CASE STUDY (MAJOR DEPRESSIVE DISORDER)

CASE STUDY (MAJOR DEPRESSIVE DISORDER)

Identifying Information

The client is a 23 years old, unmarried female named M.A. She is 3^rd in birth order. She has done FA and is currently unemployed. Her father A.A works in a bank, while her mother M.A is a housewife. The client is from a middle class family, and lives in a nuclear family system.

Presenting Complaints

·        Feeling excessive anger. (1 year)

·        Constant irritability. (1 year)

·        Crying a lot. (1 year)

·        Constantly feeling tension. (1 year)

·        Unable to accomplish tasks, lack of motivation. (1 year)

Interview Information

The client’s illness started a year ago in December 2019, a few days after her brother got married. The client reported that some days after her brother’s wedding, her mother’s side of the family (especially her maternal grandmother and aunt) started accusing her sister in law of practicing black magic. They did so because they often observed her sister in law muttering and whispering to herself, her lips constantly moving as if reading something. Another reason was that the client’s aunt got sick after eating the food made by her sister in law. Due to this, all the family from the client’s mother’s side stopped drinking or eating anything that was made by her sister in law. The client reported that she did not believe any of the things her sister in law was being accused of and one day drank a cup of tea made by her. After a few days, according to the client, she started having crying spells, almost stopped doing all household chores because she did not feel like it and felt fatigued most of the time. She also began feeling angry and irritated most of the time and often felt lost and confused. She often started to feel as if she was not good enough, and that others are more pretty, more intelligent and more confident than her.

The client’s family then took her to faith healers who, for several months, continued to treat her but to no effect. Her family then decided to bring her to the hospital for treatment in February 2019. The client was hospitalized for 15 days and was then discharged when she showed improvement. The client was prescribed Avon tablet and some antidepressants which she stopped taking 2 months after lockdown (because of Covid-19) because according to her they had no effect on her. The client began to feel the same symptoms again and was brought by her mother for treatment at the hospital in November, 2020.

The client was a very responsible and active person before her illness and had interest in fashion designing and reading books. She liked doing all the household work and contributed in its maintenance well. However, she stopped doing all this after her problems began. Although the client was introverted, a bit reserved, withdrawn and was not very social even before her illness. She considered herself to be a very reserved person who does not share problems and troubles with other people because she did not want to burden them or worry them.

The client was born through normal delivery and had a normal childhood. She experienced no abuse or serious injury in her childhood.

The client’s family consists of her parents, 4 brothers, 1 sister and a sister in law. The client reported that she has congenial relationship with her father but he is mostly busy with his job and has no fix work hours so they rarely get to spend much time together. She also has congenial relationship with her mother and is closest to her. Although she does tend to fight with and scream at her mother when she gets angry or irritated. According to the client, her mother used to scream back at her when they fought before but now she does not say anything in return and keeps quiet. She has congenial relations with her brothers as well but they too are always busy (3 brothers work in a phone shop, 1 is studying). The only complain she has about her eldest brother is that he does not permit her to get a job. The client is also close to her younger sister, who is also studying. According to her, she also has congenial relations with her sister in law and has never yelled or fought with her and would not do so even now since her sister in law is pregnant. The home environment is mostly pleasant but gets disturbed when the client has her anger and crying spells. She has these spells especially when she is stopped or prevented from doing something or when her cousins and their children visit their house and create commotion. No history of psychological illness was reported in the family.

The client was an average student throughout her academic years. She was liked by her teachers who never complained about her because she was well behaved. She did her FA and scored average and then did a diploma in fashion designing because she was interested in it very much. She had good relations with everyone at school and college, but had only few close friends. She has a best friend since school and they both went to the same college, but the client revealed that she has also not told about her issues and problems to even her best friend.

The client reached puberty at the age of 12 when she was in class 7 and her reaction towards pubertal changes was normal. She reported that she received this information from some books and her best friend. No homosexuality was reported by the client. She is moderately religious.

Tests Administered

• Beck Depression Inventory ………….. BDI

Behavior during Session

The client’s stated age seemed to be in correspondence with her actual age. She was of an average height. She was dressed in a neat but wrinkled abaya and headscarf. She remained cooperative throughout the session and revealed all the information without any hesitation. She maintained adequate eye contact throughout. No involuntary or abnormal movements were observed. The rate, content and tone of speech was adequate. The client reported suicidal thoughts at the time of history taking. She was well oriented with time, place and person. She had adequate judgment and insight. She had adequate attention and concentration. The client’s short term, recent and remote memory was tested and was adequate.

Psychological Evaluation

On Beck Depression Inventory (BDI), the client scored 38, which indicates severe depression. Most of the items in which she scored high revolved around despair in future, hopelessness and inability to progress in life.

Tentative Diagnoses

296.33 (F33.2) Major Depressive Disorder, recurrent episode, severe.

Prognosis

The client’s prognosis is unfavorable. The factors in favor of her prognosis are that she has family support and is educated. However, the points against her prognosis are that her adherence to medication is not good and she also does not respond well to or completes the tasks assigned to her by the psychologist.

Recommendations

• Follow up sessions held periodically to monitor the effectiveness of the treatment.
• Ensuring the client’s adherence to medication. 

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