Key Issues
Biological
It is possible to outline one biological issue evident from Sam’s background. Although there is no relevant information about pregnancy and birth history, and no relevant previous illnesses were informed about, such a psychiatric problem as depression is not uncommon for Sam’s family. Her mother had long-term depression, while Sam’s sister also has certain related struggles. Sam does not take any medications that could potentially cause psychoactive effects, and she is not exposed to nicotine, drugs, and high doses of alcohol.
Psychological
Prior to her current condition, Sam experienced her parents’ divorce which was a result, primarily, of her mother’s depression. The other potentially harmful events and potential stressors were not reported.
Social
Social factors are more beneficial, as prior to her current state, Sam has a circle of friends and support from them, mother, and stepfather. However, she is not in a romantic relationship which also could contribute to her condition (Marcelo et al., 2017).
Spiritual
It was reported that religion plays an important role in Sam’s life and can be a valuable factor that can positively influence her recovery (Marcelo et al., 2017). She had not had suicidal intentions prior to her current condition.
Assessment
It is possible to present one valid assessment tool to clarify the diagnosis, which is expected to be moderate major depressive disorder. The Patient Health Questionnaire-9 (PHQ-9) is a self-administered tool used the determination the severity of major depression based on current diagnostic criteria (Torous et al., 2015). It will ensure the correctness of the diagnosis through proving and complementing already reported signs and assist in the determination of its severity, which is especially vital at the beginning of the treatment process.
Diagnostic Impressions
Signs and Symptoms
- Depressed mood most of the day (American Psychiatric Association, 2013).
- Feelings of sadness that have been present.
- Diminished interest in regular activities.
- A lack of enjoyment in any normal activities.
- Insomnia or hypersomnia nearly every day.
- Sleeping 1-2 hours or 12-13 hours per day.
- Fatigue or loss of energy most days.
- The presence of constant fatigue.
- Recurrent thoughts of death and suicide.
- Occasional thoughts about suicide are present.
- Diminished ability to think or concentrate.
- Struggle with concentrating and thinking is present.
- Experiencing feelings of worthlessness.
- Struggle with feeling worthless is present.
- Loss of appetite as non-indicated in DMS-5 symptom.
Other DSM Conditions Considered
During the process of deciding which diagnosis is the correct one, the following DSM conditions were considered. Disruptive Mood Dysregulation Disorder does not fit because of the patient’s age, as she is not a child that could potentially have such a disorder (American Psychiatric Association, 2013). Persistent Depressive Disorder (PDD) can be a second possible diagnosis, which is likely to be ruled out by (PHQ-9) as it is a relatively mild form of depression.
At the same time, Sam even has her social relationships troubled, indicating a more severe form of the disease, especially in the view of her genetics. Premenstrual Dysphoric Disorder was considered but did not fit as no dependency between menstrual cycles as the manifestations of symptoms were reported (American Psychiatric Association, 2013). Substance/Medication-Induced Depressive Disorder was ruled out as no medications have been taken. Simultaneously Depressive Disorder due to Another Medical Condition is not possible as no conditions were reported.
Consideration of Theories and Factors
It is possible to consider a theory of normal and abnormal development with respect to the factors that affect Sam’s development and could potentially lead to the expression of her condition. Based on Erikson’s eight stages of psychological development, it is possible to outline one of them, which can potentially be a cause of abnormality (Knight, 2017). Stage six, “Intimacy vs. Isolation,” relevant for people 19-40 years old, indicates that a lack of strong intimate relationships results in loneliness and isolation which fits the case.
Multicultural or Social Justice Considerations
It is possible to outline some nuances taking into consideration counseling-related concerns with respect to social justice and cultural aspects. The patient has potential access to all the resources and rights of society. Although, it shall be emphasized that Sam is a social worker and communicate with individuals with different conditions, which, considering the depression of the patient, can be a deteriorative experience for both the client and her surrounding at the workplace.
Treatment Recommendations
Key Issues
- Loneliness because of the absence of intimate relationships.
- Vulnerability to depression because of genetics.
- Divorce of parents that happened in the childhood.
- Loneliness because of not living with family.
Recommendations for Individual Counseling
Based on the previously outlined key issues, it is possible to provide appropriate recommendations. The vital approach that shall be considered and complimented with antidepressants is psychotherapy intended to adjust to a crisis and explore relationships and experiences while developing positive interactions with others to ensure the modification of Sam’s attitude toward intimate affection (Mayo Clinic Staff, 2018). The other recommendation is to utilize supplements, vitamins, and essential oils while adjusting to lifestyle through exercising (Higuera, 2020). In the event, additional measures are necessary electroconvulsive therapy (ECT) or repetitive transcranial magnetic stimulation (rTMS) are advisable (Higuera, 2020).
Specific Considerations
In this case, the patient being in crisis made the treatment plan more focused on reducing the intensity of reactions, such as emotional, mental, behavioral, and physical ones. The purpose of this is to reveal the condition immediately instead of emphasizing finding and eliminating the root cause. The patient’s crisis could potentially make the situation seem more severe, resulting in a wrong degree of severity or the type of depression determination.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.
Higuera, V. (2020). Everything you want to know about depression. Healthline. Web.
Knight, G. Z. (2017). A proposed model of Psychodynamic Psychotherapy linked to Erik Erikson’s eight stages of psychosocial development. Wiley Online Library, 24(5), 1047-1058. Web.
Marcelo, S., Medeiros, R., & Mosini, C. A. (2017). Are we ready for a true Biopsychosocial–Spiritual model? The Many Meanings of “Spiritual.” Medicines, 4(4), 79. Web.
Mayo Clinic Staff. (2018). Depression (Major Depressive Disorder). MayoClinic. Web.
Torous, J., Staples, P., Shanahan, M., Lin, C., Peck, P., Keshavan, M., & Onnela, J. (2015). Utilizing a personal smartphone custom app to assess the Patient Health Questionnaire-9 (PHQ-9): depressive symptoms in patients with Major Depressive Disorder. JMIR Mental Health, 2(1). Web.