A Comprehensive Case Study Analysis of Major Depressive Disorder in a Patient Following a Traumatic Accident

QUESTION

Case Study Info Michelle, a 51 year old former hairdresser, came to a psychiatric clinic at the urging of her primary care doctor. A note sent ahead revealed that she had been tearful and frustrated at her last medical appointment, and her doctor, who had been struggling to control her persistent back pain, felt that an evaluation by a psychiatrist . Greeting Michelle in the waiting room, the psychiatrist was struck both by her appearance and her manner: here was a woman with shaggy silver hair and dark sunglasses, seated in a wheelchair, who offered a limp handshake and a plaintive sigh before asking the doctor if he would mind pushing her wheelchair into his office. She was tired from a long commute and disgruntled because no one on the street had offered to help her out upon her arrival. Once settled, Michelle stated that she had been suffering from unbearable pain for the last 13 months since the night that “changed everything.” Apparently she had locked herself out of her apartment and, while trying to climb in through the fire escape, had fallen and fractured her pelvis, her tailbone, her right elbow, and three ribs. Although she did not require surgery, she was bed-bound for 6 weeks and underwent several months of physical therapy. Daily pain medication was only moderately helpful. She had seen “a dozen” doctors in various specialties and tried multiple treatments including anesthetic injections and bioelectric stimulation therapy, but her pain was unrelenting. Throughout the ordeal, Michelle smoked marijuana daily, explaining that a joint enjoyed in hourly puffs softened her pain and helped her to relax. Michelle denied using alcohol or any other drugs besides those prescribed to her. Prior to the accident, she had worked at a neighborhood salon for more than 20 years. Michelle stated that she had a number of very devoted clients and that she relished the professional camaraderie she had with her colleagues, whom she referred to as “my real family.” She had been unable to work since the accident on account of the pain. Michelle became visibly distraught while speaking of not working. “These doctors keep telling me I am good to go back to work,” she said with visible anger, “but they don’t know what I am going through.” Her voice broke. “They don’t believe me. They think I am lying about the pain.” She added that although friends seemed sympathetic and reached out to her after the accident, they seemed less so now. Michelle had begun to let calls go to voice mail most of the time because she just did not feel up to socializing on account of the pain. Moreover, in the past month, she had stopped bathing daily and was not motivated to clean her apartment. Without the structure of work, she found herself up until 5:00 in the morning and pain woke her several times before she finally got out of bed in the afternoon. As for her mood, she said, “I’m so depressed it is ridiculous.” Michelle often felt hopeless of any possibility of living without pain but denied ever thinking about suicide. She explained that her Catholic faith prevented her from ever considering taking her own life. Michelle had never seen a psychiatrist before and did not recall ever feeling depressed prior to her accident. She did state that “a hot temper” was a trait among many family members. She spoke of only one meaningful romantic relationship, years before, with a woman who was emotionally abusive. Michelle revealed some legal history, several arrests for theft when she was in her 20’s. She said that she was “in the wrong place at the wrong time” and was never convicted of a crime. CLINICIAN’S DIAGNOSTIC NOTES OVERVIEW OF MENTAL DISORDERS CASE HISTORY:_________________________________________________________ CLIENT NAME:__________________________________________________________ IMPORTANT/INTERESTING DATA: SUMMARY OF CLINICAL THOUGHT PROCESS AND DIAGNOSTIC DETERMINATION: DIAGNOSIS 2 & 3 ARE ONLY USED IF THERE IS A CLEAR SECOND OR THIRD DIAGNOSIS. THESE WILL NOT ALWAYS BE USED. DIAGNOSIS 1 (WITH CODE NUMBER):______________________________________________________ DIAGNOSIS 2 (WITH CODE NUMBER):­­­______________________________________________________ DIAGNOSIS 3 (WITH CODE NUMBER):______________________________________________________

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