How to Deal With Depression

Nowadays, many people suffer from depression. Living with depression is one of the hardest journey a person may encounter. Male or female, known personalities or rich and poor may suffer from depression. It is an internal battle that is a tragic experience. It is considered a mental health crisis.

Depression is feeling of emptiness, feeling of loss... loss of motivation, drive and energy. It is a mentally breakdown. It most of the time associate with hopelessness and helplessness. All are just darkness and no light at all. And there's a voice saying that you are not good enough.

There's of feeling of suicidal.... thinking to end their miserable lives and escaping from this suffering. There's a thoughts that you like to step out of this awful journey and you feel that it is better off dead.

Believe it or not, we are the one who creates our own negative feelings. The reason why we get depressed is because the consistent thoughts we think and we beliefs we hold and it is because there is an external factor involves that didn't materialize in their lives. There is a thought that you are not good enough and not worthy at all. Everything is out of control or you can't control. You have a stable job but can't have a sense of happiness.

Having this mental health condition is not something to ignore. Here are some ways to overcome depression:

• Accept and love yourself. With depression, remember that you are not alone and depression is real. It is hard yes definitely. Remember, in life there is up and down, winning and failures, and those trials, obstacles and problems will crash you but don't let yourself be defeated by this battle of life. DO NOT LET THEM. 
• Establish a support system. Need to take a break. Staying connected with people and social activities specially those that you are interested and having fun with will help you to change your mood and thoughts. Share your thoughts to someone you know that care for you. 
• Maximizing rational thinking and minimizing irrational thinking. Know why you feel depress and think the right thing. It is not easy to do it specially the person is down however; having self awareness will definitely help. 
• Watch motivational videos and listen to success stories. Fill up your mind with positive thoughts. Be knowledgeable and aware of what depression is. In this way, it will help to identify the situation and can stop to go into a deeper stage of depression.
• Speak up. A depressed person might think that he will not understood by many people and are not connecting to what you may say, but communicating with people helps a lot not only yourself but to other people to make mental health awareness. Let your pain and suffering release.
• Consult and seek help to professional provider. Some psychotherapy and some medications might needed to help treat depression. 
• Face your problems. Don't let them to bring you down. In every storms, there is a rainbow coming out after. Have positive mindset and faith that everything will go on its proper places. Let this trials mold you to become a better version of yourself. Let those challenges make you stronger and the pain leads you to your greatest growth and use it to build your character. 
• If you can do exercise or do physical activities like travelling, mountain hiking, biking, swimming or any activities you love are great help. It will help your brain to function properly to think positively. Even a simple walk or going outside to buy things will do. Stay busy and do the things that work for you and avoid being alone for a long time.

Depression just like other diseases is curable. It will go away and crisis in life will teach you the lesson to move to the next chapter of your greatest life. Life is not perfect but if your mind is strong and at peace, your reaction will be how can I work this out instead of why it is happening to me and the people will look to you and giving them strength and hope by reacting positively. Ensure you are in positive position next time, whatever pain you are suffering from, and ensure that it won't show again. So you can inspire others, people will say "he did it and if you did, I can do it too!" You deserve to experience how great life can be.  Don't give up, YOU ARE WORTHY. 

Milieu Therapy

Milieu means environment or surroundings. Milieu therapy is the treatment of mental disorder or maladjustment by making substantial changes in a patient's immediate life circumstances and environment in a way that will enhance the effectiveness of other forms of therapy. The objective or goal of milieu therapy is to use the environment or manipulate the surroundings to make client's hospital experience be therapeutic. Having a therapeutic community setting, client is expected to learn about adaptive coping skills, interaction and relationship skills and to develop autonomy.
Milieu therapy is a scientific planning by structuring an environment in order to effect behavioral changes and to improve the psychological health and bring individual to its maximum functioning.

Bettleheim coined the word milieu therapy in 1948 that used in children during that time but as time goes by, milieu therapy evolved to better hospital integration and community psychiatry with different structure therapeutic activities that are effective and efficient for the treatment or rehabilitation regimen.

