MSE Youtube Video

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The Formulation Exam – youtube case scenario 1) History (prose) Janet is 31 and has been admitted for attempting suicide by drinking alcohol and taking anti-depressants. She has a boyfriend. She has many friends at work, which she socially drinks with approximately 4 days a week. She works in a restaurant. Janet has two children, a son and a daughter. Her son currently lives with her brother, as she is unable to care for him. She does not know where her daughter is as she was taken away by child services 10 years ago. Her daughter was in foster care for some time before she was permanently adopted. She drinks with her friends to feel happy, as she is sad most of the time. She drinks to get drunk, and she tends to pass out from her drinking. Her father is dead, and there is no mention of a mother. She seems to have some contact with her brother and sister, as she visits her son sometimes. There is no information given about psychiatric history other then that she has been on anti-depressants for some time. 2) MSE (note form) Behaviour: poor eye contact, stooped posture Appearance: kempt, nothing unusual Speech: low and slow, breaks between words, steady at times Mood: Subjective. Really sad most of the time, thinks of killing herself a lot of the time but does not think she’ll go through with it most of the time, worries, guilt. Objectively. Depressed, very low. No changes in weight or appetite, normal sex drive, poor concentration, finds work motivating, finds enjoyment in friends and drinking, and boyfriend. Easy to go to sleep, possibly due to alcohol but wakes in the early mornings, and problems going back to sleep. Has worries and anxieties about her daughter’s whereabouts and care. High suicide risk. Thoughts: doesn’t think she’s a good mother, feels bad about it. Seems to carry guilt for loosing her daughter, and for being unable to care for her son. “I feel aughfull, shitty mum, causing stress to my family”. Negative thoughts about not wanting to be here anymore. Thinks of suicide a lot, unsure if she’ll go through with it. “Easier if I lay down and fall asleep”. Worries about her daughter and where she is. Some mornings, she feels her heart racing, short of breath and chest pains (possible panic attacks) lasts for 10-15min. She sits in bathrooms until symptoms pass. Her preoccupations involve smoking marijuana whenever it is

available, but prefers drinking 8-10 beers or 4-5 shots, sometimes both. Perceptions: Visual – saw eagle when visiting father’s a grave, a spirit but sister saw it too. Saw an old lady at a funeral who had died two years before that day e.g. a spirit. Not of high frequency or common, no information to whether substances where taken. Cognitions: orientation - seems aware of time and place. Attention/concentration - low, problems finishing book, used to like to read, can’t seem to focus. Memory – complaints about poor memory. Insight: Little or none, does not want to go to psych ward. Lack of awareness to her problem, wants to go back to work. 3) Differential Diagnosis (note form and prose) Major depression i.e. clinical depression, due to severe episodes of sadness and continued feelings of hopelessness, guilt and suicide. Need to rule out depression from alcoholism as there is a recurrent drinking pattern, and substance abuse (marijuana). The visual hallucinations are infrequent, but a MRI scan could rule out possible brain abnormalities or lesions. The patients has been on anti-depressants for some time which suggests most likely a major depression, having persisted for some time. The drinking could be adding more weight to her condition, so there is a need for detox in order to evaluate this variable. The patient also seems to suffer from panic attacks, which needs more sufficient information for treatment. 4) Explanation (prose) No information is supplied about childhood and upbringing so difficult to suggest predisposing risk factors. However, the death of her father, as well as the children being taken away from her could be possible stressors for the depression, feelings of guilt and anxiety. More information is needed for biological factors. Her colleagues seem to encourage and add weight to her drinking problem, as it is constantly reinforced. Her poor psychological state and outlook on life are also reinforcing the drinking, as she claims it is the only thing that makes her feel better. Her boyfriend, brother and sister seem to be her only

forms of support. She mentions “causing them stress”, this could suggest that they are unsupportive of her condition. 5) Prognosis (prose) Major depression is a life-long struggle and is in need of treatment. As the patient is already on anti-depressants, the medication may need to change or be increased. Cognitive behavioural therapy could also improve her chances. Her young age and the availability of close relatives and friends are also helpful. Her lack of insight, and her unwillingness for therapy may reduce her chances of improving. Patients with major depression tend to have their first episode between 20-30, as she has already been treated for this, it is assumed that this may be her peak. Major depressive patients tend to have another episode or peak between 30-40 years of age. This patient is in need of hospitalization as suicide risk is high. Luckily, only 3.4 of cases actually do commit suicide so with psychotherapy, medication, CBT or any combinations her outlook may change. Mainly, the first issue to be addressed is the constant drinking of alcohol, which may suggest alcoholism or just alcohol abuse. As the patient was under the influence at the time of attempted suicide, this could possibly be an influencing factor, and with proper rehabilitation for drug and alcohol misuse, the symptoms may reduce.

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