Dysthymic Disorder Analysis 1

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Dysthymic Disorder Analysis

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Dysthymic Disorder Analysis

Marla is a 42-year-old Hispanic female who sought help from the mental health clinic for a variety of symptoms which caused her distress and impaired her level of functioning in daily life. Initially, Marla complained of vague symptoms including “trouble sleeping, feeling jumpy all the time, and an inability to concentrate” (Axia College,2007). Marla felt these symptoms to be the cause of her decreased performance levels at work. Concern about her employment led Marla to seek help for her troublesome symptoms.

Upon intake Marla’s symptoms require further analysis to reach diagnosis. As the symptoms meet various criteria for multiple diagnosis major depression, panic disorder with agoraphobia, and post traumatic stress disorder must be ruled out. Suspected diagnosis upon intake is Dysthymic Disorder or Major Depression. A full assessment will be done on Marla and diagnosis of her condition will be made. After diagnosis has been confirmed a brief overview of the disorder and possible causes will be given followed by the development of an effective plan of treatment to return Marla to a higher level of functioning with reduced symptoms.

Clinical Interview

Marla participated in an in-depth clinical interview process. Initial questions posed to Marla to establish a starting point for further analysis included the following:

  1. Maria, how long have you been experiencing these symptoms of trouble sleeping, “feeling jumpy all the time” and not being able to concentrate?
  2. Do you have any other physical symptoms such as gastrointestinal problems, chest pain, or headaches?
  3. Have you recently experienced any traumatic event prior to the onset of your symptoms? (accident, serious illness, relationship break-up, etc.)
  4. Are you generally an anxious person or would you consider yourself a “worrier”?
  5. Are you currently taking any prescription medication? If so what medication and how long have you been taking them? Have you recently stopped taking any medication?
  6. Has anyone in your family been diagnosed with a mental illness? If so, who? What was the diagnosis?
  7. With regard to your “trouble sleeping”, what specific sleeping problems are you experiencing?
  8. Do you find your symptoms to be constant or do they come and go?
  9. Have you lost interest in any activities you normally find enjoyable? What kinds of things do you do for fun or to relax?
  10. Maria, if I ask you to rate the severity of your symptoms with regard to how bothersome they are for you? What would you rate this on a scale of 1 to 10?

Marla’s responses to the initial interview questions allowed for better focus on multiple issues. Most significantly, the length of time Marla has noticed symptoms suggested Dysthymic Disorder to be a main focus. Although Marla described symptoms of depression and confirmed family history of depressive illness the severity of symptoms does not meet the criteria for a diagnosis of major depression. In addition, lack of any current trauma further allows for the ruling out of post-traumatic stress disorder.

After considerable assessment this clinician is confident that Marla is able to be diagnosed, according to the DSM-IV, with 300.4 Dysthymic Disorder. A complete result of DSM-IV Multiaxial Evaluation for Marla isas follows:

Axis I 300.4 Dysthymic Disorder, Late Onset, Prior Major Depressive Episode (Full

Remission)

Axis II V71.09 No diagnosis

Axis III none

Axis IV Occupational Problems, Inadequate Social Support Network

Axis V GAF= 60 (current)

Dysthymic Disorder Summarized

Dysthymia is a chronic condition which can last for many years. Although sharing similar symptoms as major depression, Dysthymia involves less intense symptoms which persist for at least two years. In addition, no major depressive episode or mania has been present during the first two years of illness. During the minimum two-year period, the individual diagnosed with Dysthmic Disorder will report not having relief of symptoms for more than a two month period at any given time and a depressed mood will be prevalent most of the time. The individual with a Dysthmic Disorder will have two or more prevalent symptoms of the disorder including changes in appetite, sleep disturbance, decreased energy or fatigue, lowered levels of self-esteem, troubles concentrating or impaired decision making skills, and a possible sense of hopelessness (Axia College,2007).

