessions for CBT can be arranged with regular sessions and for a significant duration to help her develop sustainable and long-term health beneficial results (Fancourt & Finn, 2019). To derive significant recovery for Mei along with the enhancement of her quality of life and regain her motivation towards life along with her education. The physical or face-to-face medium of psychotherapy should be considered for the treatment as it will have a relatively better influence and help the healthcare professionals to understand Mei. The nurses must treat Mei with sensitivity and possess all the skills necessary for psychological nurses (McPherson et al., 2020). The nurses providing care to Mei should be active listeners, show efficient communication, display excellent attention and observatory skills, and possess cultural sensitivity to provide a secure environment for Mei (Ray, 2021).

Part 3- Self Reflection

As a nurse, I understand the complications associated with psychological patients and the legal and ethical obligations that must be considered while providing care to patients not from a native background. In the case of Mei, I understood that she had developed a deep feeling of insecurity due to being away from her familiar and comfortable environment. Mei felt secure and comfortable with her grandparents and performed significantly well academically. As per my understanding and my knowledge as a nurse, Mei’s deteriorated learning performance is associated with the increase in the frequency of abuse from her mother and lack of comfort in Australia. The psychologically and emotionally damaging environment Mei is exposed to in Australia has led to recurrence and worsening symptoms of major depressive disorder. As a professional clinical nurse, I consider applying cognitive behaviour therapy and interpersonal therapy in Mei's treatment; significantly beneficial in enhancing her overall physiological and psychological well-being.

The impact of Mei’s MDD is influencing the quality of her learning and academic performance. Being a nurse, I would provide Mei access to different support resources and implement all the psychotherapy methods which promote positive recovery and enhance her learning abilities of Mei to formulate a healthier life and secure environment for her. I would incorporate CBT and IPT psychotherapies in my care plan for Mei to promote positive recovery in her. The combination of CBT and IPT in the treatment of Mei would promote overall well-being. I feel that the integration of these psychotherapy interventions along with the pharmacological agents will lead to the development of a positive outlook on life. CBT would help me understand her psychological triggers and reactions, which would help me develop efficient techniques for modifying her thought patterns and inculcate positive thinking along with the behavioural modifiers for enhanced recovery.

It will help me to develop an interpersonal relationship with Mei and help her in trusting me to assist her in overcoming the psychological distress and regulating her worsening MDD symptoms. IPT is considered effective in the cases like domestic abuse as it focuses on the interpersonal aspect of the individual's life. While providing care to Mei and implementing psychotherapy for her, I would ensure to practice and justify all the nursing practice guidelines and maintain cultural security to ensure that she receives dignified, kind, and culturally sensitive care. Showcasing these qualities in my care would help build a trustworthy and comfortable environment for Mei to express herself clearly and overcome her insecurities. To ensure that my treatment is enhancing Mei’s overall health and learning capabilities, I will maintain a regular follow-up to assess her progress and evaluate the effectiveness of my care plan. Apart from this, I will also help her by providing her access or information regarding different support resources that would assist her with overcoming the unhealthy and abusive domestic environment.

References

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Elias, E., Zhang, A. Y., & Manners, M. T. (2022). Novel Pharmacological Approaches to the Treatment of Depression. Life, 12(2), 196. https://doi.org/10.3390/life12020196

Fancourt, D., & Finn, S. (2019). What is the evidence on the role of the arts in improving health and well-being? A scoping review. World Health Organization. Regional Office for Europe. https://apps.who.int/iris/bitstream/handle/10665/329834/9789289054553-eng.pdf?sequence=1&isAllowed=y

Hodes, M., & Vostanis, P. (2019). Practitioner Review: Mental health problems of refugee children and adolescents and their management. Journal of Child Psychology and Psychiatry, 60(7), 716-731. https://doi.org/10.1111/jcpp.13002

Holz, N. E., Tost, H., & Meyer-Lindenberg, A. (2020). Resilience and the brain: a key role for regulatory circuits linked to social stress and support. Molecular Psychiatry, 25(2), 379-396. https://doi.org/10.1038/s41380-019-0551-9

Hong, X., Li, Y., & Xue, Z. (2022, June). A Review of Studies on Major Depressive Disorder. In 2022 8th International Conference on Humanities and Social Science Research (ICHSSR 2022) (pp. 2819-2824). Atlantis Press. https://dx.doi.org/10.2991/assehr.k.220504.512

Karrouri, R., Hammani, Z., Benjelloun, R., & Otheman, Y. (2021). Major depressive disorder: Validated treatments and future challenges. World Journal of Clinical Cases, 9(31), 9350. https://doi.org/10.12998%2Fwjcc.v9.i31.9350

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