Psy_270_Final_Project_-_Psychological_Disorder_Analysis

Final Project: Psychological Disorder Analysis Your Name Here University of Phoenix Axia College Intake Marla is a 42-year-old Hispanic female who came to the mental health clinic seek help for several symptoms currently causing her distress and impairing her level of function. Initially, Marla stated she was suffering from “trouble sleeping, feeling jumpy all the time, and an inability to concentrate (Axia College, 2010).” Marla believes her performance at work has suffered as a result of these symptoms. Fear of losing her job was the impetus for Marla to seek help. Following intake, further analysis of Marla’s symptoms is required in order to reach an accurate diagnosis. The suspected diagnosis upon intake is dysthymic disorder, but since her symptoms meet the criteria for major depression, panic disorder with agoraphobia, and post traumatic stress disorder, further questioning is needed in order to rule these out. Following diagnosis, Marla will be provided with an overview of the possible causes and a treatment plan in order to reduce her symptoms and return her to a higher level of functioning. Clinical Interview Marla participated in an in-depth clinical interview process. Initial questions posed to Marla to establish a starting point for further analysis included the following: 1. Please tell me about what type of person your father was/is 2. What kind of relationship did you have with him as a child and what kind of relationship do you have with him now' 3. Please tell me about what type of person your mother was/is. 4. What kind of relationship did you have with her as a child and what kind of relationship do you have with her now' 5. Please tell me about your relationships with siblings 6. Please tell me what you remember most about your childhood. 7. Please tell me about your most memorable experiences in grade school, high school, and college (if applicable). 8. Have you had any significant romantic relationships' Are you in a relationship now, or if you would like to be' 9. Please tell me about what makes you happiest in your current life. 10. Please tell me about what upsets you most in your personal life. This clinician was able to focus on multiple issues following Marla’s responses to initial interview questions. Significantly, Marla indicated that the length of time she had been experiencing these symptoms indicated dysthymic disorder to be the diagnosis. Marla also confirmed a family history of depression and Marla indicated that she, too, had suffered from depressive symptoms. However, the severity of symptoms does not meet the criteria for a diagnosis of major depression. In addition, Marla indicated that she has not recently suffered from a traumatic event, thus ruling out post-traumatic stress disorder. Significantly, when asked about what makes her happiest in her current life, Marla stated that she could not think of anything that makes her truly happy. She stated that overall her life consisted of work and sleep, with little else in between. She felt that she had more to offer to her job and to others but she just could not get motivated to do anything different. After considerable assessment this clinician is confident that Marla’s diagnosis is, according to the DSM-IV, 300.4 Dysthymic Disorder. A complete result of DSM-IV Multiaxial Evaluation for Marla is as follows: Axis I 300.4 Dysthymic Disorder, Late Onset, Prior Major Depressive Episode (Full Remission) Axis II V71.09 No diagnosis Axis III none Axis IV Occupational Problems, Inadequate Social Support Network Axis V GAF= 60 (current) Summary: Dysthymic Disorder With a potential of lasting for many years, dysthymia is a chronic condition. Although it shares symptoms similar to major depression, the key differentiation is that dysthymia involves symptoms less intense than those of major depression, but these symptoms persist for at least two years. It should be noted that no major depressive episode or mania should be present during the first two years of illness to confirm a diagnosis of dysthymia. Further, during the minimum two-year period of symptoms, the sufferer will have experienced no relief from symptoms for more than a two-month period within the two-years, and a depressed mood will be prevalent for most of the time. Further confirming a diagnosis of dysthymic disorder, the individual will have two or more common symptoms of the disorder including changes in appetite, sleep disturbance, decreased energy or fatigue, lowered levels of self-esteem, trouble concentrating and/or impairment in decision-making skills, and possibly a sense of hopelessness (Axia College, 2007). Many individuals diagnosed with dysthymic disorder may also meet the criteria for other diagnoses of mental illness. Therefore, Marla must be carefully monitored throughout her treatment for other conditions including anxiety disorder. Also, there is the possibility that sufferers of dysthymic disorder may develop double depression. This happens when major depression and dysthmia occur in tandem. Individuals with double depression will experience symptoms of