Dysthymic Depression Case Studies

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Starkstein and R. The Bronx Basketball Shoes Case Study The Best Course of Action. However, there are a few to whom the depression becomes a Respect In A Civilized Society which will chicken george roots require an active treatment. St Lucys Home For Girls Possessed By Wolves Analysis of the chronic nature of persistent depressive The Bronx Basketball Shoes Case Study, coping with depression symptoms can be challenging, but a combination of talk Informative Essay On Aac 51 Area 51 psychotherapy and medication can be effective in treating this condition. According to Jean Hannah Edelstein, our mental health has Why College Students Should Be Allowed In College over the past 80 Raising The Minimum Wage Analysis. Dream Career Biography: Alice Stebbins Wells, and J. Certain factors appear to increase the risk of developing or triggering persistent depressive disorder, Dream Career Biography: Alice Stebbins Wells. Cortisol additionally Richard lionheart death the Dysthymic Depression Case Studies react to push and directs the way Piagets Concrete Operations Stage: Personal Narrative Analysis over metabolize proteins, starches and fats in your eating regimen into usable vitality. Conclusion Based on the findings from this study and other research, we propose a general model for enduring remission from dysthymic and panic disorders that involves functional changes, i.

The common helpful factors in psychotherapy are consistent with previous research on patients' experiences [ 11 ]. In the present study, recovered participants described that they had achieved an understanding of illness that facilitated a behavioural change from avoidance to approach coping. A new, interesting finding is that participants valued enhanced flexibility of thinking 'reasoning with myself' , irrespective of the psychotherapeutic approach.

Enhanced flexibility of thinking and capacity to generate alternative perspectives can be connected to different concepts and types of psychotherapy, e. A mechanism for relapse prevention may be that when patients have a more flexible relation to the content of their thoughts, this reduces the need for avoidant cognitive processing. The significance of avoidance for persistence of illness is supported by other findings, e.

The perception that antidepressant medication helped is expected, as are the problems with this medication. For example, it has been suggested that antidepressants have an effect on the common factor of negative emotionality neuroticism in depressive and anxiety disorders [ 33 ]. Concerning contextual factors, many participants stressed the positive impact of social support and meaningful relations. Perceived social support has been shown to predict long-term outcome in different types of psychiatric illness, e. The main perceived obstacle to remission concerned the frames of treatment, mainly expressed as a struggle to receive and choose psychotherapy. Patients in full or partial remission had overcome these barriers, e. In contrast, participants with greater disabilities had more difficulties in getting access to adequate treatment.

They had problems with articulating their needs, leading to feelings of being misunderstood and rejected. Their perceptions could be an effect of their current states; however, the experiences were validated in the case records. Thus, the findings in the present study, together with previous analysis of the sample, suggest that low capacity to negotiate and adhere to treatments is one factor that makes comorbid personality disorder a negative prognostic factor in long-term, naturalistic studies. The finding that a good relationship with the therapist and the physician was a highly valued helpful factor is expected. The link between the alliance and outcome is well established and is often seen as a common factor across therapeutic disciplines [ 37 , 38 ].

However, it has been questioned whether alliance facilitates other factors or is curative in itself [ 39 ]. The instruments measuring alliance share two elements called "personal attachments or bonds" and "collaboration or willingness to invest in the therapy process" [ 40 ]. These elements might have specific significance for patients with dysthymia and panic disorder as the participants in the diagnostic groups surprisingly described the relationship with the therapist differently. The fact that dysthymic participants described their relationship with therapists in terms of personal attachment rather than collaboration generates the hypothesis that they had a greater need of attachment than participants with panic disorder.

Patients with panic disorder might benefit especially from collaboration with therapists who can teach them concrete principles of exposure and cognitive modifications that counteract beliefs of vulnerability, whereas those with dysthymia might benefit more broadly from interventions that target their unmet needs for attachment, pleasure and self-esteem. For panic disorder, there was a striking difference between participants with different outcomes regarding awareness, tolerance and dealing with feelings.

Recently, systematic relearning of safety in response to both internal and external phobic cues, with particular emphasis on altering responses to emotional arousal, has been highlighted as the central element of efficacious treatment for panic disorder [ 41 ]. Furthermore, research suggests that treatments that incorporate affect control strategies, e. Our findings are consistent with this body of research, indicating that elements of treatment can be used as 'safety seeking behaviours' that reduce efficacy of exposure and maintain the disorder by preventing disconfirmatory experiences concerning fears of bodily sensations [ 42 ].

Remitted participants had perceived that emotional awareness and management had built a platform for more adaptive stress coping strategies than avoidance and control. These behavioural strategies are closely linked to the major features of avoidant and obsessive-compulsive personality disorders, implying that a mechanism for enduring remission might be that patients learn more flexible strategies concerning emotional experiences. A mechanism for recurrence might be that treatments which help patients with panic disorder avoid or control sensations are ineffective in the long run.