Basic assumptions:
Skinner created seven basic assumptions on which a therapeutic community is based:

• The health in each individual is to be realized and encouraged to grow.
• Every interaction is an opportunity for therapeutic intervention
• The client owns his or her environment
• Peer pressure is a useful and a powerful tool
• Inappropriate behaviors are dealt with as they occur
• Restrictions and punishment are to be avoided.

Principles of Milieu Therapy:

• To promote a fundamental respect for individuals
• To use opportunities for communication between client and staff for maximum therapeutic benefit.
• To encourage clients to act at a level equal to their ability and to enhance their self-esteem
• To develop social skills and improve relationships.
• To provide opportunities for clients to be part of unit management.
• To be responsible to their own actions.
• Peer pressure is utilized to reinforce rules and regulations.
• Team approach is emphasized.
• Group discussions and temporary seclusions are favoured approaches for acting out behavior.
• The nurses function is to be therapeutic as well to achieve these goals.

Schizoid Personality Disorder

Presenting signs and symptoms:

• Neither desire nor enjoy close relationships even within their own family
• Prefer to live apart from others, choose solitary activities, have little interest in sexual activity with others and might describe themselves as "loners".
• Show emotional coldness, detachment or flattened affect.
• Occupation often involves little interpersonal contact.

ANTISOCIAL PERSONALITY DISORDER

Presenting signs and symptoms:

• An extended history of antisocial behaviors like persistent lying, cruelty to animals, vandalism, stealing, hurting people, substance abuse, are usually begins at the age of 15 and continuing into adulthood.
• Substance abuse is the most frequent comorbid Axis I disorder.
• Impassivity and repeated aggressiveness towards others.
• Deceitfulness like use of aliases, lying or conning others for personal profit or pleasure.
• Failure to honor financial obligations, duties and responsibilities at work or in family or relationships.
• Total lack of remorse for physically or emotionally hurting or mistreating others or swindling or stealing from others.
• At times presents as charming, self-assured, and adept.
• Interaction with others through manipulation, aggressiveness and exploitation, totally lacking empathy or care for others.
• There is significnt familial pattern to criminality in general and ASPD in particular.

Abnormal Thought Process

• Neologisms - words a person makes up that have meaning only for the person himself, often part of delusion. New words formation.
• Tangentiality- association disturbance in which the speaker goes off to the topic. When it happens frequently and the speaker does not return to the topic, interpersonal communication is destroyed. It is the tendency to speak about topics unrelated to the main topic of discussion. Wandering from the topic and never returning to it or providing the information asked.
• Looseness of association - connections in thought are interrupted. A disturbance of thinking in which the association of ideas and thought patterns becomes so vague, diffuse, fragmented and unfocused as to lack any logical sequences or relationship to any proceeding concepts or themes. Mostly seen in schizophrenia.
• Flight of Ideas - Constant flow of speech in which the person jumps from one topic to another in rapid succession. there is connection between some topics, although it is sometimes hard to identify. Characteristically seen in manic states of bipolar disorder.
• Thought blocking - sudden or abrupt stop in the middle of a train of thought, the person may or may not be able to continue the idea. It is a sudden cessation of a thought in the middle of a sentence.
• Circumstantiality - Before getting to the point or answering a question, the person gets caught up in countless details and explanations.
• Word Salad - mixture of words and phrases that have no meaning.
• Confabulation - filling in a memory gap with detailed fantasy believed by the teller to maintain self-esteem.
• Perseveration - involuntary repetition of the same thought, phrase or motor response to different questions or situations.

Abnormal Motor Behaviors

• Echolalia - repeating the speech of another person.
• Dyskinesia - Having distortion of voluntary movements, such as involuntary muscular activity like myoclonus, tic, spasm
• Waxy Flexibility - having his extremities placed in a certain position and holding that same for a long time or for hours.
• Echopraxia - repeating the movements of another person.
• Parkinson-like symptoms - making mask-like faces, tremors, shuffling gait and muscular rigidity.
• Akathisia - motor restlessness, patient is unable to sit still or lie quietly. 

