Reference no: EM133255715

CASE : FEELING EMPTY

History

A 34-year-old call center manager attends her general practitioner (GP) surgery with her boyfriend. She complains of tiredness and a lack of enthusiasm for life. These complaints started a year ago but have worsened over the past two months. She has been forced to take time off work as she was constantly arguing with the senior manager and found it difficult to remain calm and composed at work. She has also been irritable with her boyfriend and gets upset easily if he tries to 'motivate' her. She knows that he is well-meaning but still finds it very irritating and yet feels guilty for responding to him in this way. She has lost all interest in sex or going out socializing. Despite being offered a great deal of support by her boyfriend, she constantly worries that he will leave her. Over the past six weeks, when she has been at home, she has spent most of her time in bed. She admits shamefacedly that there are days when she does not wash or even brush her teeth. She vacantly watches the television, not able to take in anything. She feels 'empty' most of the time and finds it upsetting that she cannot even react to her boyfriend's efforts at reaching out to her. She watches TV until late, finding it difficult to sleep. In the morning, she feels exhausted and tends to lie in bed until late. She has had thoughts of dying but resists acting on these as she does not want to punish her boyfriend or her mother, who lives by herself.

She is an only child. She lives with her boyfriend in his flat. She is close to her mother and visits her weekly. Her father died following a stroke last year. She is healthy and has no medical problems. She does not drink or use drugs. She remembers being admitted to a psychiatric unit on a section at the age of 19 as she had become 'very high'. She remembers taking lithium for a while but now has been off it for years. The only other psychiatric episode she can recall was on holiday to Greece when she became quite elated and was convinced that she was Venus, the goddess of love. She went to the local market topless, was arrested, and was admitted to a local psychiatric hospital. She was treated as an inpatient for two weeks and was discharged with some medication. She has only hazy memories of the episode but remembers not taking the medication on her return to the United Kingdom.

Questions

1. List at least three possible diagnoses and the evidence for each?

2. What is the most likely diagnosis? List the evidence that supports your choice.

3. List the potential difficulties in treating a client with this diagnosis.

4. List possible treatment options for a client with this diagnosis and explain what a course of treatment might look like.