Severe, prolonged depression affects a person's risk for physical illness by

A. Providing companionship can help reduce feelings of isolation and agitation that may be exacerbated by sundown syndrome. Presence and interaction with a supportive person can provide comfort, reassurance, and a sense of security, which may help manage anxiety and agitation during the late hours.
B. Engaging in stimulating activities in the late afternoon or evening can sometimes worsen symptoms of sundown syndrome. Instead, activities should be calming and relaxing as excessive stimulation can
increase agitation and confusion. It’s better to plan stimulating activities earlier in the day.
C. Maintaining a familiar routine helps provide structure and predictability, which can be comforting for individuals with dementia. Consistent routines can help reduce confusion and anxiety, especially during the times when sundown syndrome symptoms are most pronounced.
D. While reminding the client about bedtime may seem like a good strategy, it can sometimes lead to frustration or increased agitation if the client is not ready for sleep or is confused. It is generally more effective to create a calming environment and use soothing routines rather than directly reminding the client of bedtime.
E. Reducing environmental stimulation, such as minimizing noise, bright lights, and other distractions, can help create a calm and peaceful environment. This approach can help prevent overstimulation, which is known to exacerbate sundown syndrome symptoms.

A. Depression is characterized by persistent feelings of sadness, loss of interest or pleasure in activities, changes in sleep and appetite, and difficulties with daily functioning. However, depression alone might not fully explain the abrupt change if there were no prior context of mood swings or manic behavior.
B. Bipolar disorder is marked by extreme mood swings that include manic or hypomanic episodes and depressive episodes. The observed behaviors—active participation and high energy followed by a
sudden shift to tearfulness and withdrawal—are consistent with the mood cycling seen in bipolar disorder. The manic or hypomanic phase could explain the previous high level of activity, while the depressive phase explains the sudden refusal to engage and withdrawal.
C. Psychotic behavior involves a loss of touch with reality, including hallucinations, delusions, and disorganized thinking. The behaviors described (active participation and then sudden withdrawal) do not specifically indicate psychosis.
D. Dysthymic disorder (now referred to as Persistent Depressive Disorder in the DSM-5) is characterized by a chronic, mild depression lasting for at least two years. It typically involves a more consistent, persistent low mood rather than the abrupt shifts seen in bipolar disorder.