Psy res Paper details
1. At this point in the conversation what things would you like more information about concerning Maggie? I would like to ask Maggie about activities she enjoys to do and if she still does these activities. I would ask more detail about her sleeping patterns and if she has had any suicidal thoughts in past few weeks.
2. What behaviors would you have Maggie track during the week?
I would have her track her symptoms throughout the day especially periods when she is feeling depressed, when she is feeling happy, her sleeping patterns, and diet.
3. What do you see as some of Maggie?s strengths?
I feel that Maggie had a great deal of strength to leave a relationship that she knew was not good for herself. I also think she has great strength in reaching out for help when she needed it. I also think it is a strength that she has a great job and financial stability.
4. Describe two or three approaches Maggie might use to develop a local social support system? I think Maggie could try to meet friends at work and meet up outside the work place. I think she could also try going to events close to home to meet new friends and supports where she lives.
5. What diagnosis would you give Maggie after the initial interview?
Major Depressive Disorder, Single Episode, Severe with Anxious Distress 296.23 (F32.3)
Maggie meets criteria by having 5 or more of the following symptoms:
A1: Depressed mood most of the day, nearly every day, as indicated by either subjective report
A2: Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
A3: Significant weight loss when not dieting or weight gain (Maggie lost 15 pounds)
A4: Insomnia or hypersomnia nearly every day
A8: Diminished ability to think or concentrate nearly every day
B1: Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
1. What are Kathy?s strengths?
That Kathy was able to identify that she has been feeling increasingly more down, and wants to seek help for herself and children.
2. What diagnosis would you want to rule out in this case?
I would rule out Major Depressive Disorder because the criteria specifies that ?Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning;? (Pomeroy, 2015). Kathy discusses feeling blue for many years. (In Case 5.1 it is clear that Maggie meets this criteria)
3. What resources might be valuable to utilize in this case?
I would maybe suggest having her children get involved in therapy since she feels that may be effected by her symptoms. I would also suggest that Kathy gets involved with the health club again since it made her feel better when she was exercising.
4. Do you think Kathy should be referred to other professionals for further evaluation? If so whom would you make a referral? I think I would need to meet with her a few more times to get more information. It was difficult to judge what was going on exactly based on the case study in my opinion.
5. What is your preliminary diagnosis for Kathy Claybourne?
I would Diagnosis Kathy with Unspecified Depressive Disorder 311 (F32.9). I had trouble diagnosing Kathy because I felt the information she gave about her symptoms seemed a little vague. I would really want to meet with her a few more times and ask more details about her symptoms.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, DSM-5. Washington, DC: American Psychiatric Association.
Pomeroy, E., K. (2015) The Clinical Assessment and Differential Diagnosis Workbook: Balancing Strengths, Chapter 5, Case 5.1 & 5.2.
5.1-1. At this point in the conversation, I would like to ask Maggie if she has had any prior episodes of depression or if anyone in her family suffers from depression. I would like to know if Maggie is on any medication, if she has an exercise routine, and her dietary habits.
5.1-2. This week I would have Maggie keep a diet log. I would also have her keep a thought journal. As we begin cognitive behavioral therapy, I would want Maggie to recognize her thought patterns throughout the day. If she writes down her thoughts throughout the week, perhaps she will begin the notice consistent negative reaction.
5.1-3. Maggie is a smart girl who likes to read and participate in community events. She has a good job and has the bravery and confidence to follow her job to a new state, out of her comfort zone. Maggie has her religion, too, which can help her in times of crisis (it has helped her dismiss thoughts of killing herself). Also, Maggie knew that after phone calls with Leonardo ended in shouting matches that she had to end the relationship. She knows her boundaries and made a change despite the difficulty in cutting off her relationship.
5.1-4. Two or three approached that could help Maggie develop a local social support network, now that she has free time away from Leonardo would include attending a local book club (possibly go to library and inquire about opportunities), attempt to ask a coworker out for dinner one time in the month. Also, I would encourage Maggie to attend at least one community event on the weekend, even if she goes alone. See if she can meet people there who have the same interests as her.
5.1-5. I would diagnose Maggie with Major Depressive Disorder, severe, with melancholic features. Maggie exhibits almost all the symptom criteria based on the DSM-5 (making the specifier severe): depressed mood (disheveled appearance, crying, insomnia, low energy, crying), diminished interest in activities (not going to community events, not reading), psychomotor agitation (pacing in waiting room); loss of energy (she states that she feels ?groggy and unable to function), feelings of worthlessness (?people think that I am a loser?), Maggie has insomnia (wakes at 2am), and she has thoughts of suicide (Maggie states that she has thoughts of ?ending it all?). For the melancholic features, Maggie shows loss of pleasure in most activities (reading, socializing), exhibits a distinct depressed mood characterized by despondency (the case study explicitly states that ?Maggie responds despondently?) and shows significant weight loss (she lost 15 pounds since her break up), has excessive guilt (she feels ugly, hopeless to get married, unlovable), early morning awakening (she sleeps only 2-3 hours a night).
5.2-1. Kathy is a smart leader to whom people look for care. She is not only a nurse but the person who takes care of her mother and father through cancer. She also shows that she is perseverant as she, through battling her depressed mood and divorce, continued to carry on and care for her two children and maintain her job.
5.2-2. I would want to rule out Depression due to other Medical condition or Substance/Medication-Induced Depressive Disorder. There is no information in the case about any medication Kathy is taking nor did she offer this information. This is a question that needs to be asked. Also, Kathy talks about her mother always having negative thoughts and needing naps. Perhaps there is a genetic medical condition at play here.
5.2-3. In this case, I would utilize a parent training class to offer support for Kathy as she raises her children. This could help the ?burden? she describes. Also Cognitive Behavior Therapy is a good idea for Kathy so that she can begin to realize her negative thinking and work to change her perceptions.
5.2-4. Another professional that could be helpful to Kathy would be a medical doctor so he could run test and rule out any substances in her body or medical issues that are contributing to her depressed mood.
5.2-5. My initial diagnosis for Kathy is Persistent Depressive Disorder (Dysthymia) 300.4 (F34.1), severe, with melancholic features. Kathy has spoken of depressed mood for most of the day for over two years (mood began in her thirties), Kathy has poor appetite (lost 20 pounds), has insomnia (she reports waking up early and not being able to get back to sleep), reports low energy in most endeavors, the criteria for MDD is present for over two years, there is not history of mania, there is no schizophrenia, delusional disorder, or other specified or unspecified schizophrenia, or psychotic disorder. Clinical impairment to social and occupational areas of functioning. The severe is because most of the criteria is met for PDD, and all melancholic features are present: loss of pleasure in most activities (Kathy reports feeling “burnt out”), Kathy has a distinct depressed mood and reports low energy and a “blue mood most of the time”, Kathy has early morning wakening as per her report, had significant weight loss (reports losing 20 pounds).