Chris Hegman Abnormal Psychology Section 004 Axis I: 396.

22 Major depressive disorder, single episode, moderate, with melancholic features Axis II: No diagnosis Axis III: None Axis IV: Previously divorced, health problems in family, inadequate finances, academic problems, loss of contact with friend. Axis V: Current GAF = 34 Diagnosis Melissa is a 30 year old, single mother. She has three children Adam, Jennifer, and Claire. Until recently, Melissa had been working towards her bachelor degree, hoping to eventually enter law school. She is currently living in a house obtained from the settlement of her recent divorce. Before she withdrew from her classes, Melissa relied primarily on student loans and grant-in-aid in order to support her family. Melissa initially visited the psychologist seeking help for her youngest child, Adam who had recently been having trouble sleeping. However, it soon became apparent that Melissa needed help dealing with her depressed mood. The information within the case study has led me to diagnose Melissa with major depressive disorder. Melissa is currently experiencing a major depressive episode that has lasted for four consecutive weeks. In order to classify a major depressive episode, the required symptoms must persist for more than two weeks (4th ed., text revision, American Psychiatric Association, 2000). This appears to be the first time she has experienced a major depressive episode. Although Melissas mood has been depressed since her divorce, which happened over a year ago, the last few weeks she has experienced worsened symptoms. Melissas loss of interest in her friends and most of her previous activities is the first indicator of her depressive episode

(DSM-IV-TR). It is stated that after her divorce, Melissa was able to increase her mood by playing with her children or talking to her friends. Recently however, Melissa has stated that nothing seems to cheer her up and that her children have become more of a burden. The second indicator of her depressive mood is her excessive guilt (DSM-IV-TR). Melissa blames herself for her recent divorce. She suggested that she had been a poor marital partner, despite most of her arguments relating to the common differences between men and women. Her over exaggerated guilt has led her to question her value within other relationships and is largely responsible for her withdrawal from classes. Melissas worry about her divorce caused her to lose motivation within her studies. She often found it hard to concentrate and think during lectures. Melissas inability to concentrate is the third indicator of her depressive episode (DSMIV-TR). The fourth indicator is Melissas change in appetite. Melissa has stated that she has recently gained weight. Her gain in weight is significant enough that her children began to comment on her appearance. The final indicator is Melissas frequent thoughts about suicide. Although I originally consider giving the diagnosis of atypical features, the lack of mood reactivity prompted me to forgo the diagnosis. Anxiety disorders were also considered, specifically GAD, but the time requirement of six months was not met (DSM-IV-TR). Melissa does not show any signs of mental retardation and there is not sufficient evidence to diagnose her with a personality disorder. Although several of her symptoms were related to specific personality disorders, they were either better accounted for by major depression disorder or there was an insufficient number of diagnostic criteria met in order to diagnosis a personality disorder (DSM-IV-TR). Not much information was given about Melissas physical health. The case study mentioned that Melissa had been gaining weight, but I chose not to include this on the third axis. The weight gain that Melissa experienced was influential to the progression of her disorder.

However, the weight gain itself is considered to be a symptom of the disorder rather than a separately diagnosed health problem. I chose to include Melissas divorce in the fourth axis because it is the main source of her guilt and is what initiated her depressive mood. Both health problems in the family and financial issues have provided sources of anxiety and have led Melissa to question her value as a parent. They have also negatively influenced her performance in school. Melissas withdrawal from school has left her with no plan and little hope for the future, further aggravating her depression, causing her to consider suicide. Finally, the withdrawal of Melissas best friend has left her with fewer options to relieve her depressive mood. Based upon my current knowledge, I gave Melissa a GAF score of 34. Melissas depressive symptoms have interfered with her school work, as well as her relationships with her friends. Although she is not preoccupied with thoughts of suicide, she does think about suicide frequently. Melissa also cries for long periods of time and even finds it hard to do simple things such as reading. Despite these facts, Melissa has not yet abandoned her family and has not made any plans to commit suicide (Beidel & Bulik, 2012). Treatment Recommendations Since most patients tend to benefit from a combination of both medication and psychotherapy, I would recommend both cognitive-behavioral therapy and the use of selective serotonin reuptake inhibitors. The use of SSRIs would hopefully help to alleviate some of the symptoms that Melissa is experiencing, allowing her to fully benefit from the treatment of CBT. CBT would then help Melissa to identify her negative cognitions, replacing them with appropriate thoughts. CBT would also allow Melissa to identify specific behaviors which trigger negative thoughts, teaching her to behave differently in order to reduce those negative thoughts (Beidel & Bulik, 2012).

References Beidel, D. C., & Bulik, C. M. (2012). Abnormal psychology (2nd ed.). Boston: Pearson. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. (4th ed.). (2000). Washington, DC: American Psychiatric Association.