In the instance of Morris, it is clear that the proper diagnosis for this patient is that of Major Depressive Disorder. Morris is unable to hold back his tears, even when he is being interviewed for the first time by a new psychiatric health care worker, and it is also clear that he probably experiences uncontrollable crying on a regular basis, no matter what the situation may be. Further, the fact that Morris recently made a major suicide attempt is also a clue that he is experiencing Major Depressive Disorder. Another behavioral cue provided by Morris that he is suffering from this particular ailment is that he is speaking incredibly slowly, and has trouble making eye contact with anyone as he speaks. Due to the chemical havoc that Major Depressive Disorder wreaks on the brain, untreated individuals with this disorder often have trouble interpreting basic social cues, and also have trouble in their day to day social interactions. This can create a “downward spiral effect,” whereby the patient is inhibited in his or her social interactions, which then leads people in their lives to begin avoiding them or to arrive at the conclusion that the patient does not like them. As such, the patient then becomes increasingly isolated, an extraneous condition that leads them to become even more depressed.
Another major issue with Morris is that he reports that he has completely lost his appetite, and has accordingly lost 15 pounds within the last few weeks. Again, this is a major behavioral indicator of Major Depressive Disorder, and it is another “downward spiral” behavior. When patients with Major Depressive Disorder lose their appetite, and do not eat, they obviously become rather malnourished. As such, the loss of nutrients that the patient experiences leads them into further depression. Also, the patient may well experience a diminished sense of energy, and may find it even more difficult to wake up in the mornings, due to the loss of nutrients. One of the major issues that occurs with a patient who has Major Depressive Disorder is that the mood disorder causes patients to lose many of their basic survival drives, which then leads them to experience may of the outward manifestations of loss and decay, which then in turn leads them to become even more strongly depressed. As such, Major Depressive Disorder is a mental illness which can quickly turn into a behavioral “downward spiral.”
Another worrisome aspect about the case of Morris is that he is complaining that he is having trouble falling asleep and staying asleep in the last few months. Once again, insomnia is one of the hallmark symptoms of Major Depressive Disorder, and it is one of the manifestations of the disorder that can easily lead to a patient becoming even more depressed. All of us who have had a sleep disorder, or any type of sleep disruption, well know how much of an impact that sleep disruptions and a lack of sleep can have on our overall mental health. In some regards, it seems as though Morris may well have a co-morbid sleep disorder which is partially to blame for his depressive symptoms. However, it will first be necessary to treat the major mental health symptoms that Morris is experiencing prior to examining him for any other co-morbid issues. Given the fact that Morris tried to commit suicide recently, the first and foremost priority should be placed on treating his mental health issues (Otte, Gold, Penninx et al., 2016). Further, since it is quite possible that the majority of Morris’ symptoms should clear up once his mental health issues are dealt with, this gives further strength to the argument that the first priority should be placed on dealing with his depression.
As for treating Morris’ clear case of Major Depressive Disorder, it is clear in the instance of this patient that it is an endogenous mental health issue that is caused by an underlying chemical imbalance that exists within his brain. As such, the first line of treatment should be to provide Morris with a very strong regimen of anti-depressant medication therapy that will re-adjust his neurotransmitters to ensure that they function properly. One of the main issues of which Morris should be apprised is that anti-depressant medication can often take up to six weeks of use prior to the patient noticing any marked changes or improvements in their overall mood. However, if Morris adheres to his medication regimen, there is a very good possibility that he will recover, especially since his depression seems to be solely caused by an internal chemical imbalance.
In the instance of Lenore, it would initially appear that she is suffering from Major Depressive Disorder. Lenore initially appears to have all of the outward manifestations of Major Depressive Disorder; she is having trouble eating and sleeping, is voluntarily isolating herself, and cannot think of anything but her deceased husband. If Lenore had approached anyone but a mental health professional (such as her family physician) for help with these issues, it is probable that the health care provider would have simply prescribed her an antidepressant medication, and moved on for the day. From a very superficial standpoint, it is clear that Lenore is experiencing major depressive symptoms for the time being, but they honestly seem to have been completely precipitated by the death of her husband just 12 days ago.
According to Djelantik, Smid, Kleber et al. (2018),
Following the death of a loved one, symptoms of both grief and posttraumatic stress can develop in bereaved individuals. In most people these symptoms decrease overtime. However, in others they remain and spiral into symptoms of Prolonged Grief Disorder (PGD) and/or Post Traumatic Stress Disorder (PTSD). Characteristic symptoms of PGD include frequent preoccupying thoughts and memories of the deceased person, a feeling of disbelief or inability to accept the loss, and difficulty imagining a meaningful future without the deceased person, to such an extent that the person is impaired in daily functioning during at least 6 months after the loss. A key distinctive feature of PGD is “yearning for the deceased”, whereas “fear” is the hallmark symptom of PTSD. PGD will likely be included in the forthcoming edition of the International Statistical Classification of Diseases and Related Health Problems (Djelantik et al., 2016).
As such, it is quite clear that the mental health disturbances that Lenore is presently facing have been directly caused by the sudden death of her spouse less than two weeks prior. While it will be necessary to question Lenore further about any past mental health history she herself may have, or any family mental health history, it is quite apparent in this case that Lenore is simply in extreme grief over the recent death if her husband. Unfortunately, American society does not provide many official avenues whereby an individual can engage in prolonged grief over a spouse or another close relative. Generally speaking, Americans tend to assume that one can simply bury or create their dead. “shake it off,” and get on with life. However, this is just not true in many instances. In many regards, our current society tends to pathologize those who are not simply able to get over the loss of a loved one within a convenient amount of time, and the mental health care profession should start refusing to participate in this chicanery.
While it would be much easier to simply write Lenore off as being “clinically depressed,” write her a prescription, and be done with it, it is clear that this patient requires much more extensive help. In the early phases, Lenore should be prescribed an antidepressant in order to help her throughout this trying period of her life. However, Lenore should also be referred to an individual psychotherapist or counselor, preferably one who specializes in grief counseling. Moreover, Lenore should be referred to a psychological support group that deals specifically with individuals who have recently lost their spouse. In this manner, Lenore will not feel so alone in the world, and she will better understand that there is life beyond her current stage of grief.
Once all of the psychotherapy options have been exhausted, and Lenore is still manifesting many of the major depressive symptoms, such as insomnia and a loss of appetite, it may well be necessary to consider a diagnosis of Major Depressive Disorder, and to place her on stronger anti-depressant medication therapy (Grison & Gazzaninga, 2019). However, it is clear from this case scenario that the majority of the symptoms that Lenore is experiencing have been precipitated by the sudden death of her husband just 12 days prior. As such, the first “plan of attack,” from a mental health standpoint, should be psychotherapy and support groups, rather than a lengthy list of prescriptions. It may also well be the case that Lenore has a rather limited social support circle after having been married for so long, and a support group and a psychotherapist may be just what she needs in order to improve.