The Case of Susan Domain 1: Persistent Depressive Disorder Domain 2: None Domain 3: None Domain 4: GAF = 70-61 Rationale for Domain 1: Domain 1: The individual presents with a history of depression which appears to meet the criteria for persistent depressive disorder because of its occurrence for the last couple of years. It was suggested that she was to see a psychiatrist but her husband as well as her health care provider during a routine checkup. She reported getting little sleep, believing it was normal because she has not been a good sleeper for some time. Due to the lack of sleep, she is constantly tired and fatigued. During her session, she did mention that there were not times where she was very happy. There were times were she felt …show more content…
Once that term was noticed, she began to fit under major depressive disorder. Her symptoms where very similar (i.e. insomnia, overeating, fatigue, constant depressed mood, ect.), but I did notice at the beginning of her session that she has been having these symptoms for a couple years. If she did go into the clinic earlier, she may have been first diagnosed with major depressive disorder. She also had similar symptoms (at first) to bipolar disorder. She had a history of at least one major depressive episode and these episodes where creating significant distress. The main factor that ruled out both bipolar I and bipolar II disorder was the fact that she did not have any manic episodes. She did state there were times were she felt “good”, but not in a manic state. The period of feeling “good” would not even constitute as a hypomanic episode because it only lasts a couple of hours, not a minimum of four days to a week eliminating the possibility of bipolar II disorder. Once I ruled out both bipolar disorders, the thought of cyclothymic disorder came into mind. She has had depressive symptoms for a minimum of 2 years, but there are rare period of feeling “good”. The description of her feeling “good” does not signify hypomanic symptoms and does not happen often. She does not have any ongoing substance use disorders and clearly stated that she did not want sleeping pills because …show more content…
The individual did say she was at one point prescribed Elavil, but discontinued use after it made her sleepy and did not ease the depression. Domain 3: She did not report any psychosocial or environmental problems. She stated that her life was not exactly a happy one, but no negative life event occurred to make her life an unhappy one. She has the support of her husband, and did not disclose any problems related to their relationship. There has been little difficulty with her job, and it appears as her job has been stable (without promotions or demotions). Throughout her session, it appears as if there are no significant psychosocial or environmental problems. Domain 4: The individual’s overall level of functioning during the clinical interview appears to be fairly high. The GAF rating was given because even with the high level of functioning during the interview, it appears to be consistent throughout her time outside of the clinic with no major impairment in the social context. She does appear to have some mild symptoms which include depressed mood and
not associated with the disorder. These characteristics were met by the client who is as follows: 1.
Lori meets the criterion for Criteria A. This criteria will be later discussed in sections “Diagnostic Criterion met for a Major Depressive Episode” and “Diagnostic Criterion met for a Manic Episode”.
As I carefully analyze Susan’s case study, I have diagnosed her for having major depression. This is because as I’m reading her case study her sister indicates that Susan is wasting her life by staying locked up in her poorly lit house, isolating herself from the world while experiencing extreme sadness. Susan attended a mental health clinic in South Florida where she is interviewed on how she is feeling. In order for you to have major depression you must betray a depressive mood or loss of interest in nearly all activities. Likewise, the individual should experience at least 4 additional symptoms. In her case study I have found at least 9 symptoms present that help back up why I’m diagnosing her for major depression. While visiting the mental
The following essay is a case study of a client named John who is suffering from major depression and was sent to see me for treatment by his concerned wife. I will provide brief background information about John then further discuss interventions and strategies I believe can be applied in each session with my client in order to make John's life more manageable. In the essay, I will be writing as the therapist, and the sessions are based on a ten week period.
296.32 (F33.1) Major Depressive Disorder, recurrent episode, moderate severity, with anxious distress. Ms. Client meets eight of the nine diagnostic criteria for Major Depressive Disorder (MDD). Specifically, during several periods of time she experienced depressed mood, diminished interest in things she enjoyed to do, hypersomnia, psychomotor agitation, fatigue, feelings of worthlessness, decreased concentration, and suicidal thoughts without intent. Additionally, as Ms. Client expressed, these symptoms are source of continuing distress and interfere with her academics and social functioning. Also, her symptoms started four years prior to the psychological assessment and persisted intermittently since then, lasting for several weeks to several months, with the most recent period of extended length (enduring two weeks) approximately one year ago. Since the last episode she has experienced these symptoms for two to three days at a time. Although the last episode that met the criterion of two weeks duration occurred approximately a year ago, the symptoms have not disappeared, but they occur periodically since then and when they do, they cause considerable distress and impairment in functioning. Thus, the disorder cannot be coded as ‘in partial or full remission’. The specifier ‘with anxious distress’ was given, because Ms. Client reports feelings of difficulty in concentration because of worry and restlessness.
