Nursing

Depression

Describe the possible biological causes of mental illness

• Imbalance of neurotransmitters: Neurotransmitters are chemicals located in the brain and they assist individual brain nerve cells in the process of communication. An imbalance in the amounts or state of these neurotransmitters consequently leads to incorrect communication that in turn leads to improper working of the brain. This is physically exhibited as a mental illness.
• Genetics: Most mentally challenged individuals have a history of other family members suffering from mental illnesses too. Physicians believe that this mental illness vulnerability is passed among the family members through genes. With the interaction of these anomalous genes, the individual is likely to suffer from a case of mental illness (Beck, & Alford, 2009).
• Prenatal injury: When a fetus brain maturity is upset before or during birth, there is a high probability that the child will suffer from a mental condition.
• Drug abuse: When an individual abuses certain drugs like bhang for a long time, it may lead to instances of paranoia, apprehension and depression, which are symptoms of mental disturbances.
• Infections: Some infections can lead to mental damage or the acceleration of some brain indicator that may lead to the development of mental illnesses. The pediatric autoimmune neuropsychiatric disorder caused by bacteria leads to such illnesses as obsessive-compulsive disorder.
• Brain fault or harm: When the brain undergoes some sort of injury caused to some delicate areas due to events like car accidents, it may lead to the development of a mental illness.
• Others: Long-term contact with toxic substances may lead to mental illnesses. Poor dietary is also another factor (Chokroverty, 2009).

Identify and briefly discuss the function of the neurotransmitters in depression

The brain is composed of innumerable nerve cells that are not linked to each other. For communication purposes, the nerves exude neurotransmitters that can effect stimulation or inhibition in nerves and in this way, communication takes place. At least fifty different types of neurotransmitters are present in a human brain. Note that, all neurotransmitters have the ability to control actions that in turn lead to behavior change. Once a nerve transmits an impulse, it is channeled through the axon to the presynaptic membrane where the neurotransmitters are located. Once these have been discharged, they move along to the receptors contained in the postsynaptic membrane that internalizes the impulse to the designated end. In the case of depression, the neurotransmitters are secreted in surplus or deficient level that in turn affects an individual’s mood, feelings, happiness, and other impressions (Beck & Alford, 2009).

Depression is caused by three types of neurotransmitters: dopamine, serotonin and norepinephrine. Serotonin is a type of inhibitive neurotransmitter that controls sleep, anger, ingestion, sexual activities and feelings. When released in excess amounts, it causes nerve impulses to be sent back to their originating location (presynaptic membrane) instead of its destination (postsynaptic membrane). When the same is released in inadequate levels, the patient has bad moods and often becomes suicidal. Norepinephrine aids an individual to cope adequately with stress and any interruption leads to ineffective stress handling and consequently depression (Nutt, 2006). Dopamine controls the urge for incentives and contentment. When the dopamine levels are low in the brain, the affected individual derives no form of enjoyment in any activities pursued and this eventually leads to depression (Dunlop, & Nemeroff, 2007). Currently researchers have identified glutamate as being another cause for depression but further analysis is needed for the establishment of the causal relationship.

Briefly outline the cause of Margaret’s mania and briefly describe other possible biological causes of mania

Margaret’s mania was possibly caused by the doubling of her Fluoxetine Hydrochloride prescription. The medication being a serotonin selective reuptake inhibitor (SSRI) is used to institute the amount of serotonin required in the brain for normal functioning by inhibiting the serotonin present in the synaptic gap and consequently escalating the level of neurotransmitter operations. These increased actions lessen depressive indicators. Having doubled her medication, Margaret doubled the activity in her brain and therefore the manic state set in. Besides medication, other causes of mania are:

• Stress: Stress has a higher probability of leading to mania in individuals who have genetic susceptibility. When such an individuals goes through a radical or abrupt change whether positive or negative like being a newly wed or facing the death of a friend, it may lead to a manic condition (Lichtenstein et al., 2009).
• Sleep deficiency: When certain individuals lose a few hours of rest in consecutive periods, they may start experiencing mania.
• Seasons: It has been discovered that geographical seasons are a cause for mania and depression. The former often occurs in summer, while the latter is caused by winter, fall and spring seasons.
• Drug abuse: Prolonged drug abuse of substances such as cocaine and amphetamines can trigger mania. Depression on the other hand can be triggered by alcohol consumption and abuse of anesthetics.

Briefly describe DSM IV diagnosis of bipolar affective disorder and indicate whether Margaret have met the DSM IV diagnosis for this disorder

The following is the DSM IV diagnosis for bipolar affective disorder (mania):

• A discrete phase of peculiarly and steadily eminent moods, that last for a week or more.
• At least three symptoms accompany the mood swing: exaggerated self-esteem condensed sleeping hours up to three hours only, very talkative, competing thoughts, easily preoccupied and increased enjoyment actions that are objective oriented (Drevets, 2007).

Margaret’s hospitalization was prompted by the identified manic symptoms in the case study-poor sleep, inflated self-esteem, rapid pressurized speech, increased libido, increased activity, racing thoughts and the spending of her life savings on gym equipment (Nursing Bioscience 346 Assessment 1-Case Study, 2010) which meets the DSM IV diagnosis for bipolar affective disorder.

