Analysis and Diagnosis on Adolescent Depression (Case Study Sample)

A Case Study on Adolescent Depression
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Introduction
A case study involving B.J, an African American teenager, 16 years old having a combination of medical and mental problem was assigned to me during my practicum. It was part of the steps to gain knowledge in management of such cases by understanding the condition of the client. The client has recently been diagnosed with diabetes mellitus type 1, has been struggling with sickle cell anemia for the last six years, and has recently been diagnosed by a general practitioner to be having depression and anxiety. Although the client has comorbidities, the main focus of this case study is depression and anxiety.
As an intern is tend to find the therapeutic ways to help the client and solve the problem. Cognitive behavioral therapy (CBT) is one of the therapies that are effective in treatment of depression and anxiety which I applied to solve B.J problem (Riopel, 2020). Its principle is on change of the thought process which in turn changes the way an individual feels and sees the world. It encourages positive thoughts while blocking or avoiding negative thoughts. A therapist can therefore be able to assess effectiveness of the therapy by observing the behavior of the client. Change of thought process ends up changing the behavior patterns of the client (Riopel, 2020).
Analysis and Diagnosis
Referral notes from the social agency indicate that B.J came in U.S. six years ago from Senegal together with her parents. Their first language is French which is widely spoken in their Country. The client is in insulin injectable in the morning and evening to control the blood sugar and has to take a rapid and a fasting blood sugar test every day. The client is a full time student who enjoys playing with friends. She has however been struggling with her academics due to language barrier since she does not have proper fluent English, the language used for learning in US. Recently B.J has withdrawn from friends and family members with expression of low self-esteem, hopelessness in connection to all her diagnosis and poor academic performance. The client has lost interest with other school mates and only talks a few times in a day. She spends most of the time alone in the classroom or in the house. The general practitioner diagnosed her with depression. The condition has been a strain to mother, father and other 2 younger siblings. The condition was getting worse which is the reason the client was referred to our mental wellness center for specialized care and therapy.
Major depression is continuous feeling of sadness and worthlessness. Various risk factors for depression are exhibited by B.J in this case. According to Mark Ng, How & Ng, (2016) presence of chronic medical condition to the client or to the family member may lead to depression? The client in this case has diabetes type 1 and sickle cell anemia which are all associated with painful treatment procedures and painful crisis. They include daily injection and pricking for self-monitoring of the blood sugar. Anxiety is also another risk factor to depression and they may be a good guide to correct diagnosis of depression. An appointment was made with the clit and her mother for further assessment and therapy. In addition to the above medical and social history, two item questionnaires were initially used to assess for presence of depression. It involved finding the duration in which the client has been having low mood and anhedonia. Low mood included feeling hopeless and depressed. Anhedonia involved reduced interest in pleasurable activities such as playing with other learner or the younger siblings at home. The client indicated to have been having this for nearly every day in the last three weeks. It warranted use of another 9 item questionnaire (Mark Ng, How & Ng, 2016).
The nine item questionnaire that was used is consistent to symptoms identified in the DSM V, for diagnosis of major depression. It assessed the frequency of various depressive feeling over duration of two weeks. The score on the symptoms were as follows; 0 is the symptoms never existed at all, 1 if the symptom existed for several days, 2 if the symptom existed more than half the days and 3 if the symptoms were there in almost all days. The symptoms included; little interest in doing things, feeling down and depressed, insomnia, having little energy and feeling tired. Other symptoms included; poor appetite or over eating, feeling bad about oneself such as feeling that one is a failure or is letting other people down such as the parents (Mark Ng, How & Ng, 2016).
The symptoms also included; having trouble concentrating while reading, moving or speaking slowly or the other way round of being irritable, and thought that one ought to be dead. The client in this case had a score of more than 2 which was diagnostic of major depression. Proper therapeutic plan was warranted to prevent escalation of the condition. Eating disorders such as over eating contributes to development of obesity, major risk factor to development of diabetes mellitus. It therefore appears that the predisposing factors may form a vicious cycle if not well managed early. However, B.J indicated that she has not had any thoughts of suicide or feelings of self harm for the last two weeks. She could forget to administer insulin at times saying that it would not heal her any way and that she knew the disease is chronic with no cure (Mark Ng, How & Ng, 2016).
The pathophysiologic explanation of depression points towards alteration in synaptogenesis and neuronal plasticity. It leads to functional disconnection of cortical and limbic depression circuitry. Endocrine system, hypothalamic-pituitary-adrenal axis, inflammation, neurotrophic growth factor and vitamin D are linked to the pathogenesis of depression. It is also attributed to the imbalances in the neurotransmitters such as serotonin, glutamate, norepinephrine and dopamine. Pharmacotherapy targets inhibition of excess secretion of neurotransmitter that is associated with reduced symptoms of depression. Chronic stress is hypothesized to contribute to changes the immune, endocrine system and the HPA axis which in turn leads to development of anxiety and depression. In this regard, management of depression would involve a combination of pharmacotherapy and psychotherapy for better outcome (Verduijn et al., 2015).
Psychological impact of depression to B.J is the major concern for the therapist and the family members. It appears that depression changes the way B.J regards herself in her life and her worth to the people around her. The reported behavior of BJ by her and her parents indicates an individual with low self-regard. It shows signs of low energy and lack of motivation in her academic work and her social life. This leads to poor academic performance and withdrawal from other peers that she used to play with. B.J also isolated herself at certain parts of the school and would not like to participate in school activities such as games, trips and discussion groups for class work among others. In addition, B.J has also reduced her participation in house chore and caring for her young siblings. She does not engage in watching TV or computer games and movies with the family members as she used to do. In addition, she does not care a lot about her insulin syringe because as her mother indicated, she could leave the insulin outside the refrigerator (Verduijn et al., 2015).
Intrusive thoughts can be attributive factors to change in the self-process which can be internal or external. Internal factors in the case of B.J are the new diagnosis of diabetes mellitus and the associated treatment that involve use of insulin injection and daily self-monitoring. In addition, she may be having trouble communicating with collegues at school due to language barrier that hinder her good academic performance. She is not able to cope with the new experiences and occurrences in her life even as she goes through the adolescence changes. A well-functioning self characteristic is the one that is able to adapt to new experiences and take positive thought out of them (Verduijn et al., 2015).
Treatment Plan
Intervention for depression may take the direction of pharmacotherapy and psychotherapy. Use of ant depressants medications such as the scopolamine, serotonin reuptake inhibitors act by inhibiting some of the neurotransmitters that are attributed to causing depression. In their study, Cuijpers, Quero, Dowrick & Arroll, (2019) found that 75% of the patients did not prefer pharmacotherapy. Although there is general improvement after pharmacotherapy, it appears that the patient would better improve if psychotherapy is used alone or in combination with pharmacotherapy as compared to use of pharmacotherapy alone. However other studies find insignificant difference between psychotherapy and use of antidepressants. Considering the pother medical diagnosis that B.J has, it would not be recommendable to use pharmacotherapy for her case. She was using insulin and other drugs when she gets a sickling crisis. The plan for this client was therefore to use psychotherapy, specifically cognitive behavioral therapy (CBT) even though consultation with a psychiatrist would be made in order to get a prescription of antidepressants (Cuijpers, Quero, Dowrick & Arroll, 2019).
The focus in the CBT that was used on this client was on the negative thoughts that had interfered with her functioning in academic and social life. A close analysis of B.J’s condition, it appears that there are many negative thoughts in her life. They entail to her new diagnosis and the associated treatment plans and the poor compr...