PSY 270 Final- Psychological Disorder Analysis
PSY 270 Final- Psychological Disorder Analysis
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P s y c h o l o g i c a l D i s o r d e r A n a l y s i s | 1 Psychological Disorder Analysis Name Axia College PSY 270 Instructor P s y c h o l o g i c a l D i s o r d e r A n a l y s i s | 2 Psychological Disorder Analysis Marla Hernandez, a 42yearold Hispanic female, has come to the mental health clinic regarding symptoms that have begun to affect her quality of life. My initial meeting with Marla uncovered the following symptoms: difficulty sleeping, feeling jumpy, and trouble concentrating. Her symptoms have also begun to interfere with her daily functioning, particularly in her work atmosphere. To allow for proper diagnosis Marla participated in a clinical interview which uncovered various underlying causal factors. Clinical Interview: Marla Hernandez “Good afternoon Marla. Today you will be participating in a clinical interview. I will be asking you various questions which will help me determine the cause of your symptoms. It’s important that I get as much information as possible, so try to be as detailed as you can.” “Okay, I will answer your questions to the best of my ability.” “Great. Let’s get started. What made you decide to come to the mental health clinic?” “Well the main reason that I have come to you is because of the symptoms that I have been experiencing. I can’t seem to get a good night sleep and I have been having a lot of trouble concentrating at work. I have also been feeling really jumpy all the time, which is really uncomfortable. I’m sick of living with these symptoms, and I just want to get back to my normal self.” P s y c h o l o g i c a l D i s o r d e r A n a l y s i s | 3 “When you say that you are jumpy all of the time, what do you mean by that? How long have you been experiencing these symptoms? Do you happen to have any physical symptoms such as headaches, stomach aches, or anything of that nature?” “When I’m ‘jumpy’ I just feel like I can’t sit still…I’m very restless and irritable. The symptoms have been bothering me for quite some time now. I would say that it has been a little over four years. At first I thought that the symptoms would go away over time, but as time has progressed I have started to feel really hopeless. I just can’t seem to be normal like everyone else. I get migraines quite often, usually while I’m at work, which tends to make matters worse. Since I’ve been having sleeping problems I tend to get really tired throughout the day, which is really frustrating. Other than that I don’t really have any recurring physical symptoms.” “Have there been any significant traumatic events within the past four to five years of your life?” “I have not had any traumatic events occur in the past four years. I would say that the most traumatic thing is the onset of these awful symptoms. I just can’t seem to shake them no matter how hard I try.” “Is there a family history of any of the symptoms that you are experiencing?” “There are none that I know of. I guess I never took the time to find out. My mother and father never talked much about their relatives.” “Can you tell me a little about your childhood and adolescence?” P s y c h o l o g i c a l D i s o r d e r A n a l y s i s | 4 “I had a pretty normal childhood. It wasn’t great, but it wasn’t awful. My parents separated when I was eight years old, but I still saw them both on a regular basis. My mother was always extremely judgmental, and I often felt like I didn’t measure up to her expectations. I didn’t really have many close friends because I always felt like an outsider. As a teenager I struggled with low selfesteem, which I guess has continued into adulthood as well. I always did well in school and graduated at the top of my class, but I never felt like I was good enough. At work I still feel inadequate in many ways; although, my manager has told me many times that I am an asset to the company.” “Do you still have a good relationship with your parents?” “For the most part I do. I talk to them from time to time, but I don’t see them very often. Since my symptoms started I haven’t really felt like being around people too often. I guess I try to avoid social interactions because I feel like people will see me as strange or abnormal. Another reason I may be avoiding contact with my parents is my recent weight gain. For the past three years I have been gaining weight like crazy, and I’m ashamed of what my parents will think.” “You are doing a great job of answering my questions, Marla. I appreciate your honesty. I know it can be difficult to answer questions of this nature, but it is important that I get to the root of your symptoms. Now, can you tell me a little bit about your current situation? Do you have a husband or any children? How do you like your current job?” “I’m single. I’ve been in one serious relationship, but it didn’t work out. My fiancé ended up cheating on me, and we broke off our engagement when I was 25. I guess I just wasn’t P s y c h o l o g i c a l D i s o r d e r A n a l y s i s | 5 pretty enough for him. I date from time to time but other than that I keep to myself. I have a few close friends, but I don’t spend much time with them. They are all pretty busy with work, and I guess I am too. I don’t mind my job, but my symptoms definitely make it challenging. My manager gets frustrated with me because I find it hard to concentrate throughout the day.” “Do you find that your symptoms are persistent or do they seem to come and go?” “The symptoms tend to vary from time to time. One month they could be really mild, and the next month they may be more severe. Sometimes I feel as though things are not that bad, but other times I am absolutely hopeless.” “I understand how frustrating that can be. You’ve made the right choice to come here, and I’m confident that we can help you. I just have a few more questions for you. Are you currently taking any medications, or have you stopped taking any medications within the past five years?” “I’m not on any medications. The only thing that I take on a regular basis is a women’s multivitamin. I haven’t stopped taking any medications within the past five years either. I’ve had people suggest that I try antidepressants but I don’t want to take any medications without fully understanding the cause of my symptoms, which is another reason why I came here.” “That is understandable. When was your last physical exam and what were your results?” “My last