Identification data:

Name: Rajeswari Tiwari Age: 36 Yrs. Sex: Female

Bed No: F-8 Marital Status: Married Religion: Hindu
Education: Madhyamik pass. Economic Status: Stable Language: Bengali
Father/spouse: Mr. Hriday Tiwari
Address: Vill: Nimpurdanga, P.O.- Kundala, P.S. Mayureswar, Dist. Birbjum. Pin- 731246.

Occupation: House Wife Income: Nil.

Marital status: Married. Religion: Hindu.

Informant: Mother( Ms.Durga Shil)

Intimacy with the patient- Intimate.

Does the informant live with the patient- Sometimes.
Duration of relationship. Since Birth.
Interest of the informant in the patients property or money: Not present.
.

Presenting chief complaints

As experienced by patient: Patients own words-

Ami sob kichhu vule gecchilam, kauke chinte parchhilam na, ghum peto na, onnomonosko hoye jetam,
khide peto na, jokhon tokhon hasi peto- kanna peto, khub matha jontrona hoto jeta osudh khele kome
jato. Khub voy lagto , mone hoto keu amar khoti kore debe , keu ghore dhuke guli kore debe, mone hoto
dupur bela ghore bagh dhuke jabe, kono kaj korar ichha nei, sobsomay bomi bomi vab lagto. Kono
kichhu valo lagto na , mone hoto more gelei valo hobe.

As described by the patients relative: Informants own words.

O khub voy pachhilo , bachhader moto kore kotha bolchhilo, khub matha betha korto or, r kauke chinte
parchhilo na.

History of present illness:

When symptoms are first noticed by the patient and by the relatives-
Duration: (days/ weeks /months/years).before 1 wk.

Mode of onset: acute (because 1wk).

Course: Continuous .
Intensity: Increasing.
Aggravating Factors:
Predisposing factors: No significant family history , but her father was very rigid type personality.
Precipitating factors: She is tortured mentally by her mother-in-law since her marriage. for 19 yrs.
Perpetuating factors: Recent quarrelling with her mother-in-law.

Description of present illness(chronological description of abnormal behavior, associated problem

like suicide, homicide, disruptive behavior thought content, speech, mood states, abnormal
perceptions etc): She had sleeplessness, decreased appetite, severe headache, absentmindedness, apathy
to work, fear of harm by others, nausea, slurred speech and nasal intonation of voice, and then mute. She
also had the suicidal ideation.

Has there been any change in personal habit of the patient, physical health : weight gain , sleep
pattern- decreased appetite- Poor, Nasal intonation of voice.
Are there any change in thinking and behavior of the patient: Yes, she is having changing in talking
way, nasal intonation of voice and child like behavior ( demanding of chocolate, biscuits etc, crying like
babies) during depression.

Treatment history:
Drugs :
Tab. Syndopa (110mg) 1- 1- 1.
Tab. Pacitone (2 mg.) 1-1-X.
Tab. Olimelt (5 mg.) X-X-1.
Tab. Zeptal-CR 1-X-1.
Tab. Rispond Play 1-X-1.

ECT: Nil.
Psychotherapy: Nil.
Family therapy: Nil.
Rehabilitation: Nil.

Past psychiatric history:

Number of previous episodes/ hospitalization (psychiatric) with onset and course: She is suffering
from depression since 5 yrs. She had 2-3 episodes per year and each episode lasts for 1 to 1.5 months. In
between the episodes she is having the low mood. No previous hospitalization required.
Before starting of this episode the patient became very fearful , but she could not express her fearfulness,
and she had collected a knife to kill her mother-in-law, but she never attempted so.
Complete or incomplete remission: Incomplete remission.
Duration of each episode: 1 -1.5 months.
Treatment details and its side effects if any: She is treated by local psychiatrist. She had severe vomiting
for 20 days of unknown medicine. Then treated this side-effect.

Treatment outcome: She is continuing treatment since 5 yrs, the treatment outcome is varying.
Details of any precipitating factors if present: Her mother-in-law is mentally torturing her since her
marriage.

Medical history:

Surgicalprocedures/accidents/headinjury/convulsions/unconsciousness/DM/HTN/CAD/Venereal
disease/HIV positivity/any other: She had Jaundice at her 3 yrs of age and dog bite at her 5 yrs of age and
she is having the history of unconsciousness after marriage, but it is now stopped for last 10 yrs. She is
also have the history of diphtheria before 5 yrs.
Has the patient been using additive drugs or alcohol: No.

Personal history:

i) Perinatal history.
Antenatal period: Maternal infections/ exposure to radiation/any complications: Premature dribbling at
last trimester.
Intranatal period: Type of delivery-normal delivery, Home delivery by local doctor.
Birth: Full term .
Birth cry: Delayed for 1 to 1.5 hrs.
Birth defects: No.
Postnatal complications: Nil.

ii) Childhood history:

Primary caregiver: Mother.

Breast fed/Artificial mode of feeding: breast fed
Age at weaning: 1 year.
Developmental milestone: Normal.
Behavior and emotional problems: Nail biting.
Illness during childhood: Jaundice at 3 yrs of age.

iii) Educational history:

Age at beginning of formal education: 6 yrs.

Academic performance: Average.
Specifically for Learning disability and Attention deficit disorders: Nothing significant.
Extracurricular achievements, if any: Singing, dancing.
Relationships with peers and teachers: Satisfactory.
School phobia: No
Look for conduct Disorders for example Truancy/Stealing: No.

iv) Play history:

Games played: (at what stage and with whom) : Preferred the indoor games with same age and same sex
friends.
Relationship with playmates: Good.

v) Emotional problem during adolescence:

Running away from home/Delinquency/Smoking/Drug taking/Any other: Running away from home
after the scolding from her father.

vi) Puberty:

Age at appearance of secondary sexual characteristics: 12 yrs.

Anxiety related to puberty changes: Mild.
Age at menarche: 12 yrs.
Regularity of cycles, duration of flow: Regular cycle, Flow- normal.
Abnormalities, if any (Menorrhagia , Dysmenorrheal ): Nil.

vii) Obstetrical history:

L.M.P: 28.01.2011
Number of children: 2 .
Any abnormalities associated with pregnancy, delivery, puerperium: No.
Termination of pregnancy, if any: No
Menopause: Still not come.

viii) Occupational history: She is a house wife.

Age at starting work: -

Jobs held in chronological order: -
Reasons for changes: -
Current job satisfaction: -
(Including relationships with authorities, colleagues, subordinates)
Whether job is appropriate to patients background:

ix) Sexual and marital history:

Type of marriage: self choice.

