Background
As stated by the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), the major symptom of Persistent Depressive Disorder (Dysthymia) is depressed mood that occurs for more days than not for at least 2 year. Dysthymia shares the symptoms with MDD (Major Depressive Disorder), with the exception that symptoms last for 2 years (APA 2013). The way that Dysthymia is different from MDD is that the subject can function to some extent at a higher level; however, the symptoms last 2 years. To rule out possible medical causes such as diabetes or low thyroid levels, which causes a chemical imbalance that produces similar symptoms, a physical exam would be conducted.
The client, Robert, is a 39-year old obese Hispanic male who
…show more content…
lives alone in an apartment. Subject works in a sheltered workshop designed for people with disabilities.
The workshop provides classes associated with social and occupational therapy, including coping with depression, health, and outside resources. Client reports to have been sad for as long as he can remember. Client has suffered with low-level depression for over 20 years. He lives a lifestyle that fosters his depressive state including a limited social life and living in a filthy home with no motivation to clean up. Client was first diagnosed with Dysthymia in his early twenties and receives social security disability benefits for his condition. Client works occasionally but reportedly spends most of his time isolated eating, masturbating, and watching television. The early onset of his condition prior to age 21 increases the likelihood of comorbidity with personality and substance abuse disorders both observed in this client (APA 2013). Client has engaged in a variety of treatments but has …show more content…
not taken them seriously hampered by his continued substance abuse. Client has expressed his joy in “working the system” taking great pride in convincing the government to continue sending him his disability checks. Client shows no interest in changing the course or direction of his life. Client reports to have contracted almost fatal spinal meningitis at the age of 18 allegedly from sharing drugs with a carrier of the disease. Client views social security benefits as a way of life and shows no motivation to stop receiving government benefits. Client further states that he uses masturbation provide him with some temporary relief, feeling ashamed of his body and his perceptions of woman. Observations Client reports that he had to deal with a lot of fear of his environment as a child in the form of bullying. Client attributes his fear of the outside environment to his overprotective mother. Client reports polysubstance abuse at the age of 16 including LSD and Marijuana. Client reports feeling sad and disconnected as a youth and self-medicating through illegal substances to avoid the sense of discomfort felt during normal situations. Client reports that he would have preferred a tough form of guidance that included the use of violence to point out what he was doing wrong and promote healthy changes in his lifestyle. Client reports growing up in severe poverty while living in a New York City low-income housing project. Client also states that his parents were separated which is consistent with the risk factors for the disorder, which include parental loss or separation. Client states that he later moved to Banks Oregon at the request of his oldest brother. Client attributes his first feeling of depression as stemming from his chronic marijuana use. Client reports that his brother suffered from manic-depression, which is consistent with the finding that individuals with a family history of depression are predisposed to the disorder (APA 2013). Client states that he believes his illness is related to a chemical imbalance and environmental conditioning. Client reports that he was a victim of sexual abuse as a child. Client reports living an isolated life lacking the energy to do anything positive. Client describes his symptoms as including insomnia, auditory hallucinations, and compulsive behavior through indulgence in food, drugs, and alcohol. Client reports that he enjoys attention and feels better when he gets it even if it is negative attention. Client reports to be immobilized by doing something positive, relating the feeling to torture and demeaning. Client reports taking antidepressants including 200 mg of Serezone, and 5 mg of Zyprexa which he feels increases his appetite. Client reports his anxiety, paranoia of tension, and sense of continuity. Client reports receiving behavior modification therapy to help him adjust to change. Client reports attempting suicide at the age of 18 by overdosing on pills but denies any current suicidal ideation and states that he believes it is wrong. Client states that he is of Colombian descent and his situation would bring dishonor on his family back in his country. Client reports that his family is very religious with nuns and priests on both sides of his family. Client reports that he has been told that he may be bipolar. Client reports experiencing occasional delusions focused on his importance or his persecution based on different causes. Client describes himself as being angry. Diagnosis The case history and subject interview indicate that indicates that subject has been experiencing long term depressed mood, low energy and fatigue, overeating, low self-esteem, feelings of helplessness, and poor concentration all consistent with the diagnosis of Persistent Depressive Disorder (Dysthymia). Client also presents comorbidity with polysubstance abuse and personality disorders requiring further assessment to accurately diagnose. Therapeutic intervention Client is recommended for individual and group psychotherapy as well as psychopharmacology to address his symptoms.
