Major Depressive Disorder

’Night, Mother

Sample Answer Key

Date:

Your name:

Name of the client: Jessie Cates

Name of the movie:’Night, Mother

Overview

Jessie Cates is a woman who is divorced, estranged from her son, and in trouble with the law, and who lives with her gregarious, somewhat eccentric mother. She has epilepsy, is socially isolated, and doesn’t get along with her only sibling. She is a woman who believes she has no control over her life and is tired of the struggle to get through each monotonous day. She decides to commit suicide, and she spends time getting ready for that event—writing out instructions for her mother, labeling her possessions (who gets what after she dies), and making careful plans to carry out the act. Jessie decides to tell her mother what she has planned. Predictably, her mother is shocked and tries to convince her to live. They spend several hours talking—sharing feelings, problems, and secrets.

Client name: Jessie Cates

Psychiatric diagnosis: Major Depressive Episode

DSM-IV-TR criteria:

  1. Five or more of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure:
  2. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful)
  3. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
  4. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day
  5. Insomnia or hypersomnia nearly every day
  6. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
  7. Fatigue or loss of energy nearly every day
  8. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
  9. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
  10. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
  11. Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

What is the chief complaint? (In the client’s own words, and report of others)

Jessie says it is time for her “to go.” She has no relationship with her son, who engages in criminal behavior and is a disappointment to her. Her only activities involve taking care of her mother and the household responsibilities. She doesn’t have anything she enjoys. She has gotten tired of the daily struggle to “just exist.”

Based on the above information, and a close viewing of the movie, what questions would arise during history taking? What are some possible answers? You might base your questions on:

History of the client’s illness

Psychosocial history

Family history or dynamics

How long have you felt depressed? Had suicidal ideas?

Do you have a plan? What is it?

Have you ever seen a doctor or been treated for depression?

Is there a history of mood disorders or suicide in your family?

Have you attempted suicide previously?

Do you have a friend or significant person in your life with whom you share feelings or discuss problems?

How did your father’s death affect you?

How did you cope with the divorce from your husband?

Do you take time for yourself or do something to relax?

What observations do you have about the client’s behavior?

She describes significant distress in her life over a long time period. When discussing her plans for suicide, she demonstrates no ambivalence; she sounds determined to carry out her plan. Her mood is sad, and her affect is blunted most of the time. She seems to have no close ties or relationship with anyone; her relationship with her mother is more like a caretaker—meeting her mother’s needs, but not her own.

In your opinion, is the diagnosis discussed above correct?

Yes, Jessie meets many of the criteria.

What DSM-IV-TR criteria support (or negate) this diagnosis?

  • She feels depressed, sad, and empty.
  • She lacks interest or pleasure in activities.
  • She complains of fatigue.
  • She feels worthless.
  • She has a specific plan for suicide.

Jessie doesn’t meet some of the criteria:

  • Her weight is not discussed, nor are her sleeping habits.
  • She is not indecisive; rather, she is very decisive about suicide.

What treatment plan would you outline?

Examination by a psychiatrist to diagnose and treat depression, probably with medication. She might require hospitalization while her suicidal plan is definite to keep her safe. Jessie could benefit from ongoing therapy to address psychosocial issues

With what expected outcomes?

  • Jessie will have relief from depression.
  • Jessie will have the ability to keep herself safe.
  • Jessie will develop social relationships.
  • Jessie will improve her self-concept.
  • Jessie will have increased self-esteem.
  • Jessie will develop some independence from her mother.