Duration of marriage: 19 yrs.
Interpersonal and sexual relations: Satisfactory.
Extramarital relationships if any specify:No.

x) Premorbid personality:

Interpersonal relationship: Introvert.

Family and social relationships: Healthy except with mother-in law.
Use of leisure time: Reading religious books.
Predominant mood:optimistic; Stable.
Usual reaction to stressful events: Become fearful, and anxious.
Attitude to self and others : Good.
Attitude to work and responsibility: responsible.
Religious beliefs and moral attitudes: She is religious.
Fantasy life: Day dreams : No.
Habits:
Eating pattern : Regular.
Elimination: Regular.
Sleep: Regular
Use of drugs, tobacco, alcohol: No.

Family history:

Description (describe each family member briefly, age education, occupation, health status,
relationship with patient, age at death, mode of death.)
Are there any history of physical and mental illness in family?
Is there any use of alcohol or drugs in the family?
A family tree can be used to describe the number of family members, their age group and any death
occurring in the family. The following figures give an example of the family tree.
PHYSICAL EXAMINATION- Done on 08.03.2011.
General appearance The client appears silent and having apathetic look.
Height- 53
Weight- 68 kg.
Skin- Fair, skin tone is good.
Head- Clean
Eyes- Normal
Ear- Normal
Nose- Normal
Mouth- Normal
Neck- No abnormality detected
Chest- Normal
Abdomen- Soft
Upper limbs- normal
Lower limbs- Normal
Back & spine- No abnormality detected
LABORATORY INVESTIGATIONS-
On 14.02.11- Blood Hb% - 9.9 . TC- 15,000/ cmm.
Neutrophil- 62%,
Lymphocyte 18%,
Monocytes- x
Eosinophil- 20%
Platelets- 1.5 L/ cmm.
On 15.02.11-
Blood Testing- FBS-136mg/dl
Blood for Na- 137.6 Mg/dl.,
Serum K+ - 4.04 Mg./ dl.
Sugar- 167 Mg/ dl.
Urea- 27 Mg/dl.
Creatinine- 1.0 Mg/ dl.
Blood for lipid profile- Cholesterol- 127 Mg/dl.
Triglycerides- 164 Mg./dl.
LFT- Bilirubin (Total)- 0.6 mg/dl , Direct 0.2 mg/dl Indirect- 0.4 mg/dl.
SGOT- 49 U/L
SGPT- 62 U/L
ALP- 233 U/L.
Total protein- 7.5 gm/dl
Albumin- 3.8 gm/ dl.
On 19.02.11- Plasma sugar- 109 mg/ dl.

MENTAL STATUS EXAMINATION( on 08.03.2011):

Date of doing MSE: 08.03.2011
Time of doing MSE: 10.30 a.m.
General Appearance & behaviour-
Level of consciousness: Fully conscious& alert
Appearance: Her age, overweight
 Facial expression: Anxious, fearful
Eye-to-eye contact: Maintained but sometimes difficultly maintained
Physique: Endomorphic
Personal hygiene: Maintained
Posture: Closed posture
Gesture: Normal
Dress: According to season, Clean.
Gait: slow walk.
Motor activity: Decreased
Cooperativeness: Normal.
Rapport: Spontaneous.
Behaviour: Slight anxious and fearful.
Speech
Initiation: Speaks when spoken to, minimal
Reaction time: Slightly delayed
Rate: Slow
Productivity - Elaborate replies when asked for otherwise monosyllabic replies.
Volume: Soft
Amount: Paucity,
Tone: Monotonous nasal intonation of voice, Child like tone of voice.
Stream: Normal flow & rhythm of speech is normal.
Coherence: Fully coherent.
Relevance: Sometimes off target but otherwise relevant
Others: Nasal intonation of voice, childish voice.
Sample of Speech:
Q. Who are there in your house?
A. Amader barite ami, amar husband, amar dui chele meye, nonod ( Normal
expression) ar amar sasuri ache( with little anxious look). Nonod to bidhoba tai amader
sathei thake ( with normal expression).
Mood & Affect
Quality of mood: Anxious, fearful, and depressed.
Stability of mood: Affect labile, mood is flat.
Subjectivity (what patient says): Amar monta valo nei, majhe majhe voi lagchhe,
kichhu valo lagchhe na.
Objectivity (what one observes): She is looking anxious, depressed and fearful.
Predominant mood state: Anxious, Fearful
Appropriate to thought content.
Thought
At formation level: Normal
At progression level: No flight of ideas or thought blocking.
At content level: No delusions but phobias to crowd, to darkness, to lonliness, & fear of
being harmed by others.
Sample of speech:
Q. What are the thoughts coming in your mind?
A. Amar khub voy kore, andhokare thakte pari na, eka thakle khub voy lage, mone
hoy keu jano ghore dhuke jabe, amake mere felbe, dupur bela eka thakle mone hoy
ghore bagh dhuke jabe.
Perception
Illusion: Not present.
Hallucination: Auditory hallucinations of some voices whispering about her.
Memory
Immediate:
Q. Im telling you three things which you have to remember. After 5 minutes Ill ask
you have to tell the three thing. The three things are- tree, rice, and bird. (after 5 min.)
Can you remember the three things?
A. Ha mone ache, gach, vaat r pakhi.
Recent:
Q. what food did you have in your last dinner?
A. kal rate ami ruti, chana r kala kheyechhi. ( verified from her mother).
Past:
Q. In which school were you studing?
A. ami Rajdanga Uchha Balika Bidyaloye Portam. ( Verified from her mother)
Inference: Her immediate, recent and remote memory are intact.
Orientation
To time, date, day, month, year:
Q. Now whats the time can you guess?
A. Ha ekhon to sakal bela, 10 ta sare 10 ta baje.
Q. Can you tell me todays date and day?
A. Ha, aj to mongolbar, ar 8 e Mach, 2011.
To place: Q. Which place is this?
A. eta to Calcutta Medical College Hospital.
To person:
Q. Can you tell me who am I?
A. (with smile) Ha , aapni to sister didi.
Inference: She is fully oriented to time, place and person.
Insight
Q. What do you think about illness- whether it is physical or mental illness.
A. Na, eta manasik asukh.
Present fully.
Insight is rated on a 6 point scale & it is 6.
Judgement
Personal ( future plans):
Q. What will you do after going back to your home?
R. A. Ami bari gie ghorer e kaj kormo korar chesta korbo....jodi monta valo thake.
Social(perception of the society):
Q. What will you do if you see that a 2 yrs old child alone in a busy road?
A. Ami bachha take gie dhore nie or barite firie debar chesta korbo.
Inference: Her personal and social judgement is intact.
Attention & Concentration Attention: Aroused with slight difficulty.

