Major depression with psychotic symptoms. Nursing approach from a short-stay unit

Abstract

Psychotic major depression is a severe mental disorder that combines depressive symptoms with delusional ideation and sensory-perceptual disturbances, and is characterized by great deterioration and resistance to treatment; electroconvulsive therapy (ECT) is effective in severe episodes and in resistant depression. We present the case of an 80-year-old woman who is voluntarily admitted to a short-stay unit for worsening mood, with intense distress, ideas of guilt and delusional ideas of nihilistic, hypochondriac and ruin content, and passive ideas of death. After assessment according to Marjory Gordon’s functional health patterns, a care plan was developed with the NANDA, NOC and NIC taxonomies (insomnia, disturbed personal identity, unstable emotional control and ineffective coping), with individual and group psychoeducational activities during the three and a half weeks of admission. Given the initial lack of response to pharmacological treatment, clomipramine and ECT were started, with improvement and the complete disappearance of the delusional symptoms, proceeding to discharge with outpatient follow-up and continuity of care at the mental health centre.