Michael is a 22-year-old college senior whose GPA has declined with this semester’s grades. Michael plans to apply to medical school and thinks that the lower GPA may prevent his acceptance to medical school.

QUESTION

Case Study, Mohr: CHAPTER 2, Neuroscience: Biology and Behavior

In completing the case study, students will be addressing the following learning objectives:

Discuss neuroplasticity and how this concept relates to mental health and mental illness.

Briefly explain the importance of interaction between genes and environment, the role of endophenotypes, and the stress-diathesis model of psychiatric illness.

1. Michael is a 22-year-old college senior whose GPA has declined with this semester’s grades. Michael plans to apply to medical school and thinks that the lower GPA may prevent his acceptance to medical school. For the last 2 weeks, Michael has skipped most classes because he has insomnia and fatigue. Michael is now very depressed and has been thinking of suicide. He took a loaded gun from his father’s gun cabinet and then wrote a suicide note to his family. At the last moment, he telephoned 911 and told them of his suicide plan. The police came, took the gun away, and then took Michael to the city hospital to be admitted for psychiatric treatment. In the admission interview with the psychiatric nurse, Michael said that his pastor thought that only weak-willed people experienced depression and that it was a punishment for personal sins and the sins of one’s ancestors. Michael told the nurse that he must be weak-willed and will never be able to accomplish anything. The psychiatric nurse explained that multiple factors are the cause of depression. The nurse told Michael that one theory holds that an imbalance of neurotransmitters, or chemical messengers of the brain, occurs in depression. Neurotransmitters influence the individual’s emotions, thoughts, and subsequent behavior. Recent research implies that neurobiology, heredity, as well as Psychological and environmental factors may be involved in the development and progression of depression.

(Learning Objectives: 5, 6)

a. Will Michael think that the psychiatric nurse’s explanation for the cause of depression is more correct than that of his pastor?

b. Michael asks the nurse why he has to have psychotherapy. He states that he only needs to take a couple of pills to get better. How should the nurse respond to Michael’s question and comment?

c. Develop an assessment question for each of the following possible causes of Michael’s development of depression:

Genetic, Environment and Stress.

ANSWER

“Exploring the Causes of Depression: Genetics, Environment, and Stress in Michael’s Case Study”

It is likely that Michael will be more receptive to the psychiatric nurse’s explanation for the cause of depression compared to his pastor’s beliefs. The nurse’s explanation that depression is caused by an imbalance of neurotransmitters and involves multiple factors such as neurobiology, heredity, and psychological and environmental factors is supported by scientific research and the current understanding of depression. In contrast, his pastor’s belief that depression is solely a result of personal sins and the sins of one’s ancestors is based on a religious or moral perspective rather than scientific evidence. Therefore, Michael may find the nurse’s explanation more convincing and aligned with contemporary knowledge in the field of mental health.

 In response to Michael’s question and comment about psychotherapy, the nurse should provide him with a comprehensive understanding of the benefits of psychotherapy in treating depression. The nurse can explain that while medication can be helpful in managing symptoms of depression, psychotherapy offers additional advantages (Chand, 2023a). Psychotherapy, also known as talk therapy or counseling, involves a therapeutic relationship between the individual and a trained mental health professional. It provides a supportive and safe environment for individuals to explore their emotions, thoughts, and behaviors related to depression.

The nurse can explain to Michael that psychotherapy aims to help him understand the underlying causes of his depression, develop coping mechanisms, and learn new strategies for managing distressing thoughts and emotions. Unlike medication, psychotherapy addresses the root causes of depression rather than just alleviating symptoms (Gautam et al., 2020). It can also provide tools for long-term resilience and emotional well-being. Additionally, the nurse can highlight that combining medication and psychotherapy often leads to better treatment outcomes compared to using medication alone.

Assessment questions for each possible cause of Michael’s development of depression:

Genetic Factors

Has anyone in your immediate family, such as parents or siblings, experienced depression or other mental health conditions?

Are there any known genetic factors or family history of mental illness in your family?

Have you noticed any patterns of depression or mood disorders among your relatives?

Environmental Factors

Have you experienced any significant life changes or stressful events recently, such as the loss of a loved one, relationship problems, or academic pressures?

Are you facing any difficulties in your social relationships or experiencing isolation or loneliness?

What is your current living environment like? Are there any factors that contribute to a stressful or unsupportive atmosphere?

Stress

How do you typically cope with stress? Are there any specific stressors that you find particularly challenging?

Have you noticed any physical symptoms, such as headaches or digestive problems, that may be related to stress?

Are there any ongoing stressors in your life that you feel are overwhelming or difficult to manage?

By asking these assessment questions, healthcare professionals can gather information about potential genetic, environmental, and stress-related factors that may contribute to Michael’s development of depression (Iturrioz et al., 2019). This comprehensive assessment allows for a more holistic understanding of his condition, guiding the development of an individualized treatment plan.

References

Chand, S. P. (2023a, April 8). Depression (Nursing). StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK568733/ 

Gautam, M., Tripathi, A., Deshmukh, D., & Gaur, M. (2020). Cognitive Behavioral Therapy for Depression. Indian Journal of Psychiatry, 62(8), 223. https://doi.org/10.4103/psychiatry.indianjpsychiatry_772_19 

Iturrioz, E. B., Jaureguizar, J., & Garaigordobil, M. (2019). Child and Adolescent Depression: A Review of Theories, Evaluation Instruments, Prevention Programs, and Treatments. Frontiers in Psychology, 10. https://doi.org/10.3389/fpsyg.2019.00543