Major Depressive Disorder with Psychotic Features
The National Institute of Health defines major depression as “feelings of sadness, loss, anger, or frustration [that] interfere with everyday life for weeks or longer” (“Major Depression,” 2011). The DSM-IV-TR allows for a diagnosis of depression to include a subtype to further describe the characteristics of the depressive episode. One specific subtype is psychotic features, indicating “the presence of disorganized thinking, delusions, or hallucinations” (Varcarolis & Halter, 2010, p. 248). Major depression with psychotic features can be a highly debilitating disorder leading to an inability to fully function in society or carry out responsibilities. Psychotic features can further inhibit the clients ability to functional ability by filling them with delusions of being punished, allowing them to hear voices demeaning them or criticizing them. The patient in our case study is suffering from her first episode of major depressive disorder with the presence of psychotic features.
Major depressive disorder with a subtype diagnosis of psychotic features can be caused by a variety of factors including; genetics, biochemical factors, and alterations in hormonal regulation.
In twin studies it has been found that there is a concordance rate of as high as 37% in twins when one is suffering from depression. Despite this finding it has also been found that “for depression to develop . . . a genetic predisposition must also be affected by environmental factors” (Varcarolis & Halter, 2010, p. 250).
Two specific neurotransmitters in the brain are believed to play an integral role in mood regulation, these include norepinephrine and serotonin. Deficiencies or the bodies inability to utilize these neurotransmitters are thought to lead to depression. For that reason medications like serotonin and norepinephrine reuptake inhibitors were created and are diagnosed to aid in the treatment of depression.
Alterations in Hormonal Regulation
Many functions within the body are controlled by hormones. These hormones are regulated by several endocrine glands. Endocrine gland secretions from the hypothalamus, pituitary, and adrenal cortex are thought to influence depressive disorder. Hyperactivity of these glands are thought to lead to a diagnosis of depression (Varcarolis & Halter, 2010, p. 252)
Nursing Diagnosis and Interventions
Clients experiencing depressive disorder with psychotic features are in need of significant nursing and medical care and there are many possible nursing diagnosis that would apply to these clients.
Disturbed thought process
The client with depression has lost the ability to accurately interpret or cope with their surroundings especially if they suffer from psychotic features. Possible interventions for this client would include; promoting communication that will enhance the person’s sense of integrity, assist the client to differentiate between own thoughts and reality, assist the person to communicate more effectively.
Depression leads to thoughts of hopelessness and the inability to see the future with hope and courage. Interventions for this client would include; aiding the client in identifying and expressing feelings, assist the person in finding external resources to aid in depression, assess the clients risk for self harm and aid in developing coping techniques.
Ineffective role performance
Depression can limit an individuals ability to carry out normal daily functioning and assistance in this area is necessary. Interventions for this client would include; aiding the client in making a list of priorities and tasks to complete, help the client to talk about tasks, and calling a family meeting to have members understand the disorder.
In their 2008 article Mattson et al. outline the importance of social networks and financial stability in the five year recovery of first episode psychotic patients. The article begins by providing a basic synopsis of what psychosis is and some of the various contributing factors. The goal of the study was to identify major elements that would inhibit recovery and discover factors that might help in overcoming the identified barriers. The researchers outlined six clinical areas that if implemented would aid the psychotic client experiencing their first episode in healing. These six principles include; early intervention meeting with the client within 24 hours, initial structuring crisis intervention, immediate and recurring family/network meeting, continual accessibility to a multidisciplinary team, lowest possible effective dosage of antipsychotic medications, overnight care in small crisis homes. The researchers found that when these clinical procedures where implemented the client had a better chance at recovery. They found that financial and social network strain might impact patients more so than a person that does not suffer from psychosis. The six interventions mentioned above when implemented will help to reduce these stressors and aid the client in focusing on and obtaining recovery. In regards to our case study, I feel that when considering the finding of this article and the fact that this is her first diagnosed case of depression and psychosis, she will experience a very positive outcome. Our client seems to have a strong social network and although her husband appears to be overwhelmed with the new diagnosis with his assistance and presence his wife might achieve full recovery.
Major Depression. (2011). Retrieved October 3, 2011 from PubMed Health: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001941/
Mattsson, M., Topor, A., Cullberg, J., & Forsell, Y. (2008). Association between financial strain, social network and five-year recovery from first episode psychosis. Social Psychiatry & Psychiatric Epidemiology, 43(12), 947-952.
Varcarolis, E., Halter, M., (2010). Foundations of psychiatric mental health nursing: A clinical approach 6th edition. Elsevier, St. Louis.