THERAPEUTIC COMMUNICATION

It is an interaction between the nurse and client during which the nurse focuses on the client’s specific needs to promote an effective exchange of information.

GOALS FOR THERAPEUTIC COMMUNICATION SESSIONS:

·       Establish rapport with  the client by being empathetic, genuine, caring and unconditionally accepting client regardless of his or her behavior or beliefs

·       Actively listen to the client to identify the issues of concern and to formulate a client-centered goal for the interaction.

·       Gain an in-depth understanding of the client’s perception of the issue and foster empathy in the nurse-client relationship.

·       Explore the client’s thoughts and feelings.

·       Facilitate the client’s expression of thoughts and feelings.

·       Guide the client to develop new skills in problem-solving.

·       Promote the client’s evaluation of solutions.

NONVERBAL COMMUNICATION SKILLS

·       Facial expression

·       Body language

·       Vocal cues

·       Eye contact

·       Silence

RETT’S DISORDER

It is a pervasive developmental disorder characterized by the development of multiple deficits after a period of normal functioning. It occurs exclusively for girls, is rare, and persists throughout life.

Rett’s disorder develops between birth to 5 months of age. The child loses motor skills and begins showing stereotyped movements instead. She loses interest in the social environment and severe impairment of expressive and receptive language becomes evident as she grows older.

EPS Extrapyramidal Syndrome

ANTIPSYCHOTIC-INDUCED MOVEMENT DISORDERS

·       Extrapyramidal Symptoms – EPS are caused by antipsychotic treatment and need to be monitored/evaluated for early intervention.

Akinesia – rigidity and bradykinesia

Akathisia – restlessness, movement of the body; unable to keep still; movement of feet

Dystonia – spasmodic and painful spasm of muscle (torticollis)

Oculogyric crisis – eyes roll back forward the head (emergency situation)

Pseudoparkinsonism – simulates Parkinson’s disease with shuffling gait, drooling, muscular rigidity and tremor

Rabbit Syndrome – rapid movement of the lips that simulates a rabbit mouth movement.

·       Tardive Dyskinesia – a permanent dysfunction of voluntary muscles. Affects the mouth – tongue protrudes, smacking of lips, mouth movements.

Biperidin hydrochloride ( Akiniton) – example of anti-EPS drug

Schizophrenia

In 1908, Eugen Bleuler, a Swiss psychiatrist, introduced the term schizophrenia, which replaced the term dementia praecox, used bu Emil Kraepelin (1896). Kraepelin viewed this disorder as a deteriorating organic disease. Bleuler viewed it as a serious disruption of the mind, a splitting of the mind.

Four A’s

A – Inappropriate Affect

A – Loosening of Associations

A – Autistic Thoughts

A – Ambivalence

These four A’s provide a memory tool for recalling how schizophrenia affects thinking, mood, thought process, and decision-making ability.

Positive and Negative Symptoms:

POSITIVE:

• ·        Delusions
• ·        Hallucinations
• ·        Hostility
• ·        Disorganized thinking/behaviors

NEGATIVE:

• ·        Alogia
• ·        Affective blunting
• ·        Anhedonia
• ·        Asociality
• ·        Avolition
• ·        Apathy

Subtypes of Schiziphrenia: paranoid, disorganized, catatonic, undifferentiated and residual type.

Proxemics

It is the study of distance zones between people during communication.

Four Distance Zones:

• 1.      Intimate zones – 0-18 inches between people. This amount of space is comfortable for parents with young children, people who mutually desire personal contact, or people whispering. Invasion of this intimate zone by anyone else is threatening and produces anxiety.

• 2.    Personal zone – 19-36 inches. This distance is comfortable between family and friend who are talking.

• 3.    Social zone – 4-12 feet. This distance is acceptable for communication in social, work and business settings.

• 4.   Public zone – 13-25 feet. This is acceptable distance between a speaker and an audience, small groups and other informal functions.