Mary is more tearful and withdrawn. She is refusing to attend therapy sessions including physiotherapy. She is hardly eating any food and is starting to lose weight. Her family are struggling to get her to talk to them when they visit and she expresses negative thoughts about her future. She told her husband that she was a burden and that he would be better off if she were dead. She turned her head away when her named nurse asked her to fill in another GHQ-12.
What should the team do?
- The team refer Mary to liaison psychiatry services for assessment. Mary reluctantly agrees to referral.
- The psychiatrist assesses Mary and finds her to be significantly depressed. He discusses again the pros and cons of anti-depressant medication. Mary again voices concern about medication but after discussion with her husband who is quite distressed she agrees to a trial of medication.
- The psychiatrist keeps Mary’s condition under review and adjusts her medication as necessary. He arranges for a community psychiatric nurse (CPN) follow up when Mary is discharged from hospital.
- Mary is also referred onto clinical neuropsychology services for specialist 1:1 psychotherapy. Mary responds to medication and once her depression is slightly alleviated she engages in therapy. The clinical neuropsychologist meets with Mary on a regular basis. Therapy consists of a combination of allowing Mary the space to talk about her changes in function and cognitive behavioural therapy to focus on the negative thoughts that Mary has about her abilities and recovery that maintain her depression. The CPN and clinical neuropsychologist regularly liaise with each other.
Page last reviewed: 25 Feb 2020
