HPI and Comorbid Conditions
The patient is a 38 year old female who has MDD (Major Depressive Disorder). The issues that encouraged her to seek help included hypoactivity, sadness for no obvious reason, and auditory hallucinations that used to vary from mild to moderate (Papakostas, 2014). The diagnosis is supported by these signs. Following a thorough examination, the patient was diagnosed with MDD. The patient’s diagnosis was determined two months ago, and her mental condition has improved due to medications and therapy. The patient highlights that she does not have hallucinations anymore; nevertheless, she still has mood swings from time to time (primarily in stressful situations). Comorbid conditions include mood instability, irritability, and headaches.
Psychosocial Assessment
Being a Latin American woman, the patient belongs to a vulnerable group. In terms of her language identity, the patient speaks both English and Spanish. She is married to an African American man and acknowledges that their interpersonal problems have contributed to her condition. The patient has a master’s degree in education, and she claims to be stressed on a daily basis since she works with troubled children. She denies using alcohol and illegal drugs. However, she had problems with alcohol in her early twenties, but she managed to sign off drinking without professional help. The patient was born in a poor family, which explains her strong motivation to receive a degree. Another stress factor is her son’s health issues. As for the spiritual needs, the woman identifies herself as a Christian but neglects common religious practices.
Psychiatric Treatment History and Medications
Prior to being diagnosed with MDD, the patient did not have significant mental health issues and never needed professional help. In March, the client was examined by mental health specialists from our agency, and she was provided with treatment recommendations. In order to improve her performance at the workplace, pharmaceutical treatment was required. Given the character of her symptoms, the prescribed medications included antidepressants with stimulant qualities such as Bupropion and Fluoxetine. The patient was not prescribed antipsychotic drugs since the core reason for her hallucinations was sleep deprivation due to overtime working (Waters, Blom, Jardri, Hugdahl, & Sommer, 2018). The woman is still taking the above-mentioned antidepressants. As for nonprescription drugs, the client uses Ibuprofen and Naproxen to manage dysmenorrhea.
Mental Status Examination and Risk Assessment
The client looks anxious and seems to have a low BMI. She demonstrates rapport and answers all questions in a detailed manner. No significant abnormalities of activity. There are signs of affective flattening, and the patient has certain difficulties in describing her mood. The speech is loud and instable in tempo, whereas thoughts are clear and logical. The client’s perception is normal; there are no hallucinations. She is well-oriented and memorizes things quite easily. In terms of risks, the patient denies a family history of suicide or self-harm. Moreover, she does not have a propensity for autoaggressive behavior. However, there are certain risks of harm to others since the client has a history of alcohol abuse and often initiates interpersonal conflicts.
Treatment Recommendations and Diagnosis Evaluation
Based on the patient’s present condition, I would provide two important recommendations related to treatment. First, her condition seems to have improved due to pharmaceutical drugs, and this is why she needs to continue taking antidepressants. However, the dosages may need to be reduced to avoid irritability and other common side effects. The patient knows a little about MDD and the role of a depressed person in managing stress factors, and this is why I would recommend the implementation of one-on-one psychoeducation programs with special attention to self-help and irritation control techniques.
In the end, the diagnosis seems to be correct since it is supported by numerous signs such as low mood, sadness, sleep problems, and hallucinations. Taking the combination of symptoms into account, I fully agree with my preceptor. Also, the positive effect of medications speaks in favor of diagnostic accuracy.
Cognitive Behavior Therapy
There are numerous treatment options applied in the field of mental healthcare, and Cognitive Behavior Therapy or CBT presents one of the most commonly used practices. The chosen therapy is often regarded as a short-term intervention. As is clear from the term itself, CBT can be called the combination of two approaches to psychology.
The theory behind the chosen therapy is related both to cognitive and behavioral psychology. In terms of the key theoretical assumptions behind CBT, it is believed that destructive habits and behaviors develop due to the presence of unwanted thoughts that are difficult to control (Sockol, 2015). Importantly, these negative thoughts often remain unnoticed by patients, and sessions with psychotherapists help them to identify particular beliefs that are responsible for their problems. Using the above-mentioned premise, therapists who use the method analyze the settled modes of thinking of their patients and connect them with outcomes to understand causal links (Chu et al., 2015).
Personally, I am going to use CBT in the future since it allows working with patients’ harmful psychological attitudes and, therefore, provides clients with numerous opportunities for self-analysis. CBT is regarded as an effective method for anxiety and depression, and I could use it in my clinical practice to make patients more resistant to stress (Ebert et al., 2015). I often meet patients who seem to be anxious and nervous for no obvious reason, and using CBT in such cases could be helpful. In particular, it would be beneficial to reduce stress in patients by using different techniques such as journaling. The necessity to monitor the presence of negative thoughts and keep track of circumstances in which they occur would help my patients to control anxiety and understand its sources.
References
Chu, B. C., Talbott Crocco, S., Arnold, C. C., Brown, R., Southam-Gerow, M. A., & Weisz, J. R. (2015). Sustained implementation of cognitive-behavioral therapy for youth anxiety and depression: Long-term effects of structured training and consultation on therapist practice in the field. Professional Psychology: Research and Practice, 46(1), 70-79.
Ebert, D. D., Zarski, A. C., Christensen, H., Stikkelbroek, Y., Cuijpers, P., Berking, M., & Riper, H. (2015). Internet and computer-based cognitive behavioral therapy for anxiety and depression in youth: A meta-analysis of randomized controlled outcome trials. PloS One, 10(3), e0119895. Web.
Papakostas, G. I. (2014). Cognitive symptoms in patients with major depressive disorder and their implications for clinical practice. The Journal of Clinical Psychiatry, 75(1), 8-14.
Sockol, L. E. (2015). A systematic review of the efficacy of cognitive behavioral therapy for treating and preventing perinatal depression. Journal of Affective Disorders, 177, 7-21.
Waters, F., Blom, J. D., Jardri, R., Hugdahl, K., & Sommer, I. E. C. (2018). Auditory hallucinations, not necessarily a hallmark of psychotic disorder. Psychological Medicine, 48(4), 529-536.