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Running Head: MAJOR DEPRESSIVE DISORDER 1

A Case Study of Mary of Mary with Major Depressive Disorder

TreSina E. Steger-Smith

Capella University
MAJOR DEPRESSIVE DISORDER 2

Introduction

MDD (Major depressive disorder) is a typical, impairing, disabling, and intermittent

condition that predicts future interpersonal issues, misconduct, unemployment, suicide

endeavors, and substance abuse (Kessler and Walters, 1998). Additionally, the condition

represents more than 66% of the 30,000 reported suicides every year (Beautrais et al., 1996).

Given this gigantic result at individual and societal levels, there is a reasonable need to create

and communicate viable medications for this issue. MDD is a disorder that has become a rather

prevalent disorder in United States. This disorder can cause drastic impairments to the patients

diagnosed with it due to the cognitive impairments related with MDD. The cognitive

impairments, particularly cognitive dysfunction, can lead to suicidal thoughts that make MDD a

disorder that needs to be taken seriously (Philip, Gregory, & Ronald, 2003). Many people

experience depressive episodes that differ in severity. Some experience depressive episodes that

cause impairment in their daily functions. These impairments are linked with symptoms of major

depressive disorder (MDD) which will be discussed later. The essay will provide a case report of

the adolescent at various stages of development and include a theoretic analysis of intervention

measures that would be administered to the patient.

A Case Report of Mary with Major Depressive Disorder (MDD)

Mary is a 17 year-old, white American female admitted to doctor's facility as a result of

dynamic suicide endeavors showed by contemplations of hanging herself by wrapping a phone

line around her neck. The issue was accompanied by holding a blade to her arm that afternoon.

Mary has a background marked by suicide ideation and has endeavored to cut herself before, yet

reported that the blade would not puncture her skin. She was concerned that she would not have
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the capacity to stop herself once more. She reported depression for as far back as three years and

a passion for death since eighth grade.

Mary is obese and seemed dismal, desolate, looking and exhibiting poor social abilities.

Her affection and love was unconcerned. Mary reported diminished vitality, trouble resting, issue

with her craving, and fractious state of mind. She likewise reported huge sentiments of misery,

uselessness, and weakness. Notwithstanding the above side effects, Mary talked about her

nonexistent companions that she has had since seven years old. The characters are from motion

pictures and TV, and she showcases their voices and contends with them. She distinguishes that

they are not genuine, but rather she will maintain a strategic distance from her companions to

invest energy with her fanciful ones. She reported one sound-related (auditory) fantasy, five days

before her confirmation, as a voice addressing her advising her to get up to rest easy.

These manifestations point to psychological despondency that MDD accompanied by

incongruent or consistent visualizations in the mind. The symptoms maybe teenage in nature

manifested in sound-related hallucinations, delusions, and fantasies. Patients exhibiting

depression more often than not have more extreme depression, a family history of psychotic and

bipolar, sadness more hopelessness, and increased imperviousness to medication treatments.

Ecological variables are likewise connected with to MDD. Mary narrated that her depressive

habit had compounded in the previous 2 weeks since her sister inhabited home once more. Her

sister is harsh towards her (she began gagging Mary for utilizing her computer, television and

other personal property), and Mary trusts her mom does not rebuff her sister legitimately.

Symptoms

Depressed mood
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In view of the K-SADS-PL (Kiddie-Sads-Present and Lifetime adaptation) which is a

semi-structured suggestive interview intended to assess significance appraisals of

symptomatology present and past scenes of psychopathology in youths as per the DSM-IV

criteria (Kaufman et al., 1997). One of the principle indications of MDD displayed by Mary is

depression as shown by her moods. This can be portrayed as feeling miserable and tragic. She

complains of irritability in addition to depression. It is critical to assess the impact of the patient,

giving careful consideration to outward appearances, stance, and manner of speaking. This is

especially critical if the individual is trying to claim ignorance about his/her emotions.

Loss of enthusiasm for her exercises/activities

Using the K-SADS-PL Mary was no longer intrigued by things already appreciated.