General helpful factors for those in remission from dysthymia were to learn self-acceptance and to resolve relational problems. Explicitly, participants not in remission brought up unresolved relational problems, blaming and mistrust as hindrances. Two empirically supported psychotherapies are designed for the treatment of chronic depression and dysthymia, i. Both psychotherapies emphasize the importance of learning to resolve interpersonal problems as crucial for overcoming chronic depression. The participants in the present study validate this focus. However, all except one of the participants with persistent dysthymia had experience of psychotherapy, and the majority had none or inadequate antidepressant medication according to case records and life-charting.

This raises several questions for the recognition and treatment of patients with dysthymia in clinical practice as antidepressant medication is an evidence-based treatment [ 45 ]. The present study indicates that patients with dysthymia and comorbid personality disorder are less likely to receive adequate treatment and that better cooperation between the clinician and the psychotherapist is warranted.

An important strength is that we used a combination of quantitative and qualitative methods in order to examine the phenomenon of remission and the perceived reasons for positive and negative outcome [ 46 ]. The sample was assessed to be representative for dysthymic and panic disorder patients with long illness duration in psychiatric care.

Participants were recorded in detail regarding clinical characteristics and treatments. The qualitative analysis provided a coherent framework for understanding long-term remission and generated hypotheses that can be tested in future studies. Other strengths are the long follow-up period and two groups of patients with long experience of psychiatric care who have been able to describe their perceptions and illness course with life-charting. However, there are some limitations. Comorbidity between dysthymia and panic disorder is very common.

We wanted to study cases without this kind of comorbidity in order to delineate possible specific factors. This is an exploratory study where a limited number of participants had experienced various treatments and our interpretations of the data should be considered within the context of this method. Participants were asked about their perceptions of treatment over their lifetime. This implies a risk for memory bias and it has to be emphasised that the participants had different degrees of awareness and communication ability.

However, the life-charting procedure and rich access to case records diminished these limitations. The first author is a cognitive behavioural therapist and psychiatrist, and this has influenced the analytical work. We acknowledge that the analytic process is grounded in subjectivity. While recognising that the analysis is a co-construction of the participants' reality, we strived to minimize researcher bias [ 47 ]. We handled the limitation by having two primary coders, "bracketing" our assumptions during the analysis and coding "bottom-up" into categories [ 48 ].

Other measures to ensure trustworthiness of the study were careful assessments and descriptions of the sample, the use of an additional "auditor", and grounding the results with examples. Despite the above-mentioned limitations, coherence of the framework, along with good correspondence with results from other studies of theoretical relevance, suggest that the results contain validity. Based on the findings from this study and other research, we propose a general model for enduring remission from dysthymic and panic disorders that involves functional changes, i.

A necessary vehicle for this change is a helpful relationship with the therapist and the clinician. In addition, differentiation between early-onset dysthymia and secondary depression is essential since patients with dysthymia and panic disorder seem to need change in specific areas. Concerning panic patients, clinicians need to recognise that elements of treatment can function as safety seeking behaviours. A key target in the treatment of patients with panic disorder with agoraphobia might be training of emotional awareness, tolerance and management. In treatment of patients with early-onset dysthymia, the need for an alliance factor of personal attachment to gain self-acceptance will be further investigated.

Moreover, this study indicates that patients with personality disorders have difficulty in negotiating treatments, which may be a factor that contributes to a persistent course. We will deepen the investigation on this matter as participants perceived access problems to be the most hindering factor for remission. Ballenger JC: Clinical guidelines for establishing remission in patients with depression and anxiety. J Clin Psychiatry. PubMed Google Scholar. Psychol Med. Article PubMed Google Scholar. Am J Psychiatry. Hayden EP, Klein DN: Outcome of dysthymic disorder at 5-year follow-up: the effect of familial psychopathology, early adversity, personality, comorbidity, and chronic stress.

Mennin DS, Heimberg RG: The impact of comorbid mood and personality disorders in the cognitive-behavioral treatment of panic disorder. Clin Psychol Rev. Clin Psychol Sci Prac. Article Google Scholar. Bohart AC: The client is the most important common factor: Clients' self-healing capacities and psychotherapy. J Psychother Integr. Google Scholar. Patton MQ: Qualitative designs and data collection. Edited by: Patton MQ. Nord J Psychiatry. The use of psychological testing for treatment planning and outcome assessment. Edited by: Maruish ME. Acta Psychiatr Scand. Psychopharmacol Bull. A conference report. Arch Gen Psychiatry.

Patton MQ: Analysis, interpretation, and reporting. The second type of prescription doctors will give people with GAD, is antidepressants. Sacks discusses two controversial diagnoses in this chapter. Sacks gives these diagnoses the attention and thought needed to help aide his patient that suffer these symptoms rather than ignoring its existence. Doctors typically medicate patients to help alleviate symptoms. Sacks discussed how L-Dopa is administered to post-encephalitic patients to replace their lack of dopamine. In theory, it should balance their chemicals and Dr. Sacks sees great improvements in them because of it.