Digit forward- Q. Can you count forward from 45 to 50?

A. 45, 46, 47, 48, 49, 50
Digit backward- Q. Now can you count backward ?
A. 50, 49...47...46, 45
Span of attention: Attention span is slightly impaired.
Ability to concentrate: Normally sustained
Names of months(backwards), Names of weekdays( backwards):
Q. Can you mention the name of the months and week days from backward?
A. Robibar, sanibar,..... sukrabar,......hm.... brihaspatibar, budhbar, mongolbar, sombar.
December, November, October,.....September, ....August...July..June...May,....
General Information
Knowledge about surroundings, festivals, sports, states, depending on patients socio-
economic status & educational background.
Q. which is the national bird of our country?
A. Ha, mayur.
Intelligence: Arithmetic ability:
Q. You have gone to market with 80 rupees, you bought 20 rupees vegetable, 25 rupees
fish & 10 rupees dal, how much rupees are left with you?
A. hm...25 taka.
Abstract reasoning:
Q. Can you explain the phrase nachte na janle uthon baka?
A. Etar mane holo nije kichhu korte na parle onner opor dosh deoa.
Inference: Her knowledge, intelligence and abstract reasoning are intact.
Special points-
Appetite: Slightly decreased..
Sleep: Decreased.
Bowels: Regular.
Bladder: Regular.
Libido: Normal.
Treatment: Continuing.

MENTAL STATUS EXAMINATION( on 09.03.2011)

Date of doing MSE: 09.03.2011
Time of doing MSE: 11 a.m.
General Appearance & behaviour-
Level of consciousness: Fully conscious& alert
Appearance: Her age, overweight
Facial expression: Anxious, fearful
Eye-to-eye contact: Maintained but sometimes difficultly maintained
Physique: Endomorphic
Personal hygiene: Maintained
Posture: Closed posture
Gesture: Normal
Dress: According to season, Clean.
Gait: slow walk.
Motor activity: Decreased
Cooperativeness: Normal.
Rapport: Spontaneous.
Behaviour: Slight anxious and fearful.
Speech
Initiation: Speaks when spoken to, minimal
Reaction time: Slightly delayed
Rate: Slow
Productivity - Elaborate replies when asked for otherwise monosyllabic replies.
Volume: Soft
Amount: Paucity,
Tone: Monotonous nasal intonation of voice, Child like tone of voice.
Stream: Normal flow & rhythm of speech is normal.
Coherence: Fully coherent.
Relevance: Sometimes off target but otherwise relevant
Others: Nasal intonation of voice, childish voice.
 Sample of Speech:
Q. Who are there in your house?
A. Amader barite ami, amar husband, amar dui chele meye, nonod ( Normal
expression) ar amar sasuri ache( with little anxious look). Nonod to bidhoba tai amader
sathei thake ( with normal expression).
Mood & Affect
Quality of mood: Anxious, fearful, and depressed.
Stability of mood: Affect labile, mood is flat.
Subjectivity (what patient says): Amar monta valo nei, majhe majhe voi lagchhe,
kichhu valo lagchhe na.
Objectivity (what one observes): She is looking anxious, depressed and fearful.
Predominant mood state: Anxious, Fearful
Appropriate to thought content.
Thought
At formation level: Normal
At progression level: No flight of ideas or thought blocking.
At content level: No delusions but phobias to crowd, to darkness, to lonliness, & fear of
being harmed by others.
Sample of speech:
Q. What are the thoughts coming in your mind?
A. Amar khub voy kore, andhokare thakte pari na, eka thakle khub voy lage, mone
hoy keu jano ghore dhuke jabe, amake mere felbe, dupur bela eka thakle mone hoy
ghore bagh dhuke jabe.
Perception
Illusion: Not present.
Hallucination: Auditory hallucinations of some voices whispering about her.
Memory
Immediate:
Q. Im telling you three things which you have to remember. After 5 minutes Ill ask
you have to tell the three thing. The three things are- tree, rice, and bird. (after 5 min.)
Can you remember the three things?
A. Ha mone ache, gach, vaat r pakhi.
Recent:
R. what food did you have in your last dinner?
B. kal rate ami ruti, chana r kala kheyechhi. ( verified from her mother).
Past:
R. In which school were you studing?
B. ami Rajdanga Uchha Balika Bidyaloye Portam. ( Verified from her mother)
Inference: Her immediate, recent and remote memory are intact.
Orientation
 To time, date, day, month, year:
Q. Now whats the time can you guess?
A. Ha ekhon to sakal bela, 10 ta sare 10 ta baje.
Q. Can you tell me todays date and day?
A. Ha, aj to mongolbar, ar 8 e Mach, 2011.
To place: Q. Which place is this?
B. eta to Calcutta Medical College Hospital.
To person:
Q. Can you tell me who am I?
A. (with smile) Ha , aapni to sister didi.
Inference: She is fully oriented to time, place and person.
Insight
Q. What do you think about illness- whether it is physical or mental illness.
A. Na, eta manasik asukh.
Present fully.
Insight is rated on a 6 point scale & it is 6.
Judgement
Personal ( future plans):
S. What will you do after going back to your home?
T. A. Ami bari gie ghorer e kaj kormo korar chesta korbo....jodi monta valo thake.
Social(perception of the society):
Q. What will you do if you see that a 2 yrs old child alone in a busy road?
A. Ami bachha take gie dhore nie or barite firie debar chesta korbo.
Inference: Her personal and social judgement is intact.
Attention & Concentration
Attention: Aroused with slight difficulty.
Digit forward- Q. Can you count forward from 45 to 50?
B. 45, 46, 47, 48, 49, 50
Digit backward- Q. Now can you count backward ?
B. 50, 49...47...46, 45
Span of attention: Attention span is slightly impaired.
Ability to concentrate: Normally sustained
Names of months(backwards), Names of weekdays( backwards):
Q. Can you mention the name of the months and week days from backward?
B. Robibar, sanibar,..... sukrabar,......hm.... brihaspatibar, budhbar, mongolbar, sombar.
December, November, October,.....September, ....August...July..June...May,....
General Information
 Knowledge about surroundings, festivals, sports, states, depending on patients socio-
economic status & educational background.
Q. which is the national flower of our country?
A. Ha, podma.
Intelligence: Arithmetic ability:
Q. You have gone to market with 100 rupees, you bought 20 rupees vegetable, 30rupees
fish & 10 rupees dal, how much rupees are left with you?
A. hm...40 taka.
Abstract reasoning:
Q. Can you explain the phrase angur fol tok?
A. Etar mane holo nije kichhu na pele nijeke evabe santona deoa.
Inference: Her knowledge, intelligence and abstract reasoning are intact.
Special points-
Appetite: Normal.
Sleep: Adequate.
Bowels: Regular.
Bladder: Regular.
Libido: Normal.
Treatment: Continuing.