Mary depicts it as not anticipating anything, or being not able experience happiness.

Weight changes

Using the K-SADS-PL, hunger changes bringing about noteworthy, inadvertent weight

change was seen in MDD manifested as appetite loss.

Sleep changes

Using the K-SADS-PL, Insomnia was evident in MDD. Mary found herself awakening

amidst the night and was not able fall back sleeping. She additionally lay alert, and restless.

Fatigue

Using the K-SADS-PL, excessive fatigue was a noticeable symptom that greatly

impacted Mary. She did not have the vitality to play out the day by daily assignments. Tiredness

is regular.
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Feelings of worthlessness

Using the (K-SADS-PL, Mary had serious sentiments of blame as well as worthlessness.

She felt undeserving of the things throughout their life. She is obsessed and experienced

extraordinary blame over present or past occasions. She additionally contrarily confounded

things said or done by others. This propagates the blame and sentiments of unworthiness.

Uncertainty and focus problems

Mary equally experienced trouble focusing on errands. This was a change from ordinary

working.

Intermittent contemplations of death or potential suicide

The fundamental worry with MDD is that of suicide. Mary showed considerations of

death. These contemplations may fluctuate contingent upon the seriousness of the misery. It was

more genuine since she has made an arrangement of how she would submit to suicide.

Intervention Measures

There are various treatments for MDD that have empirical support showing that the

treatment is compelling for the treating the psychological symptoms.

Pharmacological Treatment

A few classes of drugs are utilized to treat depression. Three primary sorts of stimulant

meds incorporate SSRIs and MAOIs. There are some current stimulant medications that do not

fit conveniently into these classes since they have diverse instruments of activity (e.g.,

nefazedone and venlafaxine). The viability rates for these energizer medicines are like the

adequacy rates of SSRIs (Stahl et.al. 2002).


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Pharmacological Treatment

IPT (Interpersonal Psychotherapy)

There is adequate confirmation that IPT is a powerful treatment for sorrow. It is normally

suggested as an intense treatment for MDD by various rules and boards (e.g., Depression

Guideline Panel, 1993). IPT has been ended up being similarly powerful as intense stimulant

treatment with amitriptyline for the lessening of misery indications (Weissman 1979).

Marital therapy

Despite the fact that there is adequate proof that marital treatment can be utilized to

viably treat conjugal friction (Beach et al., 2009), there is developing proof that marital treatment

can treat depression successfully. Behavioral therapy is similarly compelling for treating

depression and misery as cognitive treatment (Beach and O'Leary, 1992).

Family-Based-Treatment

This is another sort of intercession that is by all accounts powerful for treating

depression. For instance, extremely discouraged patients that got family treatment will probably

enhance and report less self-destructive ideation than patients that did not have family treatment

(Miller et al., 2005). This treatment adopts a frameworks strategy to comprehension brokenness

inside the family. It expect that: (a) the family is interrelated; (b) one relative can't be totally

comprehended in disconnection from whatever is left of the family; and (c) family association,

structure, and cooperation impact relatives' conduct (Miller et al., 2005).

Behavioral Treatment
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Behavioral treatment attributes MDD as a disorder that happens due to learned and

unlearned responses in which treatment is specific to the behavior. The clients report of MDD

episodes and symptoms are valid and the treatment goal is to change the maladaptive behavior

and replace it with adaptive behavior. Behavioral treatment studies relationship of contingencies

and cues and reinforcement or lack of reinforcement, focused on changing contingencies and to

change behavior. Behavioral therapy has been confirmed to endogenously increase the

production of 5-HT, that is shown through the comparison of behavioral treatment paired with

placebos to pharmacological treatment (David-Ferdon and Kaslow, 2008).

