Biopsychosocial History, Presenting Problems, and Symptoms
In this case, Hope is a 35-year-old African-American female patient. She is single, and her relationships with a family (mother, sister, and step-father) are strained, which results in a limited support system. The patient has a seven-year-old daughter, but their relationships are distant because of the influence she could have on the child. Hope has neither stable sexual relationships nor good job because of impersonal conflicts and a feeling that people betray her. As a result, her main complaints include the lack of energy, no interest in being involved in different activities, sleeping problems, no appetite, and irregular suicidal thoughts. She wants to be invisible and disappear and cannot get rid of a thought that something goes wrong with her. The symptoms are weight loss (5 pounds in the past month), eye contact avoidance, anxiety, and hypervigilance. The patient denies her participation in any religious or community activities. She does not take any drugs or other substances but admits drinking beer (2-3 glasses per week). It helps improve her mood and increase socialization at bars.
Differential Diagnoses and Final Diagnosis
Regarding her current symptoms and problems, it is possible to define major depressive disorder in Hope. According to the American Psychiatric Association (2013), low mood, hopelessness, diminished interest, weight loss, insomnia, retardation, fatigue, indecisiveness, suicidal thoughts, and feeling of worthlessness during the last four months represent a major depressive episode. Regarding the presence of all symptoms, the level of this disorder is severe (Ng, How, & Ng, 2017). Other diagnoses that should be taken into consideration are manic episodes with irritable mood or mixed episodes. However, to prove this diagnosis, additional assessment for such symptoms as distractibility or talkativeness is necessary. People with generalized anxiety disorder meet many depressive symptoms, but this condition also includes muscle tension and nausea that were not observed in the patient. Finally, the episodes of sadness can be diagnosed if the symptoms last most of the day during the last two weeks. In this case, Hope reports that some of the symptoms occur once a week. To avoid misunderstandings and give a correct diagnosis, additional information about the duration of each symptom and the use of medications is required.
Contributing Factors to the Client’s Condition
The condition of the client proves that Hope has a number of serious mental health problems that should be treated. For example, her feeling of uselessness in this life may be explained by strained relationships with the family. Hope admits that she has not spoken to her mother and sister during the last two years. Her distant relationships with the daughter also provoke hopelessness and sadness. The patient does not have any kind of support at home and must deal with her symptoms alone. Her recent loss of the job is explained by absenteeism, and her current job search does not bring any results because of the inability to meet employers’ expectations. No religious interests and no faith are the cultural factors that contribute to the lack of interest in all activities. She does not have friends or constant partners to communicate and share her concerns. Finally, his poor financial history and renting problems promote a bad environment, which results in suicidal thoughts or the desire to become invisible in society.
Clinical Treatment
Depression is a mental health disorder that worsens the quality of life and provokes changes in social functioning. The diagnosis of depression might inform a clinical treatment plan in several ways. First, the fact that similar symptoms have already been observed two times at different age periods and lasted between four and six months shows that previous SSRI antidepressant treatment was not effective. Therefore, instead of single pharmacological treatment, psychotherapy is recommended. Ng et al. (2017) underline the worth of cognitive behavioral therapy in combination with interpersonal or problem-solving therapy. It is necessary to identify the sources of all dysfunctional thoughts and replace them with good memories and positive tasks. Hope lacks adequate social support; that is why hospitalization is an optimal treatment setting to increase the patient’s ability to communicate and analyze her problems (Gautam, Jain, Gautam, Vahia, & Grover, 2017). Antidepressants usually help depressed patients, and, in this case, the analysis of Hope’s past medications, their dosage, and treatment period will help choose another option. Finally, if no adequate response is observed within the next month, electroconvulsive therapy has to be prescribed.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.
Gautam, S., Jain, A., Gautam, M., Vahia, V. N., & Grover, S. (2017). Clinical practice guidelines for the management of depression. Indian Journal of Psychiatry, 59(1), 34-50. Web.
Ng, C. W. M., How, C. H., & Ng, Y. P. (2017). Managing depression in primary care. Singapore Medical Journal, 58(8), 459-466. Web.