MENTAL STATUS EXAMINATION( on 10.03.2011)

Date of doing MSE: 10.03.2011

Time of doing MSE: 10 a.m.

General Appearance & behaviour-
Level of consciousness: Fully conscious& alert
Appearance: Her age, overweight
Facial expression: Anxious, fearful
Eye-to-eye contact: Maintained but sometimes difficultly maintained
Physique: Endomorphic
Personal hygiene: Maintained
Posture: Closed posture
Gesture: Normal
Dress: According to season, Clean.
Gait: slow walk.
Motor activity: Decreased
Cooperativeness: Normal.
 Rapport: Spontaneous.
Behaviour: Slight anxious and fearful.
Speech
Initiation: Speaks when spoken to, minimal
Reaction time: Slightly delayed
Rate: Slow
Productivity - Elaborate replies when asked for otherwise monosyllabic replies.
Volume: Soft
Amount: Paucity,
Tone: Monotonous nasal intonation of voice, Child like tone of voice.
Stream: Normal flow & rhythm of speech is normal.
Coherence: Fully coherent.
Relevance: Sometimes off target but otherwise relevant
Others: Nasal intonation of voice, childish voice.
Sample of Speech:
Q. Can you explain your house?
A. Amader barite 5 ta room,ache, 1 ta amader, baki 2 to chele meyer, sasurir 1 ta , r
nonoder 1 ta.( with normal expression).
Mood & Affect
Quality of mood: Anxious, fearful, and depressed.
Stability of mood: Affect labile, mood is flat.
Subjectivity (what patient says): Amar monta valo nei, majhe majhe voi lagchhe,
kichhu valo lagchhe na.
Objectivity (what one observes): She is looking anxious, depressed and fearful.
Predominant mood state: Anxious, Fearful
Appropriate to thought content.
Thought
At formation level: Normal
At progression level: No flight of ideas or thought blocking.
At content level: No delusions but phobias to crowd, to darkness, to lonliness, & fear of
being harmed by others.
Sample of speech:
Q. What are the thoughts coming in your mind?
A. Amar khub voy kore, andhokare thakte pari na, eka thakle khub voy lage, mone
hoy keu jano ghore dhuke jabe, amake mere felbe, dupur bela eka thakle mone hoy
ghore bagh dhuke jabe.
Perception
Illusion: Not present.
 Hallucination: Auditory hallucinations of some voices whispering about her.
Memory
Immediate:
Q. Im telling you three things which you have to remember. After 5 minutes Ill ask
you have to tell the three thing. The three things are- tree, rice, and bird. (after 5 min.)
Can you remember the three things?
A. Ha mone ache, gach, vaat r pakhi.
Recent:
S. what food did you have in your last dinner?
C. kal rate ami ruti, chana r kala kheyechhi. ( verified from her mother).
Past:
S. In which school were you studing?
C. ami Rajdanga Uchha Balika Bidyaloye Portam. ( Verified from her mother)
Inference: Her immediate, recent and remote memory are intact.
Orientation
To time, date, day, month, year:
Q. Now whats the time can you guess?
A. Ha ekhon to sakal bela, 10 ta sare 10 ta baje.
Q. Can you tell me todays date and day?
A. Ha, aj to mongolbar, ar 8 e Mach, 2011.
To place: Q. Which place is this?
C. eta to Calcutta Medical College Hospital.
To person:
Q. Can you tell me who am I?
A. (with smile) Ha , aapni to sister didi.
Inference: She is fully oriented to time, place and person.
Insight
Q. What do you think about illness- whether it is physical or mental illness.
A. Na, eta manasik asukh.
Present fully.
Insight is rated on a 6 point scale & it is 6.
Judgement
Personal ( future plans):
U. What will you do after going back to your home?
V. A. Ami bari gie ghorer e kaj kormo korar chesta korbo....jodi monta valo thake.
Social(perception of the society):
Q. What will you do if you see that a 2 yrs old child alone in a busy road?
A. Ami bachha take gie dhore nie or barite firie debar chesta korbo.
 Inference: Her personal and social judgement is intact.
Attention & Concentration
Attention: Aroused with slight difficulty.
Digit forward- Q. Can you count forward from 45 to 50?
C. 45, 46, 47, 48, 49, 50
Digit backward- Q. Now can you count backward ?
C. 50, 49...47...46, 45
Span of attention: Attention span is slightly impaired.
Ability to concentrate: Normally sustained
Names of months(backwards), Names of weekdays( backwards):
Q. Can you mention the name of the months and week days from backward?
C. Robibar, sanibar,..... sukrabar,......hm.... brihaspatibar, budhbar, mongolbar, sombar.
December, November, October,.....September, ....August...July..June...May,....
General Information
Knowledge about surroundings, festivals, sports, states, depending on patients socio-
economic status & educational background.
Q. which is the national bird of our country?
A. Ha, mayur.
Intelligence: Arithmetic ability:
Q. You have gone to market with 60 rupees, you bought 20 rupees vegetable, 25 rupees
fish & 10 rupees dal, how much rupees are left with you?
A. hm...5 taka.
Abstract reasoning:
Q. Can you explain the phrase Dustu gorur cheye sunyo goyal valo?
A. Etar mane holo asadhu manus thakar cheye na thaka valo.
Inference: Her knowledge, intelligence and abstract reasoning are intact.
Special points-
Appetite: Normal.
Sleep: Adequate.
Bowels: Regular.
Bladder: Regular.
Libido: Normal.
Treatment: Continuing.

DEPRESSION
INTRODUCTION: Variation of mood are a natural part of life. Like other aspects of the
personality, emotions or moods serve an adaptive role. The four adaptive functions of emotions are
 social communication, physiological arousal, subjective awareness, and psychodynamic defense.
Depression, a mood disorder, is a widespread mental health problem affecting many people.

DEFINITION:
Depression: It is an abnormal extension or overelaboration of sadness and grief. The word
depression can denote a variety of phenomena ( e.g. a sign, symptom, syndrome, emotional state,
reaction, disease or clinical disorder).

