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Discuss about the Classification of Body Dysmorphic Disorder.

Diagnostic and Associated Features to Support the Diagnosis

The Diagnostic and the Statistic manual of the Mental Health disorders is extensively utilized by the psychiatrists as well as the clinicians. It is mainly used for the diagnosing various types of the Psychiatric disorders.  The American Psychiatric Association mainly published it. It is mainly seen to cover all the categories of the mental health disorders not only for adults but also for the children (Schiefer et al., 2015). It has been widely used in the present generation for the different types of psychiatric diagnoses as well as for the treatment recommendations and different types of insurance coverage purposes (Uher et al., 2014). This manual is found to be mainly non-theoretical and it mainly seems to focus on the different types of the describing symptoms and different statistics and helps in leaning about which gender is mostly affected by a particular illness, the type of the inset as well as the effects of the treatment and the different common treatment approaches. This assignment will show how this tool helps in identification so specific mental health conditions of the patient. Accordingly, the professionals for the patient would develop interventions.

The patient named Kathy is seen to be reported with three important clinical symptoms, which were irritation, suicidal intention and low mood. It is important for the affected individuals to experience two weeks of low mood that remains present across all the important situations. This is mainly seen to be associated with low self-esteem, loss of different types of interests in different activities in life, lower amount of energy and pain without a clear cause (Kato et al., 2016). Throughout the entire analysis of the patient named Kathy, it was seen that she had been suffering from low mood conditions from a long time and the situation of grief and sadness to such an extent that she has lost the urge of living. She is showing suicidal intentions and this reveals of the fact that she is going through chronic mood disorders with the criteria falling into the depressive mood disorders.

While going through the history of the patient, a number of factors has been identified which help the clinicians in coming to a conclusion about the mental health condition of the patient. It is seen that the patient is already suffering from low mood since turmoil and breakups in the personal relationships with her boyfriends. She had been able to overcome it for few months after she got a good position and job in the bank but the death of her mother made her get back into periods of low mood, she suffered terribly from isolated feelings and went through emotional turmoil. Therefore, the situation was seen to gradually deteriorate for her and it reaches a negative point where her consistent poor performance due to death of her mother resulted in her losing the job. Therefore, she failed to cope up with the repeated negative events in her life making her suffer from low mood conditions from a huge number of days that ultimately resulted in poor health conditions and suffering from major depressive period.

Cultural and Gender Related Issues

The DSM-5 criteria that allocate a mental health disorder to the category of the major depressive disorders are irrational worry, preoccupation with unpleasant worries, trouble in relaxation, feeling of tensed, fearing that some awful will happen and many others (Moller et al., 2015). The criteria shows that patients need to go through depressed mood, loss of interest and enjoyment in the usual activities as well as reduction of the energy and decreased activity. The patient is seen to have no energy in completing any of her tasks and keeps herself locked indoors and does not feel like socializing. Moreover, she is suffering from depressed mood and the conditions have reached to a severe situation where she is even having tendencies of self-harm. She is having all the properties that match with the criteria for the major depressive disorder. Therefore, the risk factors that are mainly seen to affect the situations are low social support due to absence of family members surrounding her, her low coping power, inability to get good employment and settlement in life, bereavement due to loss of her mother and many others. Therefore, the prognosis measurement can be done with the help of the DSM-5 classification system (Oquendo et al., 2014). Two groups of symptoms are made by experts as group A and group B. By analyzing the symptoms, and calculating the results and the scores, it is found that she has all three symptoms of group A and two symptoms of group B. therefore, she lies in the group severe depressive episode and she needs interventions to overcome such situation and lead better quality lives.

On close analysis of the patient, it was found that she had not gone through any issues that included problems with gender and with her culture. It was mainly found that she had poor coping ability to cope effectively with the different strenuous situation in life and therefore, she had gone through various difficult periods of low moods, inability to feel energetic to perform her work and thereby took the support of marijuana to cope with the stress. Her condition did not improve and reached to an acute situation where she tried to self-harm herself.

The patient was seen to have no additional co-morbidity along with the presence of the depressive symptoms. One of the most important issues that had been identified that might worsen the physical and mental health of the patient is her additional intake of the cannabis. She is taking cannabis on a regular note so that she can manage the stress effectively and cope with her low mood conditions. However, researchers are of the opinion that use of cannabis may result in increasing the severity of the situations Sachdev et al., 2015). The studies have reported that depressive individuals who use marijuana are more prone to undertake suicidal attempts in comparison to those depressive individuals who do not take marijuana. Therefore, the healthcare professionals should also consider such substance abuse issues and then interventions need to be provided accordingly.