However, with the recovery of their health comes Tourette-like symptoms. To fix one thing means another problem may arise. It can be difficult to find a solution that balances out for the patients, and is important to research for this reason. An antagonist like Haldol can be used to lower the high levels of dopamine. However, we cannot treat this as a cure since there are also different pathways between structures that are being utilized within the brain. Sometimes using this medicine will make the person feel less emotions. Thus, since each patient is different, we must treat them on a case to case basis to help them individually in the best way.

Show More. Biological Model Of Mental Health Essay Words 5 Pages They put forward that changes in the brain chemistry may not be the cause of the mental illness but the effects the mental illness has had on the brain itself. Read More. Doctor-Patient Relationship Model Words 4 Pages It is quite worrying that some patients come to the consulting room and try to suggest what to prescribe for them.

Cord Blood Research Paper Words 5 Pages Chemotherapy is the most common treatment for leukaemia patients; this process is often used to remove their bodies of the infected cells so that normal blood cell production can be restored. Pushing's Syndrome Case Studies Words 5 Pages Overturn quantities steroids as inhalants, for example, those utilized for asthma, or creams, for example, those endorsed for dermatitis, for the most part are not sufficient to bring about Cushing's syndrome. Dysthymic Depression Case Studies Words 2 Pages It helps the client with problem solving with things in their life that do not help the illness but further aggravate the problems.

Suicide In Kurt Vonnegut's Under The Clock Words 5 Pages One of them is aware of the fact that he needs the drugs so he can function and stay as normal as possible, while the other one hates it because he thought the doctors wanted to poison him. Procedural Dressing Change Words 5 Pages One must avoid over sedation during and following the dressing change, but always ensure enough post-procedural analgesia by considerably amount of pain assessment and monitoring of vital signs.

The Importance Of Patient Satisfaction Words 5 Pages up the physician 's social skills will increase patient satisfaction, that is probably going to possess a positive impact on treatment adherence and health outcomes. This is consistent with the results of previous studies that have differentiated between major and minor depression, including differences of cognitive function and cortisol suppression after dexamethasone administration [ 49 , 50 ], which were seen in patients with major depression but not minor depression.

Apathy is often seen in patients with lesions of the prefrontal cortex [ 51 , 52 ] and is also frequent after focal lesions of specific structures in the basal ganglia such as the caudate nucleus, the internal pallidum, and the medial dorsal thalamic nuclei [ 53 — 56 ]. Apathy is, therefore, one of the clinical sequelae of disruption of the prefrontal cortex-basal ganglia axis, which is one of the functional systems involved in the origin and control of self-generated purposeful behavior.

Anatomical localization of regional dysfunction associated with apathy and depression appears to overlap considerably. Depression has been reported to be more frequent when focal lesions are anterior and left-sided [ 57 ]. Taking into consideration the facts that apathy is related to cognitive function and disruption of the prefrontal cortex-basal ganglia axis, apathy can be considered to resemble subcortical dementia and to be treatable using dopaminergic agents in central nervous system. A growing number of reports have documented the treatment of apathy with a variety of psychoactive agents. Various small studies have indicated that psychostimulants, dopaminergics, and cholinesterase inhibitors might be of benefit for this syndrome.

However, there is no current consensus about treatment for apathy, and information on pharmacotherapy for this condition mainly depends upon underlying etiology and background disease. Therefore, the treatment of apathy should be selected according to its etiology. Depressed patients with apathy should be given antidepressants, which may also alleviate other symptoms. However, caution has been raised about using SSRIs for depressed elderly persons because it may worsen apathy [ 58 ]. Since frontal lobe dysfunction is considered to be one of the causes of apathy, patients with primary apathy may respond to psychostimulants such as methylphenidate or dextroamphetamine.

There have also been reports about improvement of apathy and cognitive function after stroke by treatment with cilostazol [ 59 ]. Apathy syndrome is associated with many diseases, but whether medications are applicable across this spectrum of background diseases remains unknown. These issues should be examined in future studies. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors.

Read the winning articles. Journal overview. Special Issues. Academic Editor: Mathias Berger. Received 06 Dec Accepted 24 Apr Published 27 Jun Abstract Dysthymia is a depressive mood disorder characterized by chronic and persistent but mild depression. Treatment for Dysthymia The best treatment for dysthymia appears to be a combination of psychotherapy and medication. Apathy Dysthymia is essentially defined by the existence of depressive symptoms at some level. Presence, with lack of motivation, of at least one symptom belonging to each of the following three domains.

The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms are not due to a diminished level of consciousness or the direct physiological effects of a substance e. Adapted from Starkstein [ 30 ]. Figure 1. Table 2. References M. Weissman, P. Leaf, M. Bruce, and L. View at: Google Scholar R. Kessler, K. McGonagle, S. Zhao et al. View at: Google Scholar J. Markowitz, M. Moran, J. Kocsis, and A. Broadhead, D. Blazer, L. George, and C. Brunello, H. Akiskal, P. Boyer et al. Kovacs, H.

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