Dipressive disorder: An illness characterized by depressed mood and loss of interest or pleasure in
life.

INCIDENCE: The life time risk of depression in males is 8 -12% and in females it is 20-26%. It
occurs twice as frequently in women as in men. The median age of depressive disorder is 18 yrs in
males and 20 yrs in women. The highest incidence of depressive symptoms has been indicated in
individuals without close interpersonal relationships and in persons who are divorced or separated.
Prevalence of suicide shows large peak in the spring and a smaller one in October. Psychotic
depression is uncommon, less than 10% of all depression.

CLASSIFICATION OF DEPRESSION- ICD-10.

F32 Depressive Episode

F32.0 Mild Depressive Episode
F32.1 Moderate Depressive Episode
F32.2 Severe Depressive Episode Without Psychotic Symptoms
F32.3 Severe Depressive Episode with Psychotic Symptoms
F32.8 Other Depressive episodes- Atypical Depression
F32.9 Depressive Episode, unspecified
F33 Recurrent Depressive Disorder

CONTINUUM OF EMOTIONAL RESPONSES:

PREDISPOSING FACTORS
GENETICS OBJECT LOSS PERSONALITY COGNITION BEHAVIOURAL LEARNING BIOCHEMISTRY

PRECIPITATING STRESSORS
LOSS LIFE EVENTS ROLES PHYSIOLOGY

APPRAISAL OF STRESSOR

COPING RESOURCES
SOCIAL SUPPORT ECONOMICS SENSE OF MASTERY

COPING MECHANISMS

CONSTRUCTIVE DESTRUCTIVE
 CONTINUUM OF EMOTIONAL RESPONSES

ADAPTIVE RESPONSES MALADAPTIVE RESPONSES

Emotional Uncomplicated Suppression of Delayed Depression/ Mania

Responsiveness grief reaction emotions grief reaction

Emotions such as fear, joy, anxiety, love, anger, sadness and surprises are all normal parts of the
human experience.
At the adaptive end there is emotional responsiveness. This involves the person being affected
by and being an active participant in the internal and external worlds. It implies an openness to and
awareness of feelings. Also adaptive in the face of stress is an uncomplicated grief reaction.
Such a reaction implies that the person is facing the reality of the loss and is immersed in the work
of grieving. A maladaptive response is the suppression of emotion. This may be a denial of ones
feelings or a detachment from them. Prolong suppression of emotion, as in delayed grief reaction,
will ultimately interfere with the effective functioning. The most maladaptive emotional responses
or severe mood disturbances are recognized by their intensity, pervasiveness, persistence and
interference with social and physiological functioning. This characteristics apply to the clinical
states of depression and mania, which complete the maladaptive end of the continuum of emotional
responses.

ETIOLOGY:

ACCORDING TO BOOK IN MY PATIENT

BIOLOGIC THEORIES-
Alterations in neurochemicals, genetic, endocrine and circadian
rhythm functions.

Nuerochemical: Levels of norepinephrine and serotonin are decreased Not known

and dysregulation of acetylcholine and GABA.

Genetic Theories:
Major depressive disorders occur more often in first degree No clear etiology is seen.
relatives than they do in the general population.
Studies of identical twins show that when one twin is diagnosed
with major depression, the other twin has a greater than 70 %
chance of developing it.

Endocrine Theories: The hypothalamic-pituitary-adrenal (HPA) axis

is a system that mediates the stress response. In some depressed people
this system malfunctions and creates cortisol, thyroid and hormonal
abnormalities.
Circadian rhythm theories: Circadian rhythms are responsible for
the daily regulation of wake-sleep cycles, arousal and activity patterns,
and hormonal secretions. These changes might be caused by
medications, nutritional deficiencies, physical or psychological
illnesses, hormonal fluctuations.

Changes in Brain anatomy: Loss of neurons in the frontal lobes,

cerebellum and basal ganglia has been identified.

PSYCHOSOCIAL THEORIES-

Psychoanalytic theory: According to Freud (1957) depression results

due to loss of a loved object, and fixation in the oral sadistic phase
of development. In this model, mania is viewed as a denial of
depression.

Behavioural theory: This theory of depression connects depressive

phenomena to the experience of uncontrollable events. According to
this model, depression is conditioned by repeated losses in the past.

Cognitive theory: According to this theory depression is due to

negative cognitions which includes:
Negative expectations of the environment
Negative expectations of the self
Negative expectations of the future

These cognitive distortions arise out of a defect in cognitive

development and cause the individual to feel inadequate, worthless and
rejected by others.

Sociological theory: Stressful life events, for example, death,

marriage, financial loss before the onset of the disease or a relapse
probably have a formative effect.

TRANSACTIONAL MODEL OF STRESS/ ADAPTATION-

According to this model depression occurs as a combination of
predisposing factors ( family history and biochemical alterations), past
experiences( object loss in infancy, defect in cognitive development)
and existing conditions ( lack of adequate support system, inadequate
coping skills, other physiological conditions). Because of weak ego
strength, patient is unable to use coping mechanisms effectively.
Maladaptive coping mechanisms used are denial, regression,
repression, suppression, displacement and isolation. All these factors
lead to clinical depression.

PSYCHOPATHOLOGY:
The psychopathology of the affective disorders can most easily be described by reference to the
similarity of the abnormal affect with normal emotions of the same kind. In depression the patients
sadness deepens to a morbid depression, and the difficulty in concentration becomes retardation of
all thought and action. Depressive patients may show a complete failure of all insight, deny that
they are ill and hold steadfastly to their ideas of guilt and punishment.
CLINICAL MANIFESTATIONS: A typical depressive episode is characterized by the following
features, which should last for at least two weeks in order to make a diagnosis:

ACCORDING TO BOOK IN MY PATIENT

Depressed Mood- sadness of mood or loss of interest and loss of Present

pleasure in almost all activities(pervasive sadness), present
throughout the day(persistent sadness).
Depressive cognitions- Hopelessness ( a feeling of no hope in Slightly present
future due to pessimism), helplessness( the patient feels that no
help is possible), worthlessness( a feeling of inadequacy and
inferiority), unreasonable guilt and self blame over trivial matters
in the past.
Suicidal thoughts- Ideas of hopelessness are often accompanied
by the thought that life is no longer worth living and that death
had come as a welcome release. These gloomy preoccupations
may progress to thoughts of and plans for suicide.

