Subjective
L. is a 39-year-old Caucasian woman diagnosed with stage IA uterine cancer one year ago and depression (three months ago), a single mother (two underage children) working as a maths teacher. The client had a surgical intervention (hysterectomy) three weeks ago. Mental health concerns reported: frustration, lack of interest in daily activities, unrealistic expectations concerning hysterectomy, abnormal irritancy, and high proneness to conflict at work. L reports self-esteem problems – she believes that the disease will make her “a no oil painting” and prevent her from having new relationships. The patient claims to have sleep problems. Medications are taken after surgery: Ovestin and Microfolline.
Objective
General/musculoskeletal: normal gait and posture, weight loss (normal), daytime sleepiness, decreased appetite, mild back, and ankle pain.
HEENT/neurology: no eyesight problems, tension headache from time to time, no nose/ear pain, mild tooth pain, slow speech, no significant changes related to senses
Cardiovascular/respiratory: no chest pain, PND, SOB, or abnormal cough. No exposure to smoke or toxic substances.
Gastrointestinal/genitourinary: no swallowing and digestion problems, mild stomachache after spicy food. The loss of reproductive function, menopausal symptoms, mild vaginal pain.
Mental status exam: lack of self-care, no signs of alcohol, or substance abuse. Takes all questions seriously and is ready to cooperate. No dystonia or other abnormal movements; looks inactive and avoids making eye contact too often. Apathetic and sad mood, flat affect. Speech is quiet and slow, L. uses almost no gestures, no problems with short-term memory, no articulation reduction. Thoughts are logically coherent and organized, L. focuses on her fears and “lack of mental toughness”. Implicit suicidal thoughts, mild auditory hallucinations due to sleep deprivation, no orientation, or memory problems.
Assessment
Diagnosis: MDD.
Summary: the patient has a persistent sad mood and cannot put up with physical changes after cancer surgery, there is also the fear of being rejected by men.
Plan
Treatment goals: reduce fear, help the patient build self-confidence, and accept changes related to surgery, reduce irritability.
Interventions: CBT techniques such as journaling and cognitive restructuring to get rid of harmful ideas, verbal psychoeducation, and PST to develop problem-solving attitudes.
Supplemental Paper
Given that cancer affects both physical and mental well-being, this disease can be detrimental to people’s quality of life. The situation under analysis refers to the case of depression in a woman who had a hysterectomy a few weeks ago. In this case, it is important to further explore the connection between uterine cancer and depression since this type of cancer may have an impact on women’s self-identity.
Depression can develop in women with uterine cancer due to different reasons, and problems related to the feeling of femininity are among them. The way that women perceive their femininity can change depending on life stages. However, the most common thing associated with being a female is fertility. In fact, it is often impossible to preserve reproductive function in patients with uterine cancer, and there is evidence that younger women (those of the climacteric age) are more likely to become depressed than older patients (Theunissen et al., 2017). The necessity to accept the diagnosis of cancer and realize its possible consequences is a significant stress factor in itself. The risks of depression become even higher if total hysterectomy is performed since it involves hormonal changes and physical pain (Chen et al., 2017).
In the end, there is a range of psychotherapeutic interventions helping cancer patients to cope with life changes and get rid of communication problems. Among the most effective methods used to treat depression in people with cancer are CBT, psychoeducation, and problem-solving therapy (Smith, 2015). Given that the positive effect of all interventions has been proved clinically, all methods can be used to achieve treatment goals identified in the SOAP note.
References
Chen, C. Y., Yang, Y. H., Lee, C. P., Wang, T. Y., Cheng, B. H., Huang, Y. C.,… Chen, V. C. H. (2017). Risk of depression following uterine cancer: A nationwide population-based study. Psycho-Oncology, 26(11), 1770-1776.
Smith, H. R. (2015). Depression in cancer patients: Pathogenesis, implications and treatment. Oncology Letters, 9(4), 1509-1514.
Theunissen, M., Peters, M. L., Schepers, J., Schoot, D. C., Gramke, H. F., & Marcus, M. A. (2017). Prevalence and predictors of depression and well-being after hysterectomy: An observational study. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 217, 94-100.