Client meets the criteria for 296.21 Major Depressive Disorder. The patient has symptoms of depression, being worried, hopelessness, suicidal, and sad.
Jennifer meets the diagnostic criteria of development of emotional or behavioral symptoms in response to a stressor within 3 months, has marked distress that is out of proportion to the severity of the stress, has significant impairment in social, occupational, and other functioning areas, and symptoms do not represent normal bereavement. Jennifer would not meet the criteria that the
There is no indication she has had a manic or hypomanic episode. Her depression may be complicated by grief due to her father’s death one year ago. Her symptoms seem to get worse after his passing.
The U.S. Geological Survey registered the Tohoku Earthquake as a megathrust earthquake.4 Being the largest and most powerful type of earthquake, a megathrust earthquake is one that occurs in a subduction zone, an area where one of the earth’s tectonic plates sinks under another (Fig. 2). Although it takes hundreds of years for a megathrust earthquake to start, they are particularly devastating because they deform the ocean floor, resulting in a tsunami.4,5
Ellen Waters meets criteria for a diagnosis of Bipolar II Disorder (296.89), current episode depressed with atypical features, mild severity. There are several things in her case that make this diagnosis clear. She reports chronic depression throughout her life, but she also describes “highs” consisting of elevated mood lasting for several months at a time during which she functions on little sleep and gets a lot done, runs up high telephones bills talking to people, and experiences racing thoughts. Additionally, she reports that her friends have obviously concerned about her abrupt changes of behavior from her depressive norm, and would often tell her that she needed to slow down or calm down. All of these are consistent with hypomania and she lacks some of the hallmarks of mania—she is still able to function at work and socially for the most part, she has not needed to be hospitalized as a result of her “highs” and she has not experienced any psychosis—thus ruling out a Bipolar I diagnosis. She is currently experiencing a depressed mood and panic attacks, which is the reason why she has been referred for treatment. She states that she was depressed for most of the month prior to this visit.
31 y/o AA male patient seen today for psychiatric-mental health assessment. He is awake, alert and oriented x4. He is calm, cooperative and follows commands during assessment. The patient reports he is depressed, difficulty sleeping and nightmares at night. The patient explained his depression is as a result of deep thinking from a news he received two days ago from his elder brother that his mother is ill. Stressors identified by the patient include losing his job a week ago before the news about his mother; his wife is 6-months pregnant with their first child, who currently works part-time at her present job; patient relates difficulty paying monthly bills and inability to provide adequately for his family as a man. The patient denies mood swings, suicidal/homicidal thoughts and ideation. Patient reports his spouse is at work at the moment and he does not want to put stress on his wife due to her current condition. Patient denies been hospitalized for depression or psychiatric illness; and denies family history of mental illness. Patient reports he is seeking help because he does not like feeling this way using terms of “helpless and loss of worth from his spouse”. Patient reports he needs help with his depression and nightmares before his current condition get out of hands and ruined his marriage.
Even though most of the patients fully return to a functional level between the crises, approximately 30% of them report having severe difficulties in their work role function (Goodwin & Jamison, 2007). When the patient has acute mania, Haloperidol is the most used medication for its properties of rapid sedation (Goodwin & Jamison, 2007). Another medication that is used is IM olanzapine to calm acute manic agitation (Goodwin & Jamison, 2007). When the patient has extreme hyperactivity, typical antipsychotics are used to relieve symtoms of dehydration and cardiovascular stress (Goodwin & Jamison, 2007). Lithium is a very common medication given to a patient with manic episodes (Goodwin & Jamison, 2007). One important aspect to take into account with Lithium is that the dose should be administered downward as the mania starts to diminish to keep the blood level in a reasonable range (Goodwin & Jamison, 2007).
The patient returned for a final time and it was present that her situation had gotten even worse. She was forgetting to give phone messages and stopped cooking afraid of burning down the house. Her score on the Mini-Mental Status exam decreased to a 20/30 and her GDS stage is at a 5.
Jessica is a twenty-eight-year-old married female who works at a large hospital. She has high expectations for herself because she has graduated with honors at both college and medical school. For the past few weeks, she has been feeling tired and unhappy. She has had a demanding and high stressful job at a large hospital for two years. She feels that she is unable to perform well at her job and has trouble concentrating at work and at home. She is uninterested in her usual activities and has many negative thoughts that keep her awake at night. Two diagnoses that best fit this case study are Major Depressive Disorder and Generalized Anxiety Disorder.