Reference no: EM133510192
Pamela was a 43-year old married part-time librarian who came to the mental health clinic to deal with her most recent bout of depression. In discussions with her husband, she had reluctantly agreed that her depression over the past three weeks had been so impactful that she really did need to speak with someone. She told the social worker who assessed her that she had been feeling deeply depressed for these past several weeks. She had all but stopped functioning due to feelings of exhaustion, remaining in bed most of the day with no interest in any of her typical activities. She tried to read (one of her most loved hobbies) to get her mind off her sadness, but could not sustain the focus to read more than a few sentences. She rarely bathed unless prompted by her husband. If left alone, she would sleep all day. She had had no appetite at all during the past several weeks and had already lost ten pounds. Pamela reported that her husband had grown frustrated with her for continually saying that she wasn't worth being with, and that he should just leave her.
Pamela stated that she had been this depressed a number of times before since her late teens or early twenties. At other times, however, she felt exceptionally well. She recalled for or five times since her young adulthood when she felt so good that she needed virtually no sleep at all. At these times, she stated that she felt brilliant - exceptionally creative and energetic. She recalled a day when she read non-stop for nearly twenty hours and finished three lengthy novels. When asked at the time why she was reading for so long, she replied that she thought it was perfectly obvious -she wanted to see what happened in the books. Pamela admitted that she was hospitalized twice when she was having these episodes, mostly because her family and others around her were concerned. Though she thought she was more than fine, she was told that she was speaking extremely rapidly and in a very disorganized fashion. When asked if she ever did anything during those periods that caused her problems or that she regretted later, she did admit that once, during the course of a party, she initiated sexual interactions with two separate men she had just met that evening. She reported that she later felt guilty and shocked at what she had done because it was so uncharacteristic of her. She admitted that, since she has been married, she does feel very sexual when she has these "great moods", but that she still couldn't understand why she had pursued those two men that night. Pamela stated that these exceptional moods lasted about 8-10 days before subsiding.
Pamela had been in treatment several times and had been prescribed medications, the names of which she couldn't readily recall. She said that she would take them for a while and then eventually stop because she didn't like how they made her feel "flat". When asked to describe what she meant by "flat", she said that on her medicine she felt fine, but that there seemed to be no zest or fun in life. This was hard to take for long, so she typically stopped her medicine after a few months.
Pamela denied use of alcohol or drugs. She had no significant medical history and denied suicidal/homicidal ideation intent or plan.
On examination, Pamela was a well-groomed, slight woman who often averted her eyes and tended to speak very softly. No abnormal motor movements were noted, but her movements were constrained, and she did not use hand gestures. Her mood was depressed. Her affect was sad and constricted. Thought processes were fluid, though possibly slowed. Her thought content was notable for depressive content.
Her insight and judgment were intact.
Task
Provide your diagnosis of Pamela. Including any and all pertinent diagnoses and specifiers. Then, in narrative form, describe what you identified in the case that led to your diagnosis. Did you consider any other diagnoses before deciding on the one you selected? If so, which ones? Why? How did you eliminate them?