Suicidal risk is much more in the presence of following factors:

a) Presence of marked hopelessness
b) Males; age>40 yrs unmarried, divorced/ widowed.
c) Written/ verbal communication of suicidal intent and/or
plan.
d) Early stages of depression.
e) Recovering from depression (at the peak of depression, the
patient is usually either too depressed or too retarded to
commit suicide)
f) Period of 3 months from recovery.
Psychomotor activity- In younger patients(<40 yrs), retardation
is more common.
Slowed thinking & activity, decreased energy and
monotonous voice .
In severe form, the patient can become stuporous (depressive
Stupor).
In older patients( e.g. post menopausal women), agitation is
common.
Marked anxiety, restlessness(inability to sit still, hand
wriggling, picking at body parts or other objects) and a
subjective feeling of unease.
Physical symptoms-
Heaviness of head, vague body aches,
General aches and pains
Hypochondrial features
Reduced energy and easy fatigability.
Somatic symptoms are-
Psychotic features-15-20% cases.
Delusion, hallucinations, grossly inappropriate behaviour or
stupor
Mood- congruent (e.g. nihilistic delusion, delusion of guilt,
delusion of poverty, stupor)
Mood-incongruent( e.g. delusion of control)
Somatic Syndrome- The somatic syndrome is characterized by:
Significant decrease in appetite or weight.
 Early morning awaking, at least 2 (or more) hours before the
usual time of awakening.
Diurnal variation, with depression being worst in the
morning.
Pervasive loss of interest and loss of reactivity to
pleasurable stimuli
Psychomotor agitation or retardation.
Other symptoms-
Fatigue
Thought of death
Decreased libido
Dependency
Spontaneous crying.
Passiveness.

INVESTIGATIONS AND DIAGNOSIS:

ACCORDING TO BOOK IN MY PATIENT

1. Psychological tests- Beck depression inventory.

Hamilton rating scale for depression to assess
severity and prognosis.
2. Dexamethasone suppression test showing failure
to suppress cortisole secretions in depressed
patients.
3. Toxicology screening suggesting drug induced Based on ICD 10 criteria- Depression with psychotic
feature.
depression.
4. Based on ICD- 10 criteria.

TREATMENT:

ACCORDING YO BOOK IN MY PATIENT

 I. PSYCHOPHARMACOLOGY- 14.02.11-
a. Antidepressant- Antidepressants establish a blockade Tab. Escitalopram (10) X-X-2.
for the reuptake of norepinephrine and serotonin into Tab. Sulpitac (50)- X-X-1.
their specific nerve terminals.This permits them to Tab. Sodium Valproate (500)-X-X-1.
linger longer in synapses and to be more available to
15.02.11-
postsynaptic receptors.
Tab. Escitalopram (10) X-X-1.
SSRI- It inhibates the reuptake of serotonin &
Tab. Sulpitac (50)- X-X-1.
increasing its levels at the receptor site.
Citalopram(Celexa), Fluoxetine(Prozac), Sertraline Tab. Sodium Valproate (500)-X-X-1.
(Zoloft). Tab. THP (20)- 1-X-X.
TCA- It blocks the reuptake of norepinephrine &/or 19.02.11-
serotonin at the nerve terminals, thus increasing the Tab. Nexito/ S. Voata (10 mg)- 1-X-1.
NE & 5-HT levels at the receptor site. Amitriptyline Tab. Olimelt( 10mg)- 1-X-1.
(Elavil), Clomipramine (Anafranil), Tab. DVX-Na(500mg)-X-X-1.
Imipramine(Tofranil). Tab. THP(2mg)-1-X-X.
MAOIs- It degenarates the catecholamines after Tab. Sulpitre(50mg)-X-X-1.
reuptake, a functional increase in the NE & 5-HT
levels at the receptor site. Isocarboxazid (Morplan) 08.03.11-
Other newer Antidepressant drugs- Bupropion. Tab. Olimelt(10)-1-X-1/2 for 1 day.
II. PHYSICAL THERAPIES- Then= -X-1/2 For 1 day.
a. ECT- In severe depression with suicidal risk. Then= X-X-1/2 For 1 day
b. Light therapy- During winter months to relieve seasonal Then omit.
depression. Continue others.
c. Repetitive Transcranial Magnetic Stimulation-(TMS) and 11.03.11-
Vagus Nerve Stimulation( VNS). Tab. Nexito(10mg)-2-X-X.
III. PSYCHOSOCIAL TREATMENT- Tab. Na. Valproate(250mg)-X-X-1 For 6 days.
a. Psychotherapy- To gain insight into the cause of their Then omit.
depression.
b. Cognitive Therapy- It corrects the depressive negative
cognitions like hopelessness, worthlessness, helplessness
and pessimistic ideas.
c. Supportive Psychotherapy- Reassurance, occupational
therapy, relaxation.
d. Group Therapy- In mild depression, the negative feelings
like anxiety, anger, guilt are improved.
e. Family Therapy- It is used to decrease intrafamilial &
interpersonal difficulties.
f. Behavioural therapy- Social skill training, problem solving
techniques, assertive training.

DRUG MODALITIES FOR DEPRESSION:

DRUG GENERIC NAMEUSES SIDE EFFECT AS SIDE EFFECT NURSING ACTION
PER BOOK IN MY CLIENT
Tab. Sodium Simple, complex or Sedation, Weakness Blood studies should
Valpor valproate- absence mixed, drowsiness, be regularly seen.
SR manic episodes with depression, AST,ALT should be
Anticonvulsant BPD, organic brain weakness, visual checked.
syndrome etc. disturbances, Client is advised to
hallucination, rash, take drug with food to
alopecia, nausea, prevent GI irritation.
vomiting, Referred to eye OPD.
constipation Client is encouraged to
talk with others.
Asked to sleep well at
 night.
Blood and hepatic
studies should be
Psychotic disorders EPS, Constipation,
checked, vital signs
Tab. Olanzapine Pseduparkino- tachycardia,
should be checked,
Olimelt (Antipsychotic) nism, seizures,
dizziness.
orthostatic
hypotension,
tachycardia, weight
gain, constipation.