Evidence-Based Interventions

One of the most important interventions that seem to have the most positive benefits on the mental health of the patient is the psychotherapy. These therapies mainly help in the treatment of depression by talking about the condition with the patient and understanding the related issues.  Therefore, many of the healthcare professionals call these therapies as the talk therapies. Different types of therapies have been found to be effective for depression like that of the interpersonal therapy as well as the cognitive behavioral therapy. Studies have found out the benefits that remain associated with the different types of therapies (Karyotaki et al., 2015). These therapies help the affected individuals in adjusting to the crisis as well as other current difficulties that the patients face. It helps in the identification of the negative beliefs as well as the behaviors and then help in replacing them with healthier and positive ones. It also helps in the exploration of the different types of relationships as well as the experiences of the patients and help in development of positive interactions with the others (Gertlaer et al., 2015). The therapies also help in identification of the issues that help in the contribution to the depression and thereby help in changing of the behaviors that cause worsening of the situation. The patients become able to regain a sense of satisfaction and thereby help in the controlling of their own lives helping in the easing of the depression symptoms like that of the hopelessness as well as anger (Koster et al., 2017). The patients would be also able to set realistic goals for their own lives. The patients also become able to develop the ability for tolerating as well as accepting distress using healthier behaviors. Therefore, psychotherapies like cognitive behavioral therapies as well as interpersonal therapies can be used effectively. This could be applied for Kathy as he would have positive outcomes on health from these.

Another important intervention that is also advised by the professionals is the anti-depressant therapy. Many types of antidepressant are present which can be helpful in controlling the symptoms of the major depressive disorder. However, a large number of side effects are also noted  in the different research studies and therefore, it is very important for the patients to consult with the doctors if any form of the side effects arise (Opie et al., 2015). Different types of medications are the selective serotonin reuptake inhibitors, Serotonin-nor epinephrine reuptake inhibitors (SNRIs), atypical antidepressants, tricyclic antidepressants, Monoamine oxidase inhibitors (MAOIs) and other medications. These medications help the patients in fighting with different symptoms of depression and cope successfully. However, a number of important factors need to be considered while choosing the correct medication for the patient (Fiest et al., 2016). One medication that might be helpful and effective for one patient might not be successful as well as effective for the other patient. The professionals therefore need to make the patient understand that they might need to try out several combinations of the medications before finding the correct one that works. These would be mainly requiring patience (Taubmen et al., 2019). This might be mainly because some medication needs several weeks or much longer for undergoing full effects and different side effects to be eased out before the body becomes adjusted. It is seen that Kathy has become frustrated from the anti-depressants, as the medications had not brought out effective outcomes. Therefore, it should be made to understand to Kathy that the medications would be taking some time before they start showing full potential and therefore, she would need to be patient for the outcomes.


Many of the researchers are also of the opinion that although most of the medications are safe and are seen to carry a black-box warning, some of the medications do increase the suicidal thoughts of the individuals mainly in children, teenagers as well adults under certain cases. Therefore, it is the duty of the professionals to closely watch the patients who are taking such medications and find out whether the patient is showing any form of worsening conditions if unusual behaviors especially when starting a new medication or when choosing a change in the dosage (Kolovos et al., 2018). When patients are seen to be having suicidal thoughts while taking such medications, it should be immediately reported. Therefore, the patient named Kathy should be first analyzed whether her taking of medication is causing such symptoms or not. Accordingly, medication would be allocated for her.

Motivational interviewing as well as proper education planning for effective lifestyle management are some of the best care interventions that help in providing the patients with better quality life and provide them strength to cope with the negative incidents of life. Motivational interviewing is one of the counseling method that helps in the resolution of the different ambivalent feelings and the different insecurities that the patients possess (Koster et al., 2015). This helps in finding the internal motivation which they need to change the behaviors. This is one of the practical, empathetic as well as short-term procedures, which helps in considering how difficult it is to make life changes. Some of the important areas where the professionals would be providing more importance to in the interview and while educating the patient, are helping the patient in learning about depression. They should also help the patient in sticking to the plans, work collaboratively with the patient for learning about the triggering factors of the depression symptoms and paying attention to the warning signals (Delgadillo et al., 2015). Educating patients about the avoiding of the alcohol and use of recreational drugs need to be prevented.

