Persistent Depressive Disorder Case Study

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.

As of 2015, around 16.1 million adults suffer from Major Depressive Disorder in America and one in five teenagers will experience it (Adaa) (Everett). Depression is a temporary disease that is treatable with an assortment of medications and services (Everett). The American Psychiatric Association defines Depression and/or major depressive disorder as a “common and serious medical illness that negatively affects how you feel, the way you think and how you act.”(Psychiatry). Yet there are many forms of treatment, from medication to therapy treatments. For example, Selective serotonin reuptake inhibitors, shortened to SSRIs, are a form of antidepressants that work by “increasing levels of serotonin in the brain” (Mayo Clinic. (2018). Selective).

not associated with the disorder. These characteristics were met by the client who is as follows: 1.

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.

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

 of major depression is supported by DSM-IV criteria. I have no reason to suspect that her symptoms are caused by a mood disorder like bipolar because she exhibits no manic episodes, nor has she ever.

Client meets the criteria for 296.21 Major Depressive Disorder. The patient has symptoms of depression, being worried, hopelessness, suicidal, and sad.

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

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.

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 one year later to be assessed by an Alzheimer’s specialist. The results showed that her symptoms had worsened; she was constantly monitored while in the kitchen and in financial affairs. She scored a 24/30 on her Mini-Mental Status exam and her clock drawing got worse. The doctor then confirmed she was in stage 4 on the seven stage of Global Deterioration scale (seen on Figure 6).

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.

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.

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.