Multiaxial Diagnosis - The Case of Lisa - Essay Example

"Multiaxial Diagnosis - The Case of Lisa" is a good example of a paper on depression. Lisa, the 35-year-old Caucasian woman, was diagnosed with the major depressive disorder as per Axis I by clinician as per DSM – IV diagnosis. According to ASA “ The essential feature of a major depressive disorder is a period of at least 2 weeks during which there is either depressed mood or the loss of interest or pleasure in nearly all activities”. (ASA ,2000,pg. 349).The client was admitted to the hospital for her attempt for suicide thoughts by means of driving the car across the cliff. Suicidal thought is a symptom of the acute stage of depression and the patient falls in the category of a major depressive state. The client was observed as considerably distressed and disturbed. Lisa reported a state of dysphoria for a period of six months, which is a major symptom of depressive disorder. She was feeling a lack of energy and pleasure which clearly establish that her mental illness is a major depressive disorder.
According to DSM the patient suffering from depressive disorder feels worthless and finds no interest in the activity of everyday life. She is seen to be sleeping more as a result of being depressed and also overweight due to binging food habits. She has fallen as a victim of an eating disorder and practiced binge eating as a result. She tries to overcome her depressive state by eating food with excessive calories. Another activity of Lisa was shopping excessively and as a result, she incurred heavy financial debt. “Research has shown that compulsive shopping behavior is often accompanied by depression, anxiety, and other negative emotions. Indeed, people affected by compulsive shopping disorder often report an uncomfortable tension that is relieved -- at least temporarily -- by shopping”(Owen, 2010).

                        The client has seen to be spending money with no control and also have borrowed a lot of money from the bank. She was finding relief in excessive shopping and binge eating in order to overcome her depressive thoughts. She bought luxury products and received temporary relief from depression but incurred heavy financial debts and also lost a job in this process. All this elevated her mental illness which ultimately ended up in suicidal thoughts. She has had a history of impulsive buying tendency and had several debts to formal employers and also been declared bankrupt in the early years of her life. She confessed to the clinician that she never had any compulsive shopping mentality and she only shopped in order to avoid loneliness and emptiness in her life.

                        The client has never had any history of mental illness or consultancy with psychiatry and the disorder began to develop in six months' time. She has been eating compulsively in order to overcome her depression resulting as a result of debt and loss of a job. However, she had been suffering from an eating disorder since adolescence and this underlying problem emerged as she developed stress and depression. She was also having a very bad real relationship with both men and women. The relationship was very brief and ended up on a very negative note.

In the investigation of Lisa’s case, the clinician established that she was suffering major depressive disorder (Unipolar Depression) on Axis I.Eventhough client show some traces of compulsive eating and shopping disorder it cannot be categorized into these as she has shown major symptoms of depression and suicidal thoughts. The client has thoughts of worthlessness, despair, lack of energy and thoughts of ending a life which is not the symptoms of compulsive eating or shopping disorder symptoms. Since Lisa needed to be observed more in order to categorize for Axis II, the clinician has mentioned no diagnosis for the same.

Regarding Axis III, the clinician did not gather any information which showed that the patient suffered from any disease that could lead to depression. The client did not report any past or previous medical problems. With regard to Axis IV, the clinician evaluated that client suffers from a problem related to social environment, occupation, and economy. Lisa is currently unemployed and also had a problem with men and women close to her and also suffering from financial debt. Clinician gave 41-50 for Axis V, as Lisa needs inpatient treatment. “Among both children and adolescents, depressive disorders confer an increased risk for illness and interpersonal and psychosocial difficulties that persist long after the depressive episode is resolved; in adolescents, there is also an increased risk for substance abuse and suicidal behavior”(Lewinsohn,1997,pg.9-12).

            The client seems to have reacted very disturbingly with her friends and with people involved in the relationship and even threaten them of harming herself. This shows that she had embedded thoughts of killing herself and this is a very acute stage of depressive disorder.

Differential Diagnosis

In the case of differential diagnosis, the client does show signs of compulsive shopping and eating disorder. But it is not be mistaken with it as the main underlying problem for it is the state of depression which the client is in. Individuals suffering from compulsive disorder do not have thought of suicide and despair. “Obsessive-compulsive disorder in which people have obsession or compulsion which are time-consuming, distressing, obstruct daily routines, relationship with others or daily functioning” (Hymen,2009,pg.17)The compulsive behavior was a part of depression and she performed this eating and shopping pattern in order to overcome her state of loneliness and feeling of isolation.

Treatment

Major depressive disorder can be treated with the help of antidepressant drugs and psychotherapy. An antidepressant drug migraine is used to treat this disorder along with cognitive therapy and interpersonal therapy “The interpersonal therapy focused on the immediate social context of the depression and the depressed person's relations with other people. The cognitive therapy focused on correcting the patient's negative thinking, irrational guilt and pessimism”(Long,1998)Patients show major improvement with all these treatments and returned back to normal life soon. Lisa should be treated for 16 weeks or more as she is suffering from a major depressive disorder. Antidepressant drug therapy is highly effective and Lisa can return to normal life if she is given inpatient treatment.

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