Cognitive-Behavior Therapy is a behavioral treatment that dealing with changing the

feelings and judgments of the person diagnosed with MDD to treat the behavioral symptoms of

MDD. CBT focuses on irrational thoughts of people with MDD in which the individual produces

a negative blame-scheme and identifies events to be extremely negative. The main goal of CBT

is to substitute rational thoughts for irrational thoughts (Beck et.al, 1985). Regarding one of the

main symptoms anhedonia, CBT works to launch a stronger reward system by disrupting the

cognitive irrational thought process that take place with learned helplessness and lack of purpose.

CBT focuses on changing the dysfunctional attitude in individuals diagnosed with MDD and

substituting it with a more functional attitude (Friedman, et.al, 2004).

Psychotherapy is another type of behavior treatment that focuses on the individual

solving problems that were established previous in life. Its main assumption is that the disorder is

caused by unconscious conflicts and childhood problems. The therapist acts abstinent,

anonymous, and ambivalent when engaged with client that is diagnosed with MDD, to enable the

client to resolve the conflict internally on his/ her own (Friedman, et.al, 2004).

Becks Depression Cognitive Theory


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Aaron T. Beck built up a subjective hypothesis that at first centered on depression and

has been extended to different zones of psychotherapy and psychopathology. He became

dissatisfied with his psychodynamic training since he felt it did not sufficiently account for

clinical and research phenomena he was seeing. Becks (1972) theory characterized depression

in psychological terms. He saw the pivotal components of the turmoil as the "psychological

triad": (an) a negative perspective of the world, (b) a negative perspective of the self, and (c) a

negative perspective without bounds. The discouraged individual perspectives the world through

a sorted out arrangement of depressive schemata that distort understanding about the world, self,

and the future in a negative heading (Beck, 1972).

As indicated by Dr. Aaron Beck, negative musings, created by broken convictions are

actually the primary driver of depressive indications. An immediate relationship happens

between the sum and seriousness of the individual's negative considerations and the seriousness

of their depressive manifestations (Beck et.al, 1979). Consequently, the more negative musings

the patient encounters, the more discouraged he/she will get to be. The hypothesis can be utilized

to comprehend Mary's issue her behavioral attributes were portrayed by the sentiment being

insufficient or flawed, every last bit of her encounters result in disappointments or annihilations,

and her future is sad. Together, these three subjects are depicted as the Negative Cognitive Triad

for Mary's situation. At the point when these convictions are available Mary's discernment,

despondency is probably going to happen.

Possible reasons behind adolescents behavior


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There are several reasons behind adolescents behavior that can lend itself to develop

habits that MDD can present itself. Some of these reasons are rapid brain development, peer

pressure, lack of physical development, and educational environment. Melnyk & Lusk (2013)

state that young people are susceptible to lagging behind in school and lack of energy and do not

participate in social and school activities. Other symptoms that contribute to the symptoms and

behaviors that exclude in MDD in teenagers could be genetic or situational at home such as

marital. The links that adolescents who have parents or closely related family members who

suffer from other mental illnesses or conditions are more likely to show signs of symptoms.

Adolescents who are in unstable home environments such as such as parents who are going

through turmoil or marital problems (Blodgett, Schaefer, & Haugen, 2014) is a breeding ground

for unhealthy conflict and can contribute to MDD. The strength and bonds of the parent-child

relationship and limit setting can prevent delinquent behavior that occurs from MDD (Lecompte

& Moss, 2014).

There are results that confirm substance abuse and identity exploration in which

commitment to identity was a buffer of identity exploration and substance abuse with similar

groups with similar ages and status. Other groups that have different status, less risky behavior

and low identity-commitment (Dumas, Ellis, & Wolfe, 2012) factor into which each adolescent

tolerates stress and other daily life functions. However, since adolescence is the time for rapid

growth, he or she can lose out on major activities that can prepare him or her for a productive life

and career.

Conclusion
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This paper aimed to provide a case report of the adolescent at various stages of

development and include a theoretic analysis of intervention measures that would be

administered to the patient with MDD. It observed that many people experience depressive

episodes that differ in severity. Some experience depressive episodes that cause impairment in

their daily functions. These impairments are linked with symptoms of major depressive disorder

(MDD).
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11

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