INFORMATION FOR CANDIDATE:

As GP you saw a 54 year old Mr. Mark Jones

one week ago for a general physical
examination. He told you that he has been
feeling down and depressed for a few months.
You arranged for him to come for a longer
consultation and he returned today.
YOUR TASK IS TO:
Take a thorough history
Discuss the most likely diagnosis and
management with the patient

HOPC: Mark had his yearly physical check-up last week and he informed his GP that he
has not been happy in his life for about 6 months. The GP arranged for another meeting
today.
Mark has noticed an increasingly depressed mood. His home life has been affected, he
finds it hard to share his feelings with his wife, they really dont talk to each other a lot.
Their sex life has quieted down since his wife has a hysterectomy 5 years ago although it
does not bother either of them a lot.
Their three children have all moved out and the house feels empty.
He does not have many friends. He now understand the saying you can feel lonely in a
crowd thats what is happening to him!
His wife copes very well, she is a lawyer, always busy and she has lots of girl friends.
His appetite is o.k. although he does not enjoy food as much as he used to. No change in
weight.
He sleeps alright.
He works as accountant, although with his general situation he does not enjoy the job as
he used to. No conflict or financial problem.
He has never thought of killing himself but he feels isolated in his position and
marginalised from other people despite being around people at work and even at home
when they have the occasional gathering of people. He often feels helpless and that there
is nobody around to cheer him up.
PHx. + FHx.: unremarkable
SHx: married accountant, 3 children who have left home over the last 3 years, non
smoker, little alcohol, no recreational drugs, NKA, no medication.
DIAGNOSIS: LONELINESS
Loneliness is to some extent part of being a normal human being, but can become
pathological and then it is described as a feeling of loss and despair, a feeling of
helplessness (e.g. with single parents there is no-one to help me when I need support and
friendship or ..to cheer me up when Im down). There is also a feeling of isolation and
alienation or marginalisation from other people.
1. Inadequate levels of social relationships
2. Loneliness is a subjective experience
3. It is an unpleasant feeling in which people experience a strong sense of emptiness
and solitude. It has also been described as social pain - a psychological mechanism
meant to alert an individual of undesired isolation and motivate her/him to seek
social connections. Common terms used to describe loneliness include: pain, lost,
nothingness, overwhelming, numb, and afraid.

Emotional vs. Social Isolation

One of the most popular typologies of loneliness was developed by Robert S Weiss. He
categorized loneliness into two types: Loneliness of Emotional Isolation (aka emotional
loneliness, attachment) and Loneliness of Social Isolation (aka social loneliness), can be
caused by a multitude of issues:
unemployment,
financial hardship,
rural droughts, bushfires or floods that devastate peoples lives and livelihoods
and isolate communities
loss of partner or loved one
lack of self-esteem unable or scared to make relationships with others
physical illness (e.g., HIV AIDS, arthritis or back pain) or incapacitation or
debilitation, problems of ageing (strokes, dementia),
mental illnesses (especially suffering from phobias, anxiety and panic attacks) or
disabilities in which sufferers are discriminated against,
new mothers or parents trying to cope with a demanding new baby,
people who are highly stressed or who move regularly from place to place
without making friends,
mid-life crisis (transitional change) and onset of menopause for women or
retirement for men especially
bullying and harassment
alcoholism, drug dependency and social isolation
Transient vs. Chronic
The other important typology of loneliness focuses on the time perspective. In this
respect, loneliness can be viewed as transient (caused by something in the environment,
and easily relieved) or chronic (more permanent, caused by the person, and is not easily
relieved).
MANAGEMENT:
Strategies and Skills:
CBT
Activity Diaries
Pleasant Activities Worksheets
Timetabling ones activities.
During therapy, emphasis is put on understanding the cause of the problem; reversing the
negative thoughts, feelings, and attitudes resulting from the problem; and exploring ways
to help the patient feel connected. Some doctors also recommend group therapy as a
means to connect with other sufferers and establish a support system. Anti-depressants as
a stand-alone treatment or in conjunction with therapy can be useful.
Alternative approaches to treating depression are suggested by many doctors. These
treatments may include exercise, dieting, hypnosis, acupuncture, herbs, animal-assisted
therapy (pet therapy) can help.