Psychological Disorder Analysis
The diagnosis given to Maria is Dysthymic Disorder. Maria has been having trouble sleeping at night, feeling ‘jumpy’, and not able to concentrate. I suspect this has been going on for a while and possibly co-occurs with other psychological symptoms. Further questioning Maria about her past and present symptom onset will help in confirming this diagnosis to help treat her appropriately. Background Information
Dysthymia comes from the words thalamus and thyroid, hence the reason it is called dysthymia.
Dysthymic disorder is described as a mood disorder with mild or chronic depression, often appearing earlier in life then major depression, often appearing to be as part of one’s personality (McGraw Hill, 2007). In diagnosing this disorder the patient must show at least two symptoms of the following six depression symptoms: low self-esteem, feeling hopeless, fatigue, eating disturbances, difficulty concentrating or decision making, and sleep disturbances.
In addition, a person with dysthymic disorder is usually not without symptoms for more than two months at a time, has a gradual onset of symptoms, and significant impairment in social or work function. Diagnosis with dysthymic disorder cannot be made if the person has an underlying condition of consisting of psychotic disorder, bipolar, or because the symptoms are due to medication, substance abuse or a medical condition. Furthermore, one who has dysthymic disorder is also more likely to suffer from anxiety disorders, substance abuse, and personality disorders such as avoidant or borderline (Dysthymic Disorder, 2004).
This disorder is most common in women than in men and affect approximately 3% to 5% of the population (McGraw Hill, 2007). The prevalence of dysthymic disorder according to a study done by Riolo, Nguyen, Greden, and King, (2005), were significantly higher in African Americans and Mexican Americans compared to whites. Lack of education remained a risk factor for dysthymic disorder; however, in whites as education went up the prevalence went down. For Mexican and African Americans though, the education effect was less obvious and dependant on the gender. Observations During the initial contact with Maria, she stated she is a 42-year-old Hispanic woman and works as an accountant. She has noticed having trouble sleeping at night, feeling ‘jumpy’ all of the time, and cannot concentrate.
As Maria states, these symptoms are causing problems for her at her workplace where she works as an accountant. I want to find out when did she first notice these symptoms? Have these symptoms been going on for a couple weeks, months, years and do they seem to come and go for a period of time?
Maria indicates these have been ongoing for some time, but most recently over the past several months has she noticed it is affecting her work. Can you give me some examples of times when you felt jumpy? What happened? Maria states when she is waiting for a client, the phone may ring, or secretary may come in to let her know her appointment has arrived and she jumps, like she were in a daze, or sleeping and something has occurred to snap her out of it. Have there been any life changing events in your life recently such as, a parent or close friend passing, divorce, marriage, birth of a child or a child leaving the home, or going to college?
What about over the years? At age 24 Maria graduated with her degree in accounting. College is also where she met her husband.
At age 25 Maria and her husband married. When Maria was 28 their daughter was born. Over the past five years her parent’s health has started to decline, so she and her siblings do what they can to support them, but it is becoming more difficult and feels her parents may need to be put in a nursing home. Depression and anxiety from these types of events can cause sleep disturbances, fatigue, jumpiness, and lack of concentration, but further more if there is a recent event, it could be what is triggering her symptoms.
Once we discuss how long symptoms have lasted and her life changing experiences, I want to find out more about her medical history. Have you or any family members suffered from any type of psychological condition before, such as depression or other condition? I want to rule out any diagnosis of psychotic episodes and bipolar, or if she is at higher risk for developing a disorder.
Maria states that she has not been previously diagnosed with anything and is not aware of depression, or any other disorders in the family. Do you take medication, or have an existing medical condition?
These will help to pinpoint if she may be disqualified from receiving the dysthymic disorder diagnosis. Maria states she has no history of medical conditions or any medication or substance use. Where does your family originate from and do you feel you have ever been treated differently by others being Hispanic? Certain minorities, particular those who are Mexican and African American, are more apt to suffer from dysthymic disorder (Riolo et. la, 2005). Maria stated her family originated in Mexico.
Her parents moved to the United States when she was an infant.
Job opportunities brought them to the states, where they were able to learn English and obtain some education classes in helping them to advance in their jobs. Tell me about your life growing up and the relationship you’ve had with family. Maria stated her parents and her came to live with extended family when they first arrived. By the time Maria was eight years old, they had saved enough money to afford their own place.
She went to school and did graduate with a diploma. Her parents were loving and took an active role in making sure she got the education she needed to live in western society.
Though they did not attend church faith was important in the household. Maria also states family is the most important; you look out for each other, help each other, and care for each other no matter what. Upon learning about Maria’s past, I wanted to find out what it is that makes Maria happy.
Describe to me what your typical daily routines are from the time you are out of bed until the time you go to bed. Maria states, she is usually up and out of bed by 4am to 5am. Has coffee and catches up on some of her clients accounting needs that she didn’t get to the day before.
At 6am she is getting ready for work. Sometimes she goes in early, but she is not expected to be there until 8am. Some days she works up to 14 hours, but says she will make time for lunch and breaks in between clients when possible.
On a day she is working late her husband will have supper ready for her, but there are nights when she does not have time to eat. Most nights she is in bed at 11pm, but lies there awake for what she says feels like hours. Some evenings and weekends she is responsible for going to her parents to take care of their needs, but occasionally her husband will do it for her.
There is no set schedule for this. What are your worries if you do not meet the needs of your parents? Maria states, family is everything.
Her parents would probably feel hurt and disrespected if she did not help them because that is not how she was raised. What do you think is wrong with you? Maria states she is not sure what is wrong? Maybe too much stress from work, caring for parents, a teenager, keeping her husband happy, it all seems to take a toll on her, but at the same time there are times when she feels normal and happy.
She is worried that she may become severely depressed and will be unable to help support her family, which is why she is seeking treatment now to find out what is wrong. Diagnosis From our discussion I feel Maria does fit the diagnosis criteria for dysthymic disorder. She is female, with a Mexican ethnic background. She speaks fluent English and is well educated, which would normally lower her risk for suffering from this disorder, but because of the Mexican background, weighs out the education factor.
She displays at least two of the depressive symptoms required, which are sleep disturbances and difficulty concentrating.
On Axis 3 issues, Maria has no history of medical illnesses that could be contributing to her symptoms. Over the last five years she has dealt with her parents declining health, which is a contributing factor to her stress and anxiety she feels. When she is relieved of these stresses there is a short term improvement. Axis 4 issues I believe factor in because she was raised in a way where she was taught no matter what she needs to help take care of family. This puts pressure on her to take help care for her husband and daughter, as well as her parents.
Axis 5, overall functioning I would rate Maria at a 60. Maria has mild to moderate depression symptoms that are affecting her at work. She does have some meaningful relationships and appears to be functioning well, but does have some occupational difficulties at this time. Therapeutic Intervention My recommendation for Maria is client-centered therapy. Maria needs help to set up a routine and schedule to prioritize daily tasks. Involving her husband during a few of these sessions will be helpful, so he can also help her to stay on schedule.
I would also recommend a self-help group for Maria in regard to caring for her parents. This will be helpful for Maria, so she can gain insight from other’s as to how to handle situations such as putting parents in a home and sharing responsibilities with siblings. At this time, I would not recommend any medication for depressive symptoms, but I would go over relaxation techniques with Maria to use at work, home, or anytime she is feeling anxious, as well as discussing ways to help her sleep. References Dysthymic Disorder, (2004). The concise corsini encyclopedia of psychology and behavioral science.
