Essay on 32-Yr-Old Jane Smith: A Case Study of Major Depression & Psychotic Features

Introduction

The patient is Jane Smith, a 32-year-old administrative assistant at a local college within Williamsburg Mental Health Center. She is educated, with 14 years of formal education where she has an associate's degree and hence, her job as an administrative assistant. She got admittance to the facility on showing signs of major depression coupled with psychotic features. Jane does not have a record of suicide attempts or any long term hospitalizations at any mental health facility. Additionally, she does not have a family history of mental illness. The purpose of the referral, therefore, was to assess the mental well-being of the patient and identify the need for clinical intervention.

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Assessment Procedures

The clinical psychiatrist assessing Jane recommended the following tests and assessment measures.

• Minnesota Multiphasic Personality Inventory-2 (MMPI-2)
• Mental Status Examination
• Review of Prior Psychological Assessment
• Review of Prior Medical Records
• Clinical Interview
• Beck Depression Inventory (BDI)
• Hamilton Depression Rating Scale (HAM-D)
• Montgomery-Asberg Depression Rating Scale (MADRS)

The Minnesota Multiphasic Personality Inventory (MMPI) is one of the reputable psychological testing and assessment tools in mental health. The MMPI-2, which is often in use in clinical settings, has a set of 567 true/false items that aim at testing individuals suspected of having mental health or clinical issues (Handel, 2017). The tool is also a favorite among clinical practitioners as it has a large research database and has been in use for a long time; hence, most practitioners are familiar with it. The assessment tool has ten clinical subscales, which only a trained psychiatrist or psychologist can interpret, and thus, it is purely clinical. One of the subscales tests for depression, and it contains 57 items, which leads up to the score of clinical depression in individuals with cardinal signs of the health disorder. The tool also tests for psychasthenic and psychopathic deviate, both of which are significant in our scenario.

The Mental Status Examination is the psychological equivalent of the physical examination as it describes the mental status and behavior of the subject under assessment. The test contains subjective and objective assessments, just like a normal physical assessment does. The tool is important in providing clinicians with information for the diagnosis and drafting of a treatment plan for mental health patients. In our scenario, the Mental Status Examination will come in handy in diagnosing for clinical depression that Jane appears to show signs of having.

Psychological assessment is a similar tool to medical assessment, only that it focuses more on the mental and behavioral aspects of the individual. The assessment contains questions which lead to the clinician making informed decisions about the mental state of the patient (Packer & Phillips, 2015). Thus, a review of prior psychological assessment in Jane's case is important to determine the possibility of having depression and other mental disorders. A psychological assessment and a clinical interview are similar in that they both assess the various factors which could lead to a person experiencing signs of a mental disorder and suffering from the suspected mental disorder. The two often go hand in hand with a review of prior medical records to determine the possibility of a history of a mental disorder in a patient.

The recommended assessment tests are significant in the scenario for a variety of reasons. For one, they have a reputable standing among many practitioners as they are reliable and valid in producing the correct results in diagnosing mental disorders. Secondly, these assessment tools are important in coming up with an objective treatment plan if the patient under review has a positive diagnosis of depression and other mental disorders that may arise in conjunction with depression. Thirdly, these assessment tools are easy to administer, and any medical practitioner can easily refer to them as they are universal (Brand et al., 2016). The reasons, as mentioned above therefore make the recommended assessment tests significant for use in the diagnosis of Jane's condition.

MADRS is a 10-item rating scale that measures the severity of depression in individuals who are 18 years and above. Each of the ten items is rated using a 7-point scale (Hallit, Obeid, El Hage & Kazour, 2019). The test usually takes an average of 25 minutes to complete. The Hamilton Depression Rating Scale is also an important and essential assessment tool for measuring depression in individuals. The tool is especially handy in measuring depression as it tracks the before, during, and after sessions of treatment of patients suffering from the malady (Kobak, 2010). The tool contains 21 items, which the practitioner administering it measures on either a 3-point or 5-point scale. The assessment tool takes an average of 18 minutes to complete and score and is, therefore, effective in assessing for depression and its related signs.

The Beck Depression Inventory is another handy assessment tool for screening for signs of depression and assessing the severity of the mental disorder. It is a widely used assessment tool as it also measures behavioral manifestations of depression in addition to determining the severity of the disease. Furthermore, the tool is usable for a broad spectrum of individuals as patients between the ages of 13 to 80 can use it as an evaluation tool. The assessment tool contains 21 items that the patient takes and self-reports rather than having a medical professional conduct the test itself. While self-reporting is one of the reasons that the tool has wide use, it is also the reason for its lack of reliability. The patients who self-report the various signs of depression can be too liberal or conservative about their signs and thus, render the assessment ineffective. The assessment tool also takes an average of 10 minutes to complete. Beck Depression Inventory, as captured in the preceding sentences, is widely used across the world, and the reason for this is because it is relatively easy for patients to use as the first line of assessment before seeking further professional help from a psychiatrist. In our scenario, however, Beck Depression Inventory would not be useful as Jane is already in the mental health facility, and thus, the tests administered will be more professional and involve a psychiatrist rather than her self-reporting on her signs.