physical exam was about a year ago. My doctor said I was overweight. He recommended that I increase my physical activity and eat healthier, which I’ve been trying to do, P s y c h o l o g i c a l D i s o r d e r A n a l y s i s | 6 but it’s difficult for me to stick to a healthy regime because I can’t seem to motivate myself. I try to go for a half hour walk every night, and I’ve started eating a little healthier most of the time.” “Lifestyle changes can be extremely difficult, but I’m glad to hear that you are taking his advice and making an effort to lead a healthier lifestyle. These types of changes take time, so keep up the good work. That wraps up our clinical interview process. You did very well, Marla. The information that you have given me has helped a great deal. I believe that I have enough background information to formulate a diagnosis.” Dysthymic Disorder The information that I gathered from Marla’s clinical interview allowed me to eliminate several disorders, which include post traumatic stress disorder and major depression. According to the DSMIV criteria Marla is suffering from Dysthymic Disorder. Although Marla’s symptoms are similar to that of major depression the severity of her symptoms are not compatible with a diagnosis of major depression. Marla also indicated that she has not experienced anything traumatic within the past five years, which rules out post traumatic stress disorder. Dysthymia is a chronic disorder that lasts for a period of at least two years. Marla’s case of dysthymia is characterized by the following symptoms: overeating, low selfesteem, poor concentration, hopelessness, and insomnia (Axia College, 2007). Dysthymia can also cause an onset of other symptoms, such as: fatigue, irritability, loss of interest in daily activities, and social avoidance (Mayo Clinic, 2008). The symptoms of dysthymia are similar to that of major P s y c h o l o g i c a l D i s o r d e r A n a l y s i s | 7 depression, but in a case of dysthymia the symptoms are not as debilitating as the symptoms of major depression. An individual with a Dysthymic Disorder must have two or more prevalent symptoms of the disorder to reach a diagnosis. Dysthymic Disorder affects 3 to 5 percent of the population and is most frequently diagnosed among women. Other mental illnesses that regularly accompany a diagnosis of Dysthymia include anxiety disorders, eating disorders, various personality disorders, and substance abuse. An individual diagnosed with Dysthymic Disorder may experience brief intervals of remission of symptoms which can last for a few months but tend to recur and typically the disorder only allows for a lack of depressive symptoms for a period of one to two days (Axia College, 2007). Causal Factors Dysthymia can be a result of various causal factors such as biochemical abnormalities, genetics, and environment (Mayo Clinic, 2008). The information provided by Marla’s clinical interview leads me to believe that the causal factors of Marla’s dysthymia lie within the cognitive model of psychology. Marla has developed false assumptions and attitudes about herself and her life experiences (Comer, 2005). Although Marla graduated at the top of her class and she is an asset at work she feels inadequate in many ways, which has led to illogical and negative self thoughts. These factors stem back to Marla’s relationship with her mother, which would be considered an environmental influence. During the clinical interview Marla mentioned that her mother was extremely judgmental and had high expectations. This has had a lasting impact on Marla and has led to her illogical way of thinking. According to the cognitive model Marla’s selfdefeating thoughts are the cause of her dysthymia symptoms. Marla’s negative way of thinking has also had an impact on her social life and her relationships. She avoids developing close relationships with others out of fear that they P s y c h o l o g i c a l D i s o r d e r A n a l y s i s | 8 will see her as “abnormal” or “strange.” This is yet another example of Marla’s illogical and inaccurate views. Treatment Options Cognitive therapy along with medication is the best treatment option for Marla. Several medications that may be helpful in Marla’s case include selective serotonin reuptake inhibitors (SSRIs) or Tricyclic antidepressants (TCAs) like Tofranil (Axia College, 2007; Mayo Clinic, 2008). Such medications will help alleviate some of Marla’s symptoms such as ‘jumpiness’ or difficulty concentrating which will help improve her work performance. Cognitive therapy is imperative to Marla’s long term recovery from Dysthymia. This type of therapy will help Marla recognize self defeating behaviors or thoughts and replace such thoughts and behaviors with positive reinforcements (Axia College, 2007). Cognitive therapy will enable Marla to lead a more fulfilling life while also improving her selfesteem. Marla’s may also want to participate in group therapy sessions with individual’s having a similar diagnosis of depressive illness. Group therapy will give Marla the opportunity to improve her social interactions and she will also learn to effectively communicate her feelings. Marla’s progress will have to be closely monitored to measure areas of improvement. It is important for Marla to understand that she must continue treatment until she is fully recovered, even if she feels better after only several treatment sessions. Marla’s case of dysthymia has been ongoing for quite some time, but with continued effort she will likely experience a full recovery. Although she stated that she sometimes feels “hopeless” she has an optimistic outlook which will be beneficial as she proceeds through treatment. Marla has made the first important step of seeking professional help from a mental health clinic, which has greatly improved her chances of eventually leading a normal functioning P s y c h o l o g i c a l D i s o r d e r A n a l y s i s | 9 life. I will continue to meet with Marla throughout her treatment plan to monitor her progress and improvement as she overcomes her dysthymia. References Axia College. (2007). Faces of abnormality interactive. Retrieved December 10, 2009 from Axia College http://www.mhhe.com/socscience/psychology/faces/bigvid.swf Comer, R. J. (2005). Fundamentals of abnormal psychology (4th ed.). New York: Worth. Mayo Clinic. (2008). Dysthymia (Dysthymic Disorder). Retrieved December 13, 2009 from http://www.mayoclinic.com/health/dysthymia/DS01111
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