Running head: FINAL PROJECT-PSYCHOLOGICAL DISORDER ANALYSIS 1

Final Project-Psychological Disorder Analysis

Nina Sbanios

University of Phoenix

Psychology

270

Kenneth D. Vaughan, MA, LPC, NCC

September 01, 2010

 Final Project-Psychological Disorder Analysis

The subject (Marla) is a 42 year old female who is seeking help from the mental health

clinic for a variety of symptoms which the subject believes is causing her distress. These

symptoms include: trouble sleeping, feeling jumpy all of the time, and an in ability to

concentrate (Axia College, 2010). The subject, whose complaint is a decreased performance at

work, feels these symptoms to be the cause. It is apparent that a concern for the subject’s

employment has prompted her to seek help for these issues.

During intake it is agreed that the subject’s symptoms require further analysis to reach a

final diagnostic conclusion as these symptoms are apparent in the criteria of a multitude of

disorders, including major depression, certain panic disorders, and post traumatic stress disorder.

Subject will be observed and a complete assessment of the subject will be made. Once this

assessment has been done a diagnosis will be made by our treatment team and together with the

client, will complete an effective treatment plan. Attending therapist will also include in the

notes the diagnosis along with the possible causes, names of treatment team members and a copy

of treatment plan.

The Clinical interview is the beginning point for the subject, as how she answers these

questions applies to the analysis and diagnosis of her issues culminating in the action of the

treatment plan. These questions included:

1. Why have you come to seek therapy?

2. What do you hope to gain from our time here?

3. I want you to tell me about your family, do you have brothers or sisters,

how do you get along with them, do any of them suffer with a mental

disorder?
 4. What was it like growing up in your family, and how has it changed (if

any) now?

5. What do you do for a living, and who are the people you are closest to?

6. How is your interaction with these people?

7. Have you now or at any time felt feelings of anxiousness, depression,

have you ever had thoughts of suicide in the past or recently, what was

your plan?

8. Is there any family history of depression or suicide?

9. Tell me how you perceive that people see you, what kind of moral or

ethical structure do you feel you have?

10. Do you take any medications at this time; do you use alcohol or any

other substance?

11. How long have you been experiencing these symptoms?

12. Have you had any other physical symptoms, such as chest pain or

stomach problems?

13. In regards to your inability to sleep, what specifically are you

experiencing?

14. Have you lost interest in any of your outside activities?

15. On a scale from one to ten, one being the least and ten being the

highest, how would you rate how troublesome your symptoms are to

you?

The subject is then sent to our Clinic Physician to make certain that no other physical

reasons may exist for her symptoms. A full physical exam along with a blood test or (CBC) will
be required to rule out any thyroid problem or history of substance abuse. The subject is asked to

come back the following week for the findings of the treatment team. The results of the test are

gathered and taken to the treatment team for evaluation. A Multiaxial Evaluation is used which

classifies the criteria from the DSM-IV. The first is Axis I which includes clinical disorders,

most V-codes and conditions that need clinical attention. In this case the subjects

Axis I would be: 300.4 Dysthymic Disorder, Late onset, the Axis II is the area for Personality

Disorders and/or Mental Illness and would look like this: Axis II V71.09 no diagnosis. The Axis

III is for general medical conditions, which in this case would read: Axis III: none. Axis IV is

for psychosocial and environmental problems, and would read, Axis IV: Occupational and social

support. Lastly, there is the Global Functioning Scale or GAF score, which would in this case

read: Axis V: GAF=60 (current) (PSYweb.com, Retrieved September, 2010).

It is the following week and the subject is back for her findings. As all tests have been

reviewed and no physical reason has been found that would equate to the subjects symptoms, the

treatment team has diagnosed the subject from her symptoms and through her initial intake

assessment. What has finally played a major contributor to the subject’s diagnosis were: trouble

sleeping, inability to concentrate, and the length to which the subject has been experiencing the

symptoms. The subject has described symptoms that correspond with Depression; and there are

other family members who are known to be afflicted. With the lack of any known traumatic

experience, and after careful consideration, a diagnosis of Dysthymic Disorder is reached.

Dysthymic Disorder is a mild, but chronic form of depression, which has lasted for at

least two years, and can affect the subject more harshly than depression (Mayo Clinic, Retrieved

September 2010). With Dysthymia the depressed mood is continual, and you will see no

episodes of mania. The individual with Dysthymic Disorder will have two or more prevalent
symptoms which include: decreased energy or fatigue, sleep disturbances, changes in their

appetite, trouble concentrating and conflicts with family and friends.

Anxiety is usually also seen in those who are afflicted with types of depression and the

symptom of feeling jumpy all the time, could mean that the subject suffers from this as well.

However the treatment team has decided to monitor the subject for this as appose to making it

part of her treatment at this time.

The exact causes of Dysthymia is not known, however researchers believe that the causes

are similar to those of depression, which include: Biochemical factors, Gene’s or heredity, and

environmental factors. However, others believe is caused by a behavioral process that is called

learned helplessness, which is where the subject’s inability to take action to make her life better,

arises from a sense of not being in control. Certainly all must be considered, in Biochemical the

subjects have many physical changes in their brains. Naturally occurring brain chemicals or

neurotransmitters are linked to mood destabilization and therefore may be linked. Genes and

heredity play a part in depression, and the subject has other family members that have these and

other symptoms, it definitely could be an underlying cause. Environment may contribute to

causes as situations such as loss of a loved one or financial difficulties are challenging to cope

with and produce high stress levels.

It appears that in the case of our subject (Marla) the diagnosis of Dysthymic Disorder

may be explained by the facts retrieved during the initial assessment, which are: The family

history of a depressive illness, and other sociocultural factors such as the lack of social support.

Research has also found that there is an increased chance of developing a depressive illness

among those of Hispanic descent, and among the female sex (Comer, 2008). All of these factors

were sufficient to be able to diagnose the subject with the answer of Dysthymic Disorder.
 As stand alone treatment, medications appear to be most effective; however, for this

disorder treatment may be twofold, medication and psychotherapy. The medications most

commonly used are SSRI’s or selective serotonin reuptake inhibitors, such as Prozac, and

Celexa. Tricyclics such as Elavil and Tofranil are also commonly used.

In conjunction with medication therapy, it has been deemed that the subject will also

benefit from psychoanalysis, by using the cognitive behavioral approach. This is to help the

subject change her thought processes, to increase her optimism and enrich the subjects self

esteem. During weekly sessions the subject will focus on identifying and changing all negative

thought processes and maladaptive attitudes (Comer, 2008).

The subject will also be required to participate in group therapy, this will enable the

subject to build on her social support system while pairing the subject with her own peers to gain

a better understanding of her own disorder. However, the subject’s treatment plan will be

reevaluated every 30, 60 and 90 days to monitor her progress and the effectiveness of her overall

treatment plan. Case conference will also be held within the treatment team in 30 day increments

to consider any changes to her treatment plan.

The symptoms for dysthymic disorder mimic those of Major Depression and are often,

(because of the length of time involved), left untreated. However, getting the right diagnosis

appears to be paramount. Once this has been established, and the subject enters treatment, they

increase their chance of recovery, are able to strengthen the quality of their life and become more

productive and stable people.

 References

Axia College, (2010), Faces of abnormality interactive, Retrieved August 2010, from Axia

website, Week-9, Psychology 270, Abnormal Psychology.

Comer, R.J., (2008), Fundamentals of abnormal psychology, (5th ed.) New York: Worth

Publishers

www.MayoClinic.com