General Observations and Impressions

The patient underwent observation, and the following conclusions came out at the end of the assessment. Jane was open and cooperative with the questions asked, and thus, her mood was stable. Her emotions were also in line with her verbal content, and she showed a broad range of emotions during the sessions. Her memory was intact as she showed a great recall of events that she both saw and witnessed during the period before coming to the facility. Jane's thought process was also intact, well-organized, and goal-oriented. Thus, she did not indicate any evidence of delusions, homicidal, or suicidal ideation or paranoia. She also had a good level of personal insight, where she was able to identify some stressors that worsened her condition. She also had a good social judgment as evidenced by the appropriate interactions with other patients and the staff attending to her in the mental facility. Jane was also cooperative with the protocol in the mental facility, which showed her enthusiasm at being able to achieve a quick discharge on remission of her condition.

Owing to the condition that Jane presented with, it is clear that the general observations require further medical tests to rule out the possibility of depression as suspected by the psychiatrist, who recommended that she undergo more psychological assessments. Jane behaved in a manner that is reminiscent of someone who is psychologically upright and not suffering from depression or other potential mental disorders which her signs point to; thus, her behavior may have had a negative impact on the general observation. During the observation, the use of APA's Ethical Principle and Code of Conduct affected the implementation of the personality assessment during the initial process for a variety of reasons (Young, 2017). For one, the clinician conducting the assessment had to ensure that the patient knew her rights during the session, and while this is important, it may have influenced her capacity to understand because she may have thought that she was a fellow clinician rather than a client seeking a psychological review. The ethical standard of privacy and confidentiality may have been a cause of concern for the attending psychiatrist as he or she may have found it difficult to seek advice from other medics on the confusing status of the patient. These two conditions may have, therefore, influenced the implementation of the assessment and led to skewed results at the end of the session.

Test Results and Interpretation

Adjustment Level: Jane's elevated scores on Depression (T = 94) and Psychasthenia (T = 92) scales indicate her dissatisfaction with her life situation and feelings of hopelessness and inadequacy. Symptoms Jane appears to suffer from major depression, which is evident in her elevated Harris-Lingoes subscales on depression (D1, T = 101; D2, T = 89; D3, T = 80; D4, T = 99; and D5, T = 80). These scores and a high score on the Social Introversion scale (T = 79) indicate the chance of suicidal PSY615:

Week Two Counseling-Based Personality Assessment Scenario tendencies: She may withdraw from personal relationships and struggle with separation, which links to her depression. Perceptions of Environment and People Jane's elevated scores on Fears (T = 77) and Anxiety (T = 80) indicates that she does not feel safe or comfortable in most environments. Reaction to Stress: Jane's elevated D1 subscale and low ego strength indicate that she is not able to cope well with stress, even under normal circumstances. Jane likely reacts to stress by withdrawing and isolating herself from the stressors. Self-Concept Jane's score on Low Self-Esteem (T = 89) is evidence of low ego strength and a poor self-concept. Emotional Control: Jane seems to have a lack of emotional control with her depression. She appears to be struggling with feelings of hopelessness and despair. Elevations in the level of depression should be monitored, particularly if the elevations extend over a long period. Interpersonal Relationships: In addition to her depression, Jane's score on Social Introversion (t = 79) indicates she is aloof, ruminative, and withdrawn. Other indicators include elevated scores on Familial Discord (T = 72) and Family Problems (T = 83), which supports the evidence that she may have turmoil in the family.

Psychological Resources: Jane has attended college and appears intelligent. She has some satisfaction with work, so she knows that she is successful on some level. Her high score on Negative Treatment Indicators (TRT, T = 85), coupled with depression, may indicate a negative attitude toward therapy. Social Dynamics: Jane's parents are divorced, and her home life was likely filled with conflict and dissension. Her parents were highly critical, which may be the source of her isolated introversion, anxiety, and depression.

Diagnostic Impressions: Jane's MMPI profile indicates that she suffers from major depressive disorder, and she is at risk for suicidal tendencies. Jane may also have a bipolar personality and problems with mental processes, but she does not appear a danger to others at this time.

Summary and Recommendations

From the results of the evaluation, it is clear that Jane suffers fr...