Question

Hi! Below is the case study and I want to make sure I'm on the right track. I bolded the questions I'm interested in (1-5). Looking for people who are familiar with the DSM-5/abnormal psychology and able to answer all questions completely. Thank you! Detailed answers extremely appreciated!

Questions:

1. Diagnosis; what is the evidence for it?

2. Treatment; typical treatment used for this diagnosis AND most effective treatment. IF the person is in treatment, what should we target first in terms of symptoms? How likely are they to stay in treatment and how likely are they to recover? Are meds involved and if so, what broad “type” of meds work for this disorder,?

3. Differential diagnosis (why is it this disorder and not this disorder)

4. Does the person have more than one diagnosis, what would DSM say about the criteria for diagnosing that

5. What would the primary causal theories be?

CASE STUDY:

Paul is a 30 year old engineer who is quite successful and lives in New York with his girlfriend. He normally loves his life, but over the past four or five months he just can’t seem to get excited or happy about anything. He has a lot of work issues - the company was sold and the owners, who were his friends, pretty well just took the money and ran - leaving all the employees (including Paul) in chaos (with the new owners) .Paul is now very unhappy at work and most of the other employees (all of his friends) have left for new jobs, but Paul just can’t seem to get his act together to even look for a new job. His girlfriend notes that he is moody, irritable and always tired, he never wants to go out and he has stopped exercising and stopped pretty well all of his fun hobbies or activities. He does not even enjoy taking his dog out for a walk, and his dog was always his favorite thing in the world (next to his girlfriend). Mostly Paul just seems to sit around on the couch watching television and doing nothing when he is not at work. He does not drink or do drugs, but he does not eat healthy either. He has gained 20 pounds is six months and he does not really care. He says that he often thinks that he would be better off dead. Medically he is fine and he has tons of money and lots of friends who care about him and he even has a great family who are in frequent contact with him. His girlfriend is concerned, as is his family, as Paul does not seem to be “snapping out of it”. They send him to a psychologist to try to figure out what is wrong (his medical doctor said there were no medical problems evident).

Answer 1

It can be termed as severe depressive episode without psychotic symptoms, according to ICD 10, evidences being,(i) lack of interest in things which were ineteresting earlier(ii)symptoms persisting more than 2 weeks, (iii) feeling of worthlessness (iv) considerable amount of distress or agitation.(v)loss of self esteem(vi) Somatic symptoms of being tired.

There are various approaches used to treat this,psychotherapy, intake of antidepressants, and electroconvulsive treatment. Psychotherapy include cognitive behavioral therapy, interpersonal therapy, psychodynamic therapy etc. Drug therapy include, selective serotonin reuptake inhibitors (SSRIs), serotonin norephinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants etc. Electroconvulsive treatment is used in rearest of cases depending on the severity of symptoms.

Most effective treatment is a combination of psychotherapy and drug therapy. If in treatment the person, the first symptom that should be tackled is, encouragement to involve in social activities, keeping them engaged as much as possible.It is not hard to keep them under treatment and gradually with the help of psychotherapy, drug therapy and change in lifestyle recovery is possible but chances are that they might reoccur.

Differential diagnosis are,(1)mild depressive disorder because the symptoms persists more than 2 weeks and there is significant difficulty in continuing with ordinary work and social activities.(2)Moderate depressive episode because it is more than 2 weeks all of the above stated symptoms still persist and to a severe intensity.(3) Severe depressive episode with psychotic symtoms because there is abscence of delusion and hallucination.

Theories of depression are based on behaviorists theory, they belive that environment plays a vital role in shaping the behavior. It can be observed or learnt like in operant or classical conditioning and social learning.Psychoanalytical theory which states that the past experiences play a vital role in shaping the behavior.Sigmund Freud coined psychoanalysis, he distinguished between actual losses and symbolic losses, both can lead to depression.Cognitive approach, it is based on individuals thinking, negative thinking leads to depression. Humanist theory is based on human needs, individuals attain satisfaction when their needs are fulfilled but develop depression when there are obstacles or failure to attain it.