List three different medications that may be used to treat Margaret as described in the case study above

• Mood stabilizing medication- Lithium, Gabapentin, Oxcarbazepine, Lamotrigine, Topiramate and Valproate
• Atypical antipsychotics medication-Olanzapine, Quetiapine, Risperidone and Aripiprazole
• Antidepressant medication-Fluoxetine, Bupropion, Sertraline and Paroxetine

From the above selected medication, describe two side effects for each and the biological reason for each

Mood stabilizing medication

• Headaches: Majority of the mood stabilizing medication are anticonvulsants, which is a term used to describe medication that inhibits epileptic seizures. This is realized through the repression of neurons that may lead to the triggering of seizures. With this activity, the repressed neurons/pressure may lead to headaches (Beck, & Alford, 2009).
• Constipation/diarrhea: Individuals suffering from mania have low or high production of thyroid in their body. Mood stabilizing medication may lead to the increase or decrease of thyroid levels that in turn lead to diarrhea or constipation respectively.

Atypical antipsychotics medication

• Drowsiness: These drugs act to reduce the activity level in human beings. When the bodily activity levels take a sudden deep, it may cause temporary dizzy accounts on the patient (Beck, & Alford, 2009).
• Skin rash: With reduced body functions, individuals using this medication may gain weight due to a reduction in the rate of metabolism. An increase in the levels of fats in the body leads to skin rashes caused by the extra fat.

Antidepressant medication

• Reduced libido: Decreased activity levels affect the sexual drive to low rates and consequently cause sexual problems in both men and women (Beck, & Alford, 2009).
• Agitation: With the repression of such factors as the sexual drive and other activities, individuals tend to be easily agitated as the body adapts to a different method for the release of body pressures.

Briefly discuss current research relating to the biological considerations associated with suicide and affective disorders

Researchers have dedicated their time to unraveling the biological association between depression and suicide. As earlier noted, low levels of serotonin lead to low mood swings which effect suicidal thoughts. SSRI enhance suicidal thoughts in young children and adults between the ages of eighteen and twenty-four (Thomson, et al., 2005). However, it is not clear as to whether they induce the same feeling in individuals above the age of twenty-four. Depressed patients have an extremely high probability for committing suicide as opposed to manic (Guze, 2009). It is believed that mitochondria activity and sodium ATPase pump are increasing the rates of suicide in depressed and manic patients (Swerdlow, & Koob, 2010). Physicians have also involved themselves into researching non-drug prescriptions, light and wake therapies, for depression in a bid to overcome the side effects associated with the three types of treatment as they increase chances of suicide (Sullivan, & Payne, 2007). In addition to this, it endangers the lives of unborn children (Yehuda, et al., 2009).

 

 

References

Beck, A. T., & Alford, T. B. (2009). Depression: causes and treatments. Philadelphia, PA: University of Pennsylvania Press.

Chokroverty, L. (2009). 100 Questions & Answers about Your Child’s Depression Or Bipolar Disorder. Sudbury, MA: Jones & Bartlett Learning.

Drevets, W. C. (2007). Orbitofrontal Cortex Function and Structure in Depression. Annals of the New York Academy of Sciences, 1121, 499-527.

Dunlop, B. W., & Nemeroff, C. B. (2007). The role of dopamine in the pathophysiology of depression. Arch Gen Psychiatry, 64 (3), 327-337.

Guze, B. S. (2009). Biological psychiatry: is there any other kind? Psychological Medicine, 19, 315-323.

Lichtenstein, P., Yip, B., Pawitan, Y., Bjork, C., Cannon, T., Sullivan, P., & Hultman, C. (2009). Common genetic determinants of schizophrenia and bipolar disorder in Swedish families: a population-based study. The Lancet, 373 (9659), 234-239.

Nursing Bioscience 346 Assessment 1-Case Study. (2010).

Nutt, D. J. (2006). The role of dopamine and norepinephrine in depression and antidepressant treatment. J Clin Psychiatry, 67 (6), 3-8.

Sullivan, B., & Payne, W. (2007). Affective Disorders and Cognitive Failures: A Comparison of Seasonal and Nonseasonal Depression. Am J Psychiatry, 164, 1663-1667.

Swerdlow, N. R., & Koob, G. F. (2010). Dopamine, schizophrenia, mania, and depression: Toward a unified hypothesis of cortico-striatopallido-thalamic function. Behavioral and Brain Sciences, 10, 197-208.

Thomson, P. A., Wray, N. R., Thomson, A. M., Dunbar, D. R., Grassie, M. A., Condie, A., Walker, M. T., Smith, D. J., Pulford, D. J., Muir, W., Blackwood, D. H. R., & Porteous, D. J. (2005). Sex-specific association between bipolar affective disorder in women and GPR50, an X-linked orphan G protein-coupled receptor. Molecular Psychiatry, 10, 470–478.

Yehuda, S., Hanoch, A., Dov, I., Netta, H., Gary, D., Yoav, S. B., & Alan, A. (2009). Post-adoption depression among adoptive mothers. Journal of Affective Disorders 115, 62–68