Group therapy should focus on the goals of developing communication and socialization and coping skills to reduce his isolation and allow him to better interact with this environment. Individual therapy should include cognitive-behavior therapy to address his unrealistic ideas, pessimistic expectations, and self-critical evaluations. Behavior therapy can also assist client to develop healthy routine and life strategies in place of the isolation he is now experiencing. Psychotherapy should also address his polysubstance abuse, which is inhibiting his progress. Subject also presents with signs of malingering, which may be evidence of a personality disorder or residual effects of his addiction. Subject presents with above average intelligence, which adds to the possibility that he has deliberately acclimated to his condition as it supports his addiction and keeps his disability benefits intact. Individual psychotherapy should also address his reported child abuse to evaluate how this real or imagined event is affecting his condition. Psychopharmacology should include antidepressants to reduce symptoms specifically Prozac and Tofranil, which have been proven to be helpful. Treatment should begin with a full medial examination to rule out any chronic medical conditions, which may be contributing to his symptoms. Client also requires a full drug toxicology
screening to identify his current level of substance abuse. Current research indicates that subjects with comorbid relationships between Dysthymia and Substance Abuse will have worse treatment outcomes (Diaz et al 2009).
Equally important, therapy for parents with children who abuse drugs, participate in treatment interventions in a therapeutic setting with the Family Therapy Model, using Cognitive Behavior Therapy or CBT. The main goal of CBT is to improve family relationships by promoting sobriety and correcting the erratic or destructive behaviors/patterns, which aid in a person’s addiction. The goal is to educate family members about triggers, in the event of a relapse or erratic behaviors that resurface. In the event, families can resolve conflict in a positive way and recognize future erratic behaviors, before it's too late. Nevertheless, the Strategic family therapy is the best option, for Ryan and his family because of the relationship and separation
thyroid due to the birth of a child. This depression can be brought on by
Smyth, N. (1994). Addictions counseling: a practical guide to counseling people with chemical and other addictions/The addiction process: effective social work approaches/Clinical work with substance-abusing clients (book). Social Work, 39(5), 616.
Working with those with co-occurring diagnosis may require the clinician to have specific training due to the nature of having varying complications. The training may require for those to have a multi-problem view point to cover the multidimensional problems which may or have occurred. Client’s with the diagnosis of depression and substance abuse/dependence need to have a treatment plan which is client-centered. “A client-centered treatment plan is based on a careful assessment inclusive of immediate needs, motivation for change, and readiness to change.” (p 23).
The Addition Severity Index is a well-known and widely used tool for use in treating alcoholics and other addicts. It is an approximately 45 to 60 minute long interview comprised of questions about the patient’s life. The interview covers eight subscales focusing on many different parts of a person’s life which helps to provide a comprehensive understanding of their life. The severity is scored on a ten point scale ranging from no problem or treatment indicated to extreme problem, treatment absolutely necessary. The scale helps the interviewer determine the seriousness of a client’s problem and to plan an effective course of treatment. The ASI can also be found in a self-administered paper-and-pencil form and an interactive CD-ROM multimedia version for the computer (Maleka, 2004). This test has been found to be reliable by most but some others do not agree. It is difficult to say whether or not the test is a reliable and valid measure of treatment due to the complexity of the questions. Once a client’s psychosocial needs are identified it is easier to find treatment suitable for that client. There are some problems with the test such as it is not properly designed to cover such a wide population (Maleka, 2004). Other problems include irrelevant questions for alcoholics and other drug users, difficulty remembering relevant information, and lying and exaggerating information for the best interest of the patient (Maleka, 2004). Use of the ASI can be found to be particularly problematic when used with the homeless or double-diagnosis patients. The ASI can be used in a wide range of treatment settings including clinical, research, and administrative. This comprehensive evaluation is a useful tool that helps professionals understand the
Furthermore, each alternative has its advantages and disadvantages. Trying to solve this problem completely alone is probably the worst solution. A person receives no outside support or help. A rehabilitation/recovery center is expensive but provides strict daily routine and continuous professional guidance and support. The patient is away from family and his normal life; therefore, he may resort back to alcohol when he is back in the "real world".
 Mild, chronic depression has probably existed as long as the human condition, although it has been referred to by various different names. The DSM-III replaced the term “neurotic depression” with dysthymic disorder--which literally means ‘ill-humored’-and it was added to the Diagnostic and Statistical Manual of Mental Disorders, 1980
Addiction is a dependence on a substance where the individual who is affected feels defenseless and unable to stop the obsession to use a substance or prevent a particular behavior. Millions of Americans have addictions to drugs, alcohol, nicotine, and even to behaviors such as obsessive gambling. Pharmacotherapy is a treatment process in which a counselor can use a particular drug to counter act an addictive drug or behavior. Not all counselors agree with this type of treatment. However in order to provide a client with an ethical treatment and unbiased opinions they should be made aware of all scientific evidence of different treatment options. “Thus, attention to addiction pharmacotherapy is an ethical mandate no matter what prejudices a counselor may have” (Capuzzi & Stauffer, 2008, p. 196). Some particular pharmacotherapy’s a counselor may use for the treatment of addiction are Bupropion (Wellbutrin, Zyban), Disulfiram (Antabuse), Naltrexone (ReVia, Depade), Methadone (Dolophine), and Buprenorphine (Temgesic, Suboxone).
