Mental Health Nursing: Depression and Adjustment Disorder Case Study

Introduction and Patient Overview

Depression is a widespread psychiatric disorder that affects many people. Grief is a natural reaction experienced when one suffers a significant and permanent loss, most commonly the loss of a loved one. When the client enters the room, she looks around and makes eye contact. She appears well-composed — she smiles and speaks happily about her family and her dog. She shows no signs of aggression, sitting quietly and observing the room. Expectations differed from reality: where an aggressive, self-neglecting patient was anticipated, the client instead demonstrated a desire for self-improvement, manageable depressive symptoms, and a willingness to open up.

The client is a 53-year-old white female who weighs approximately 112 pounds and stands 180.34 cm tall. She presented with symptoms of depression. She reported working as a janitor at Roses before being diagnosed with depression. She is allergic to morphine and amoxicillin, and has a history of gastroesophageal reflux disease and hypertension. She has undergone a Novasure endometrial ablation and a tubal ligation, and these surgical procedures led to approximately two hospitalizations. The client reports that she became stressed following the death of her mother in 2020. She is a mother of two children; her son has mental health problems related to substance use. She takes regular meals and is a member of the Baptist faith. She reported that she has never used drugs or alcohol.

Mental Status Evaluation

From my interaction with the patient, I found that the client appeared to be a well-composed individual. She became shy when maintaining eye contact and would look around the room, swing her feet, tap her fingers on the table, and shake her head. She displayed no form of aggression and remained calm throughout most of the assessment. Her speech rate was average, and she became animated and happy when discussing time spent with her best friend. Her mood was generally stable, and she grew excited when talking about her best friend and her pet, until emotions resurfaced when asked about her mother's passing — at that point, she became visibly sad.

Her psychological integrity was examined, along with her overall functioning. The client is sexually active and has a gastrointestinal disorder, but she has not neglected her personal care in any way.

DSM-5 Criteria and Diagnosis

Depression is a severe, often chronic, and disabling condition found across all cultures. Based on DSM-5 analysis, the client meets criteria for adjustment disorder (also referred to as situational disorder). The DSM-5 evaluates a diagnosis after five or more symptoms have been present for two weeks. When exhibiting major depressive disorder, the patient feels depressed for most of the day — experiencing sadness, emptiness, and hopelessness. Additional indicators include markedly diminished interest or pleasure in activities previously enjoyed, weight loss or gain, insomnia, fatigue, and loss of energy (2017–2018 Treatment of Adult Major Depressive Disorder, 2018). Diminished ability to concentrate and recurrent thoughts of death are also noted. These symptoms represent more than a normal stress response and can create significant difficulties in interpersonal relationships. The client demonstrated psychosocial symptoms including helplessness, sadness, depressed mood, and tearfulness.

After analysis using the DSM-5 criteria, the patient was found to have both adjustment disorder and major depressive disorder. The client's symptoms were consistent with the data collected during the nursing assessment. Adjustment disorders are primarily caused when individuals have difficulty adjusting to life after a significant stressor (Bridley & Daffin, 2020). The client had difficulty adjusting to her mother's death two years prior, which contributed to a major depressive disorder associated with psychosocial, interpersonal, and workplace disability.