A CASE OF DEPRESSION

The following is the case of Miss K. The case history and the mental status

examination presented is based on the information provided from the supervisor.

SOCIODEMOGRAPHIC DETAILS

NAME: Ms. K

AGE: 23.

SEX: Female.

OCCUPATION: Un employed

RELIGION: Hindu.

SIBLINGS: One younger sister.

SOCIO ECONOMIC STATUS: Middle class

INFORMANT: Mother.

EDUCATION: M.com

FAMILY TYPE: Nuclear

RELIABILITY/ADEQUACY:

The information obtained from the informant are reliable and adequate.

CASE HISTORY
PRESENTING COMPLAINTS:

Mother says that 'subject K' is always being alone. Crying, Lost pleasure in dressing up

like before, having negative thoughts and also attempted suicide by drinking shampoo.

HISTORY OF PRESENTING ILLNESS:

'Subject K' are self-isolation, Low appetite, crying spells, Pre- occupation of negative

thoughts, Psychomotor retardation, low self-esteem, lack of concentration, Suicidal

ideation, excessive guilt and hopelessness. Symptoms first started with pre-occupation of

negative thoughts. Subject K had a relationship failure, after that she started being alone

without talking to others, blocking all the friends from contact. Subject K always thinks

about something and cries. Speaks with others without a hope in life. Also has suicidal

ideation. 'Subject K' drank shampoo to attempt suicide. Always Talks to her mother

hopelessly and feels worthless often.

PRECIPITATING FACTORS:

Relationship failure is the precipitating factor reported by the Subject K

ASSOCIATED DISTURBANCES:

Poor appetite, lack of concentration, affected social life

NEGATIVE HISTORY:

No history of negative illness

Past medical history:

In 2019 subject K was hospitalized for treating typhoid fever.

Past psychiatric history:

In 2019 they took her to psychiatrist. But subject k didn't take medicines regularly,

discontinued the medication

FAMILY HISTORY:

Subject K has father, mother and a sister. Father is an alcohol dependent. Mother is an

housewife, father’s occupation is not enquired, younger sister is working in an IT

company.

GENOGRAM:

No history mental illness in the family

Subject K
PERSONAL HISTORY

Birth and early development:

Born as a normal child, “no developmental delay”

Behaviour during childhood:

Subject N was jovial and bold during childhood

Physical illness during childhood:

No history physical illness during childhood

Schooling history:

Good academic performance during school and college.

Occupation history:

Before 2019 subject K worked as a tele caller, due to lock down ' subject K' resigned the

job. During 2021 ' subject K' worked as an accountant for few days, but because of pre

occupation & lack of concentration she discontinued the job.

Menstrual history:

Subject N says that she has irregular menstrual cycle

Substance use or abuse disorder:

No history of substance uses or abuse disorder

There is no information provided about the premorbid personality.

Social Relationship:

Subject N is an outgoing person, her social life was normal

Intellectual activity:

Normal Intellectual activity

Mood:

Normal stable mood

Character:

Being calm and polite.

Attitude towards work and responsibility:

Focused to complete the work and takes care of the mother

Interpersonal relationship:

Subject N was having good interpersonal relationship within the family

Energy and Initiative:

Subject N completes household works with energy and initiative

Fantasy life:
No history of fantasy life

MENTAL STATUS EXAMINATION (MSE)

Appearance/Behavior:

Subject K was clean & well-groomed and dressed neatly

General:

Decreased activity "low physical activity"

Eye contact:

Maintained proper eye contact

Posture:

Sat comfortably and kept hands on her lap

Psychomotor activity:

Psychomotor retardation

SPEECH

Tone:

Subject N maintained Normal tone of speech

Reaction time:

decreased pauses in between questions and answers

Subject N responded relevantly and relatively

THOUGHT

Thought process:

Subject N thoughts were loosened

Thought content:

Subject N has Suicidal ideation

MOOD AND AFFECT

Subject N was in Depressed mood

Subject was sad in full range

Appropriate to the content and congruent to the stated mood

PERCEPTION

No history of delusion or hallucination

CLINICAL ASSESSMENT OF COGNITIVE FUNCTIONS

Orientation:

Subject N was able to orient the place where she is now, time and the person

Memory:
Immediate memory was good, Recent and Remote memory is average

Intelligence:

Subject N was able to narrate a small childhood story

Comprehension:

Subject N understood the question and answered accordingly

Abstraction:

Subject N was able to able to abstract the session of the day s

Insight:

Grade-V (awareness of illness)

Judgement:

Subject has good judgement

SUMMARY

Subject k's mother took for the counselling with the complaint pre occupation of negative

thoughts. Subject was so cooperative throughout the session. After interviewing subject

K and her mother complaint of this mental illness started during lock down period.

Subject K had a relationship break up, that boy started to threatened & black mailed her

asking unusual things from her. That incident put her into excessive guilt. After the
incident she was hospitalized for treating typhoid fever. After that hospitalization subject

started to have the presenting complaints.

Assessment conducted:

“Beck's depression inventory” was conducted with “subject R”. She scored 53.

Interpretation:

Score above 40 indicates extreme depression.

CASE FORMULATION

Diagnostic frame work:

DSM-V criteria for major depressive disorders are:

-Depressed mood

-Diminished interest or pleasure

- Decrease in appetite

-Psychomotor retardation

- Excessive guilt

- Diminished ability to concentrate

-Suicidal ideation/ Suicidal attempts without a specific plan

(MDD with melancholic features)

PROVISIONAL DIAGNOSIS

Subject K was diagnosed before as OCD

DIFFERENTIAL DIAGNOSIS:

The reported symptoms are coming under the DSM-5 criteria for Major depressive

disorder with melancholic features

THEORETICAL FRAME WORK

LEARNED HELPNESSNESS THEORY:

According to Seligman’s learned helplessness theory 1974, depression occurs when a

person learns that their attempts to escape negative situations make no difference. As a

consequence they become passive and will endure aversive stimuli or environments even

when escape is possible.

OPERANT CONDITIONING

Operant conditioning states that depression is caused by the removal of positive

reinforcement from the environment (Lewinsohn, 1974).

BECK'S THEORY

One major cognitive theorist is Aaron Beck. He studied people suffering from depression

and found that they appraised events in a negative way.

1. The cognitive triad (of negative automatic thinking)

2. Negative self schemas

3. Errors in Logic (i.e., faulty information processing)

PLAN FOR INTERVENTION

Medications are effective for most people with depression but only psychiatrist can

prescribe medications to relieve symptoms.

Psychotherapy can be effective for depression, such as cognitive behavioral therapy or

interpersonal therapy. Psychotherapy is also known as talk therapy or psychological

therapy.

Electroconvulsive therapy (ECT), electrical currents are passed through the brain to

impact the function and effect of neurotransmitters in your brain to relieve depression.