NURSING MANAGEMENT:

Nursing Assessment :
Dysfunctional grieving related to real or perceived loss, bereavement, evidenced by
inappropriate expression of anger , inability to carryout ADL.
Fear and anxiety of darkness at night related to altered though process as evidenced by
verbalization and facial expression.
Self esteem disturbance related to learned helplessness, sensitivity to criticism, negative
and pessimistic outlook.
Altered communication process related to depressive cognitions, evidenced by nasal
intonation of voice.
Altered sleep and rest, related to depressed mood and depressive cognitions as
evidenced by difficulty in failing asleep., early morning awakening and verbal
complaints of not feeling well-rested.
 NURSING CARE PLAN: (ACCORDING TO BOOK)

NURSING DIAGNOSIS GOAL/ OBJECTIVE PLANNING INTERVENTION EVALUATION

Nursing Care Plan on 08/03/2011
Nursing Diagnosis Goals Planning Nursing Intervention Evaluation
1. Dysfunctional STG To help the Enough time should Enough time has The disturbed thought
grieving related to patient to cope up be spent with the been spend with the processes are
real or perceived loss, effectively client to develop IPR patient to develop infrequently been
bereavement, LTG To help her in The client should be IPR. remembered and she
evidenced by getting over those made to realize that The client has been is optimistic and
inappropriate thoughts and returning she has been accepted reassured that she practical.
expression of anger , to normal life. To focus and had been accepted
inability to carryout reinforce reality, Irrational feelings are
ADL. irrational thinking discouraged and
should be client is made to face
discouraged. the reality
Individual Individual
psychotherapy and then psychotherapy is done
group psychotherapy and sample time is
should be given. given for planned
To provide interaction.
attention in a
sincere, Attention is given
interested undividedly to the
manner client
STG To help the To plan activities in She is asked and The client has improved
2. Self esteem
patient feel worthy and which the patient can encouraged to do all and now does many
disturbance related to
competent show her worth her daily activities work by herself, takes
learned helplessness,
 Nursing Diagnosis Goals Planning Nursing Intervention Evaluation
sensitivity to criticism, LTG To enable the like doing prayers, other patients for
negative and pessimistic patient to develop a Help the client to taking bath, feeding prayer.
outlook. sense of worthiness, most of the activities etc.
take up social roles, herself. She is encouraged to
depend less on others take the role of
Activities should be leader so that she
planner in such a regains her past
manner that the client social roles.
can socialize

STG To help the A convenient

3.Altered
communication process
related to depressive
cognitions, evidenced
by nasal intonation of
voice.
4. Altered sleep and rest,
related to depressed
patient in having a environment should be A therapeutic
interest in talking and created for socialization environment is
sharing. provided so that the The client feels
Socializations should
LTG To help the client can socialize with comfortable and
be planned with
patient to enhance her other patients socializes with others.
other patients also
self concept and The client is
A group should be
increase social encouraged to
selected where the
interaction. participate in the
client can contribute
various ward
something
activities to make her
feel that she is
wanted.
To teach patients
STG Describe factors The client is taught
 Nursing Diagnosis Goals Planning Nursing Intervention Evaluation
mood and depressive that inhibit sleep. good sleep habits about the sleeping
cognitions as evidenced Identify strategies to habits , to sleep by The client does not
To instruct the client
by difficulty in failing improve sleep. 10:30 pm and rising complain of insomnia to
to maintain a fixed
asleep., early morning LTG Report an sleep time daily at time at 6am an extent as previously
awakening and verbal optimum balance of rest night and rising time Her mother is asked done.
complaints of not and sleep. at morning. to provide congenial
feeling well-rested. environment for
To be gentle but firm
sleeping. i.e. putting
while setting limits
off the lights etc.
regarding time spent
To provide various
in bed, when she
activities during the
should be up from
day time so that she
bed etc.
is worked up
To provide a quite,
Frequent naps in the
peaceful, time for
afternoon are
resting
discouraged
To decrease
environmental
stimuli (bright lights)

To provide a night
time routine of
comfort measure
(back rub, tepid bath
warm milk) just
Nursing Diagnosis Goals Planning Nursing Intervention Evaluation
before bedtime

The client should

always be asked to go
to sleep by 10:30 pm.

To give frequent
activities during
daytime

To discourage the
patient for frequent
naps in the afternoon
Nursing Care Plan on 09/03/2011
Nursing Diagnosis Goals Planning Nursing Intervention Evaluation
1. Dysfunctional STG To help the Enough time should Enough time has The disturbed thought
grieving related to patient to cope up be spent with the been spend with the processes are
real or perceived effectively client to develop IPR patient to develop infrequently been
loss, bereavement, LTG To help her in The client should be IPR. remembered and she
evidenced by getting over those made to realize that The client has been is optimistic and
inappropriate thoughts and returning she has been accepted reassured that she practical.
expression of to normal life. To focus and had been accepted
anger , inability to reinforce reality, Irrational feelings are
carryout ADL. irrational thinking discouraged and
should be client is made to face
discouraged. the reality
Individual Individual
psychotherapy and then psychotherapy is done
group psychotherapy and sample time is
should be given. given for planned
To provide interaction.
attention in a
sincere, Attention is given
interested undividedly to the
manner client
STG To help the To plan activities in She is asked and The client has improved
2. Self esteem
patient feel worthy and which the patient can encouraged to do all and now does many
disturbance related to
competent show her worth her daily activities work by herself, takes
learned helplessness,
 Nursing Diagnosis Goals Planning Nursing Intervention Evaluation
sensitivity to criticism, LTG To enable the like doing prayers, other patients for
negative and pessimistic patient to develop a Help the client to taking bath, feeding prayer.
outlook. sense of worthiness, most of the activities etc.
take up social roles, herself. She is encouraged to
depend less on others take the role of
Activities should be leader so that she
planner in such a regains her past
manner that the client social roles.
can socialize

STG To help the A convenient

3.Altered
communication process
related to depressive
cognitions, evidenced
by nasal intonation of
voice.
4. Altered sleep and rest,
related to depressed
patient in having a environment should be A therapeutic
interest in talking and created for socialization environment is
sharing. provided so that the The client feels
Socializations should
LTG To help the client can socialize with comfortable and
be planned with
patient to enhance her other patients socializes with others.
other patients also
self concept and The client is
A group should be
increase social encouraged to
selected where the
interaction. participate in the
client can contribute
various ward
something
activities to make her
feel that she is
wanted.
To teach patients
STG Describe factors The client is taught
 Nursing Diagnosis Goals Planning Nursing Intervention Evaluation
mood and depressive that inhibit sleep. good sleep habits about the sleeping
cognitions as evidenced Identify strategies to habits , to sleep by The client does not
To instruct the client
by difficulty in failing improve sleep. 10:30 pm and rising complain of insomnia to
to maintain a fixed
asleep., early morning LTG Report an sleep time daily at time at 6am an extent as previously
awakening and verbal optimum balance of rest night and rising time Her mother is asked done.
complaints of not and sleep. at morning. to provide congenial
feeling well-rested. environment for
To be gentle but firm
sleeping. i.e. putting
while setting limits
off the lights etc.
regarding time spent
To provide various
in bed, when she
activities during the
should be up from
day time so that she
bed etc.
is worked up
To provide a quite,
Frequent naps in the
peaceful, time for
afternoon are
resting
discouraged
To decrease
environmental
stimuli (bright lights)

To provide a night
time routine of
comfort measure
(back rub, tepid bath
warm milk) just
Nursing Diagnosis Goals Planning Nursing Intervention Evaluation
before bedtime

The client should

always be asked to go
to sleep by 10:30 pm.