chronic, mild depression with periodic intensification of symptoms related to major depression (Axia College, 2007). Dysthymic Disorder affects 3 to 5% of the population and is diagnosed more often in women than in men. Other mental illnesses regularly accompany a diagnosis of dysthymia including anxiety disorders, eating disorders, various personality disorders, and substance abuse. Although the individual suffering from dysthymic disorder may experience brief intervals of remission for a few months, the condition tends to recur and generally a reprieve lasts no more than one to two days. Causal Factors of Dysthymic Disorder There are several theoretical approaches as to the cause of Marla’s diagnosis with dysthymic disorder. First, because Marla reported a family history of depression, her symptoms may be explained through the biological theory of depression. For those who have a family history of depression, research suggests there is a possibility of a predisposition for developing unipolar depression for individuals with such a family history. The biological perspective also suggests a genetic component in the abnormal functioning of neurotransmitters and/or hormone levels, leading to the development of a depressive illness (Comer, 2005). This clinician believes that Marla’s condition can be explained by biological conditions as well as some causal sociocultural issues. First, as discussed previously, Marla has a family history of depressive illness, which may have predisposed her to developing both her previous bout of major depression and her current struggle with dysthymia. Since Marla reported feeling isolated, this suggests the possibility of poor social support, aiding in the development of a depressive disorder. In addition, the chances of developing a depressive disorder are higher among Hispanics and females, both of which may have played a role in Marla’s disorder (Comer, 2005). All of these factors in combination have allowed for Marla’s illness to occur. Personal Treatment Plan This clinician is considering prescribing Marla one of two antidepressant medications, both of which allow for the reduction of depressive symptoms. First, a tricyclic medication such as Trofranil, or, more likely, a second-generation antidepressant such as Prozac, may prove effective in Marla’s case. While both medications will probably work and have been proven effective for treating unipolar depression, Prozac or another selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SRNI) may have fewer side effects such as drowsiness, dry mouth, constipation, dizziness, headache and weight gain, among others (Mayoclinic.com, 2010). Both SSRI and SRNI medications may also reduce anxiety, which may help Marla feel less “jumpy,” while increasing her cognitive functioning. Marla would also benefit from cognitive-behavioral based therapy. These therapy sessions will challenge Marla’s unrealistic ideas and pessimism and self-critical outlook (Axia College, 2007). This method will also teach Marla to develop strategies for taking advantage of life’s opportunities (Axia College, 2007). Further, a behavioral approach will assist Marla in developing better coping strategies and communication skills (Axia College, 2007). Careful focus should also be given to identifying negative though processes and to change or reduce Marla’s maladaptive attitudes (Comer, 2005). Marla may also benefit from group therapy sessions with individuals who have a similar diagnosis of depressive illness. These sessions will give Marla the opportunity to develop a social support network as well as offer her interaction with people who share similar diagnoses, helping Marla feel less isolated. These sessions may also help Marla by receiving encouragement and suggestions about how to cope with her illness from people who have been successful at living with dysthymia. Of course, Marla’s treatment plan will be evaluated regularly and her progress will be monitored to ensure the plan’s overall effectiveness. Conclusion Although similar to major depression, dysthymic disorder is often overlooked and often goes untreated. There is a tendency to assume that the attitudes and behaviors of individuals with dysthymia are simply negative personality traits because the disorder can span years, even a lifetime (Axia College, 2007). Living with dysthymic disorder can be a lifelong battle for individuals who suffer from it. However, with proper diagnosis and treatment the prognosis increases significantly. Careful assessment and an individualized treatment plan will increase the likelihood of a positive outcome and better quality of life. References Axia College. (2007). Faces of abnormality interactive. Retrieved from http://www.mhhe.com/ socscience/psychology/faces/bigvid.swf . McGraw Hill. Axia College. (2009). PSY/270 Abnormal Psychology Course Syllabus. University of Phoenix. Comer, R.J. (2005). Fundamentals of abnormal psychology (5th ed.). New York: Worth Publishers. Mayoclinic.com. (2010). Depression: Tricyclic antidepressants and tetracyclic antidepressants. Retrieved from http://www.mayoclinic.com/health/antidepressants/MH00071.