In your role as a human services professional, it is imperative you understand the etiologies of psychological disorders as you work with justice-involved individuals. Identifying the cause of a psychological disorder, whether intrinsic, extrinsic, or idiopathic, provides you with a basis for determining the root cause of the disorder.
Anna had a long history of severe mental illness dating back more than 20 years. During her first depressive episode, she had killed her baby while suffering psychotic symptoms. She also made two serious suicide attempts. Anna has been divorced twice and now lives alone in federally subsidized home. She has an adult daughter who is deaf and severely handicapped. Prior to her last arrest, her daughter lived at home, and Anna cared for her with help from local social services. Her daughter was placed in residential care when Anna was incarcerated. Because of the previous infanticide, social services had always monitored the situation regarding risk factors for her daughter’s safety; however, this was less of an issue now that her daughter was an adult. Anna’s illness history is characterized mainly by depressive episodes with psychotic features. She had experienced episodes of paranoid thoughts when she believed her neighbors knew all about the past and she was reluctant to go out because she felt persecuted. Anna felt extreme guilt at having killed her child. When psychotic, she would shout that she was evil and deserved to be punished. It seemed that the guilt had affected her considerably to manifest in a negative self-concept. Even when well, Anna never spontaneously talked about herself in a positive manner.
Primary Diagnosis:
Major Depressive Disorder - recurrent, severe, with psychotic features. DSM-5 296.35, ICD-10 (F33.3)
Generalized Anxiety Disorder (GAD). DSM-5 300.02, ICD-10 (F41.1)
You are continuing in your role as a human services professional working at a psychological treatment center in a local correctional facility. You will be sitting in on a session between the individual from your chosen scenario in the case study and their psychiatrist, and your supervisor wants to ensure you understand the complexities of the disorder before the session. Your supervisor has asked you to prepare an analysis of the etiologies of the disorder development to review before the session.
Research the disorder diagnosed in the scenario you chose to learn more about symptomology and etiology.
700 word analysis of the symptoms presented by the individual in the scenario to determine a possible etiology. If necessary details are missing from the case study, fill in the gaps with information from your research. In your analysis, you should:
Describe the symptoms presented by the client.
Analyze symptom development within the client. Consider these guiding questions:
When did the symptoms begin?
How often do the symptoms occur?
How long do the symptoms last? Have they changed over time?
Analyze possible risk factors presented by the client that could have led to the diagnosis. Consider these guiding questions:
Are men or women more commonly diagnosed with this disorder?
Are there situational factors that commonly contribute to this diagnosis?
Analyze the etiology of disorder development from a biological, psychological, and social perspective.
Cite a minimum of 2 peer-reviewed journal articles.
Full Answer Section
- Psychotic features:Delusions (paranoia about neighbors knowing her past), hallucinations (believing she deserves punishment).
- Guilt:Feeling extremely guilty about harming her child.
- Negative self-concept:Even when well, unable to speak positively about herself.
- Generalized anxiety:Excessive worry and nervousness.
Symptom Development Analysis:
- Onset:The case study doesn't specify the exact age of onset, but mentions "a long history of severe mental illness dating back more than 20 years," suggesting symptoms began in her early adulthood.
- Frequency:The case study describes recurrent depressive episodes, indicating they occur multiple times throughout her life. The frequency of psychotic features and anxiety is unclear.
- Duration:The duration of depressive episodes is unknown, but psychotic episodes seem to occur during her depressive phases. The negative self-concept appears persistent, while details about anxiety duration are lacking.
- Changes over time:While the case study doesn't mention specific changes, it suggests a possible decrease in the risk to her daughter due to her being placed in care. This might influence the content of her delusions and anxieties.
Possible Risk Factors:
- Gender:According to the National Institute of Mental Health (NIMH) (https://www.nimh.nih.gov/health/topics/depression) women are more likely to experience MDD than men.
- Situational factors:The case study mentions several potential situational factors:
- Childhood trauma:The infanticide suggests a potentially traumatic event that could have contributed to the development of mental illness.
- Divorce:Stressful life events like divorce can trigger or exacerbate mental health struggles.
- Social isolation:Living alone, especially due to mental illness, can contribute to feelings of loneliness and isolation, worsening symptoms.
- Stigma:The stigma associated with mental illness can lead to social isolation and difficulty accessing support, further impacting mental health.
Etiology Analysis:
MDD with psychotic features is a complex disorder with a likely combination of biological, psychological, and social contributing factors:
Biological:
- Genetics:Research suggests a genetic predisposition to MDD, and studies are investigating potential genetic links to psychotic features (Kato et al., 2019).
- Neurotransmitters:Imbalances in neurotransmitters like serotonin and dopamine are implicated in MDD (NIMH, 2019).
Psychological:
- Cognitive distortions:Negative thinking patterns and distorted beliefs about oneself and the world can contribute to depression and anxiety (Beck, 1976).
- Coping mechanisms:Inability to cope effectively with stress and difficult emotions can worsen mental health symptoms.
Social:
- Childhood trauma:As mentioned earlier, traumatic experiences in childhood can significantly increase the risk of developing mental illness (Felitti et al., 1998).
- Stressful life events:Major life stressors, such as divorce or social isolation, can trigger or exacerbate depressive and anxiety symptoms.
- Lack of social support:Strong social support systems can buffer the negative impact of stress and mental illness, whereas a lack of support can worsen symptoms (Cobb, 1976).
Conclusion:
Anna's case highlights the multifaceted nature of MDD with psychotic features. While the information provided doesn't allow for a definitive diagnosis or identification of the specific causes, it points towards a complex interplay of biological, psychological, and social factors. Further assessment and exploration of her personal history, including details about her childhood, family environment, and any past treatment experiences, would be crucial for a comprehensive understanding of her condition and the development of an individualized treatment plan.