To give frequent
activities during
daytime

To discourage the
patient for frequent
naps in the afternoon
Nursing Care Plan on 10/03/2011
Nursing Diagnosis Goals Planning Nursing Intervention Evaluation
1. Dysfunctional STG To help the Enough time should Enough time has The disturbed thought
grieving related to patient to cope up be spent with the been spend with the processes are
real or perceived loss, effectively client to develop IPR patient to develop infrequently been
bereavement, LTG To help her in The client should be IPR. remembered and she
evidenced by getting over those made to realize that The client has been is optimistic and
inappropriate thoughts and returning she has been accepted reassured that she practical.
expression of anger , to normal life. To focus and had been accepted
inability to carryout reinforce reality, Irrational feelings are
ADL. irrational thinking discouraged and
should be client is made to face
discouraged. the reality
Individual Individual
psychotherapy and then psychotherapy is done
group psychotherapy and sample time is
should be given. given for planned
To provide interaction.
attention in a
sincere, Attention is given
interested undividedly to the
manner client
STG To help the To plan activities in She is asked and The client has improved
2. Self esteem disturbance
patient feel worthy and which the patient can encouraged to do all and now does many
related to learned
competent show her worth her daily activities work by herself, takes
helplessness,
 Nursing Diagnosis Goals
sensitivity to criticism, LTG To enable the
negative and patient to develop a
pessimistic outlook. sense of worthiness,
take up social roles,
depend less on others
STG To help the
3.Altered
patient in having a
communication process
interest in talking and
related to depressive
sharing.
cognitions, evidenced
by nasal intonation of LTG To help the
voice. patient to enhance her
self concept and
increase social
interaction.
4. Altered sleep and rest,
related to depressed
STG Describe factors
Planning Nursing Intervention Evaluation
like doing prayers, other patients for
Help the client to taking bath, feeding prayer.
most of the activities etc.
herself. She is encouraged to
take the role of
Activities should be leader so that she
planner in such a regains her past
manner that the client social roles.
can socialize
A convenient
environment should be A therapeutic
created for socialization environment is
provided so that the The client feels
Socializations should
client can socialize with comfortable and
be planned with
other patients socializes with others.
other patients also
The client is
A group should be
encouraged to
selected where the
participate in the
client can contribute
various ward
something
activities to make her
feel that she is
wanted.
To teach patients
The client is taught
 Nursing Diagnosis Goals Planning Nursing Intervention Evaluation
mood and depressive that inhibit sleep. good sleep habits about the sleeping
cognitions as evidenced Identify strategies to habits , to sleep by The client does not
To instruct the client
by difficulty in failing improve sleep. 10:30 pm and rising complain of insomnia to
to maintain a fixed
asleep., early morning LTG Report an sleep time daily at time at 6am an extent as previously
awakening and verbal optimum balance of rest night and rising time Her mother is asked done.
complaints of not and sleep. at morning. to provide congenial
feeling well-rested. environment for
To be gentle but firm
sleeping. i.e. putting
while setting limits
off the lights etc.
regarding time spent
To provide various
in bed, when she
activities during the
should be up from
day time so that she
bed etc.
is worked up
To provide a quite,
Frequent naps in the
peaceful, time for
afternoon are
resting
discouraged
To decrease
environmental
stimuli (bright lights)

To provide a night
time routine of
comfort measure
(back rub, tepid bath
warm milk) just
Nursing Diagnosis Goals Planning Nursing Intervention Evaluation
before bedtime

The client should

always be asked to go
to sleep by 10:30 pm.

To give frequent
activities during
daytime

To discourage the
patient for frequent
naps in the afternoon
 PROGNOSIS:
Good Prognostic Factor Poor Prognostic Factor

1. Acute or abrupt onset 1. Co-morbid medical disorder, personality disorder

2. Typical clinical features or alcohol dependence.
3. Severe depression 2. Double depression
4. Well adjusted premorbid personality 3. Catastrophic stress or chronic ongoing stress
5. Good response to treatment. 4. Unfavourable environment.
5. Marked hypochondriacal features or mood
incongruent psychotic feature.
6. Poor drug compliance.

Conclusion :
One of the most important nurses role is to educate the patient and the family member
about disease process, treatment and follow up care. Continuation of medicine is
necessary to prevent relapse of the disease process.

Bibliography:

5. Kapoor .B. Textbook of Psychiatric Nursing, vol-1 Second edition 2005, Kumar publishing house, page no 92-103.

6. Kaplan & Saddock , Comprehensive Textbook of Psychiatry, vol-1 8th edition Lippincott Willium P1ublication

7. Sreevani. R.A Guide to mental health and Psychiatric nursing. second edition. Jaypee publication.

8. Townsend C.Mary, Psychiatric Mental Health Nursing , Fifth Edition.Jaypee Brothers Publication.
 CASE PRESENTATION
OF A PATIENT WITH DEPRESSION

Submitted to- Submitted by-

Madam Aparna Ray Mousumi Sarkar
Senior Lecturer M.Sc.Nursing, 1st Year

College of Nursing Student

Medical College & Hospital

Kolkata
 CONTINUUM OF EMOTIONAL RESPONSES:

PREDISPOSING FACTORS
GENETICS OBJECT LOSS PERSONALITY COGNITION BEHAVIOURAL
LEARNING BIOCHEMISTRY

PRECIPITATING STRESSORS
LOSS LIFE EVENTS ROLES PHYSIOLOGY

APPRAISAL OF STRESSOR

COPING RESOURCES
SOCIAL SUPPORT ECONOMICS SENSE OF MASTERY

COPING MECHANISMS

CONSTRUCTIVE DESTRUCTIVE

CONTINUUM OF EMOTIONAL RESPONSES

ADAPTIVE RESPONSES MALADAPTIVE RESPONSES

Emotional Uncomplicated Suppression of Delayed Depression/ Mania

Responsiveness grief reaction emotions grief reaction