Researchers are also of the opinion that integrative medicine practitioners believe in the association of the mind and the body. These two aspects should always be in harmony with each other for staying healthy both physically as well as mentally. Some of the mind-body techniques that are found to be extremely helpful for treating patients with depression are acupuncture and relation techniques like that of the yoga or the tai-chi (Fleming et al., 2018). Some of the other techniques that can be be also incorporated for the treatment interventions are meditation, guided imagery, massage therapy. Music therapy, massage therapy, spirituality as well as aerobic exercises are also found to be important interventions that can prove to be helpful in developing the quality of the life of the patients with depression. These would be helping Kathy as well as developing a stability of her feelings and would help in gain serenity and peace and help her cope with different situations.

The patient named Kathy is showing risks for self-harm and this is the most important priority that needs to be handled by the professionals effectively. The nursing professionals need to identify the level of the suicide prevention needed. The professional in the outpatient clinic attending to Kathy need to understand whether there is a requirement of hospitalization of the patient. In case of low risk patients, professionals also need to assist whether the client is safe to go home with the supervision of the family member of the friend. The main rationale for this assessment would be to help the patient keep safe and protected from her own self-harming behavior and this can be prevented with constant supervision and safe environment 9Fiest et al., 2017). Crisis counseling should be arranged for the patients and accordingly the family members should be communicated and links for self-help should be activated. Researchers are of the opinion that clients with such disorders need to have a network of resources for helping the individual diminish personal feelings of helplessness, worthlessness as well as feelings of isolation. The client should be continuously encouraged for expression of her feelings of anger, sadness as well as guilt and help the patient in coming up with the alternative ways for handling the feelings of anger, sadness and frustrations (Baumiester et al., 2014). In this aspect, the professionals can use the cognitive behavioral therapy to address effectively this arena of the care plan. Clients need to learn about the alternative modes and ways of dealing with the overwhelming emotions and these would be helping in gaining a sense of control over her life.

Another care priority area is her impaired social interaction. She does not communicate or interact with anyone and keeps herself locked indoors. Moreover, she also lacks concentration in different of her activities and is also seen to suffer from low energy. During the various sessions that the professionals plan, one can be arranging for activities that would require minimal concentration of the patient like the drawing, playing of simple board games and many others. This is mainly because depressed people are seen to lack concentration and memory (Devenish et al., 2016). Therefore, activities which have no right or wrong or winner or loser probabilities would help in the minimization of the opportunities helping in the clients for putting herself down. The patient can be also involved in the gross motor activities that require very little attention like that of walking for example. Such activities will help in relieving tensions and would help in elevating the moods. The client can also be included in different group activities like group discussions, dance therapies as well as art therapies. Effective socialization would help in the minimization of the feelings off the isolation. Moreover, genuine regards for the others can also help in developing the feelings of self-worth among the patients. Client contacts with others need to be maximized as contacts with others will help in distracting the client from self-preoccupation. In the communities, the client and the family should be refereed to self-help groups. This would help the client and her family in getting tremendous support and insight from the people in sharing their interventions.

It is important for the healthcare professionals to establish a therapeutic relationship with the patient that would be based on empathy and compassion. The professionals need to be non-judgmental and consider the patient as unique and develop interventions based on her need rather than applying “one-for-all” methods of interventions (Klainin et al., 2015). This would help in developing trust and mutual respect between the patient and the professionals and would help in effectively providing the above-mentioned interventions besides the antidepressants that would be found comestible with her care.

Conclusion:

From the above discussion, it becomes clear that depression is one of the mental health disorder that impacts the quality of life of the patients impacting social interaction and affecting career and personal peace and stability. Therefore, professionals should first identify the symptoms and then use the DSM-5 classification system to identify the disorder and accordingly prioritizes the symptoms. Pharmacotherapy with anti-depressants, psychotherapy sessions like cognitive behavioral therapy, interpersonal therapy, and motivational interviewing would help in overcoming symptoms. Besides dance therapy, music therapy and art therapies are also useful. Proper evidence based and therapeutic interventions can help patients overcome the disorder and live quality lives.

References:

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Delgadillo, J., Gore, S., Ali, S., Ekers, D., Gilbody, S., Gilchrist, G., ... & Hughes, E. (2015). Feasibility randomized controlled trial of cognitive and behavioral interventions for depression symptoms in patients accessing drug and alcohol treatment. Journal of substance abuse treatment, 55, 6-14. https://doi.org/10.1016/j.jsat.2015.02.008

Devenish, B., Berk, L., & Lewis, A. J. (2016). The treatment of suicidality in adolescents by psychosocial interventions for depression: a systematic literature review. Australian & New Zealand Journal of Psychiatry, 50(8), 726-740. https://doi.org/10.1177/0004867415627374

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