As the majority of individual’s diagnosed with Dysthymic Disorder also meet criteria for additional diagnosis of mental illness Marla will be carefully monitored for possible anxiety disorder throughout treatment as she exhibits some symptoms of anxiety. In addition, there is a possibility for people with Dysthymic Disorder to develop double depression in which Major Depression and Dysthymia occur concurrently. In the event of this double depression the individual will experience chronic mild depression symptoms with periodic intensification of symptoms related to major depression (Axia College,2007).

Dysthymic Disorder affects 3 to 5% of the population and is most frequently diagnosed among women. Other mental illnesses regularly accompany a diagnosis of Dysthymia including anxiety disorders, eating disorders, various personality disorders, and substance abuse. The individual diagnosed with Dysthymic Disorder may experience brief intervals of remission which last for a few months but tend to recur and general course of the disorder only allows reprieve of depressive symptoms for a period of one to two days (Axia College,2007).

Causal Factors of Dysthymic Disorder

The cause of Marla’s DysthymicDisorder can be explained from multiple theoretical approaches in the development of unipolar depression. Marla’s report of family history of depressive illness is further explained through the biological theory of depression. Research has suggested there to be a possibility of predisposition for developing unipolar depression for the individual who has family history of the illness. In addition, the biological theory would hold there may be genetic component based upon problems of normal function of the neurotransmitters or hormone levels which leads to the development of depressive illness (Comer, 2008).

In Marla’s case the diagnosis of Dysthymic Disorder can best be accounted for by biological factors in combination with multiple possible contributing sociocultural factors. Family history of depressive illness may have predisposed Marla to risk of developing both her earlier experience with major depression and her current Dysthymic Disorder. In addition, poor social support have likely aided in the development of mental illness. As there is an increased chance of developing depressive illness among those of Hispanic ethnicity or among the female sex these factors may also have played a role in Marla’s disorder (Comer, 2008). This combination of factors allows for sufficient cause of Marla’s illness to be established.

Personal Treatment Plan

Marla will be considered for one of two possible antidepressant medications for the reduction of depressive symptoms. A tricyclic such as Tofranil or the second-generation antidepressant Prozac may be ideal for Marla’s case. While both have proven effective in treating unipolar depression Prozac may be better tolerated as this medication is less likely to produce undesirable side effects of dry mouth or constipation (Comer, 2008). In addition, the antidepressant medication may also work to lessen feelings of anxiety which may aid Marla in feeling less “jumpy” while increasing her cognitive abilities.

Marla would also benefit from individual psychotherapy with a cognitive-behavioral approach. These regular sessions would focus on increasing levels of optimism and enhancing self-esteem. In addition, the therapist will work with Marla to develop better coping and more effective social skills. Careful focus will be given to identify negative thought processes and change or reduce maladaptive attitudes (Comer, 2008).

Marla’s treatment plan may also include participation in group therapy sessions with individual’s having similar diagnosis of depressive illness. Group therapy will afford Marla the opportunity to increase her social support network while interacting with people who share similarities of personality. Group therapy may also aid Marla in achieving higher levels of functioning as other’s offer encouragement and suggestions about how to cope with depressive illness. Marla’s treatment plan will undergo routine regular evaluation to monitor her progress and the effectiveness of the overall plan.

Conclusion

Dysthymic Disorder, while similar in many ways to Major Depression, is often overlooked and left untreated. Because the disorder can span years there may be a tendency to assume the behaviors and attitudes experienced by the individual living with Dysthymic Disorder are nothing more serious than negative personality traits (Axia College,2007).

The individual living with Dysthymic Disorder may encounter a lifelong battle with his or her illness. However, when properly diagnosed and treated the individual’s chance of recovery increases significantly. Careful assessment and diagnosis of Dysthymic Disorder will ensure a more positive outcome and increased quality of life.

References

Axia College. (2007). Faces of abnormality interactive. date, from Axia

College, Week Nine, PSY270 - Abnormal Psychology.

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

Publishers.