Major depressive disorder is more than just sadness; it is a mood disorder, which is characterized by feelings of hopelessness, depressed mood, and a reduced ability to enjoy life. The symptoms of depression fall into five categories: affective, motivational, cognitive, behavioral, and physical. People suffering from depression may experience several symptoms, for at least two weeks, in any or all of the above categories, depending on personal characteristics and the severity and type of depression. They generally have feelings of sadness, emptiness, pessimism, hopelessness, worthlessness or unreasonable guilt; lack of interest and pleasure in daily activities, reduced energy and vitality. The cognitive ability of the brain is also affected; thinking becomes slower, concentration becomes more difficult, memory lapses and problems with decision making become obvious. Individuals , may have difficulty going to sleep or experience early morning awakenings. Some other patients may feel an excessive need for sleep, and some may be troubled by dreams that carry the depressive tone into sleeping hours, causing abrupt awakening due to distress. Appetite changes are very frequent; a total loss of appetite is common and it is associated with weight loss. The same individuals who oversleep when depressed also tend to overeat. Finally, physical complaints are common and may or may not have a physical basis. Physical symptoms can occur in any part of the body and can include pain (headache, backache), gastrointestinal problems (nausea, stomach pain, diarrhea, and constipation), and neurologic complaints (dizziness, numbness, memory problems) as well as recurrent thoughts of death and contemplation of suicide.
Nobody denies that every client and situation is unique, but there is a general layout out of a treatment plan that can be used thought out the facility to ensure success for the client. The first step in the treatment plan is to screen clients to determine if he/she meets the criteria of the facilities drug, or alcohol program. The facility will use the standard CAGE, of the Substance Abuse Subtitle Screening Inventory questioner as a screening tool. These two screening tools are consist of few questions and require only short answers to determine (American Society of Addiction Medicine, 2012). These tools are easy to use and can be done by any qualified staff according to the ASAM. If more through information is needed then the client will go under an assessment.
Depression is defined as "a state of despondency marked by feelings of powerlessness and hopelessness" (Coon, 2001). Some people can mix up depression with just having the blues because of a couple of bad days or even weeks. It is already said that depression affects about one sixth of the population or more (Doris, Ebmeier, Shajahan, 1999). Depression can happen in any age range from birth to death. The cause of depression is still obscure and becoming clear that a number of diverse factors are likely to be implicated, both genetic and environmental. Some causes are leading stressful lives, genetic factors, a previous depressive episode, and the personality trait neuroticism (Doris, et al., 1999).
“In depressive disorders, sadness and despondency are exaggerated, prolonged, or unreasonable. Signs of a depressive disorder are dejection, hopelessness, and an inability to feel pleasure or to take interest in anything. Other common symptoms are fatigue,...
Depression is well known for its mental or emotional symptoms. Symptoms for depression include: persistently sad or unhappy mood, loss of interest or pleasure in previously enjoyable activities, difficulty concentrating, remembering, making decisions, anxiety, feelings of guilt, worthlessness, helplessness, and thoughts of death or dying. “People who have endured a major depressive episode describe the experience as a descent into t...
Substance abuse complicates almost every aspect of care for the person with a mental disorder. When drugs enter the brain, they can interrupt the work and actually change how the brain performs its jobs; these changes are what lead to compulsive drug use. Drug abuse plays a major role when concerning mental health. It is very difficult for these individuals to engage in treatment. Diagnosis for a treatment is difficult because it takes time to disengage the interacting effects of substance abuse and the mental illness. It may also be difficult for substance abusers to be accommodated at home and it may not be tolerated in the community of residents of rehabilitation programs. The author states, that they end up losing their support systems and suffer frequent relapses and hospitalizations (Agnes B. Hatfield, 1993).
Major Depression is a type of depression that makes you lose interest in activities you usually enjoy, you have lack energy, trouble concentrating, you change your eating and sleeping habits, you become extremely sad most of the time and have thoughts of suicide. You will probably be diagnosed sooner, if you suffer from this, because in a short amount of time you will be a completely different person, if you’re usually a happier person in general. In order to be diagnosed these symptoms...