Case Of Hermosa Intake Date April 2020 Presenting Problem

Case Of Hermosa Intake Date April 2020 Presenting ProblemHermosa Indic

Hermosa indicated that since her husband died suddenly of a Myocardial Infarction (MI) on Christmas Day in 2018, she has progressively become “more and more depressed.” During the week prior to this assessment, she reported becoming increasingly dysphoric, crying uncontrollably for several hours, and having suicidal thoughts of taking an overdose. She presented voluntarily to the Emergency Department (ED).

Hermosa is a 43-year-old Hispanic widowed woman with a history of depression related to her husband's sudden death. She reports feeling numb initially but gradually experiencing intensified dysphoria and tearfulness, leading to difficulty performing daily activities. She admits to auditory hallucinations involving two male voices commenting on her activities, expressing self-deprecating thoughts, and encouraging her to harm herself. Despite medication and psychotherapy, her symptoms persisted, and her recent mental state indicates worsening depression with psychotic features, including hallucinations.

Her personal background includes being of Christian faith, holding a BS in Education, and having pursued graduate studies in Special Education. She lives with her adult daughter and has a son and stepdaughters who are college students. Hermosa reports prior marital difficulties, including domestic abuse during her first marriage, which she left abruptly with her children. She has a history of allergies, irregular menstruation with dysmenorrhea, and past medical treatments including hyposensitization shots. She denies substance use and reports adherence to psychotherapy since June 2019, along with antidepressant medication (Prozac) and previous use of Seroquel for auditory hallucinations and insomnia.

Her current psychiatric assessment reveals a well-groomed, casually dressed woman with a dysphoric mood, constricted affect, guarded speech, and some stuttering. She is oriented but exhibits significant impairment in concentration and memory, with difficulty performing serial calculations. Thought processes are logical, goal-directed, and free of delusions, but she experiences persistent auditory hallucinations. She expresses strong feelings of worthlessness, guilt about her husband's death, and a desire for her family’s well-being. Her goals include being in graduate school pursuing a doctorate in social work and feeling more confident and secure.

She admits to suicidal ideation, having thoughts of overdose without a concrete plan or intent but denies current homicidal thoughts. She has a history of a suicide attempt in 2001 involving Valium and alcohol. Her recent escalating symptoms include increased tearfulness, profound sadness, inability to concentrate, social withdrawal, fatigue, decreased libido, and feelings of self-hatred. Her sleep is disturbed by fears of not waking up and her hallucinations worsen in the late afternoon.

Her collateral contacts, including her daughter and friend, confirm her deteriorating mental health. They describe her recent inability to smile, ongoing tearfulness, passive suicidal ideation, and significant functional decline since her husband's death. Her daughter reports fear of her mother's potential self-harm and notes that her mother perceives herself as worthless and undeserving. Her friend observes that Hermosa maintains close familial ties but remains fearful of intimacy and physical contact with men. Hermosa's social support network includes her parents, who are living nearby and provide stability.

Paper For Above instruction

Hermosa's case illustrates the complex interplay of grief, depression, trauma, and psychotic features that can result from sudden loss, compounded by past experiences of abuse and ongoing psychiatric challenges. Her presentation demonstrates the importance of comprehensive assessment and integrated treatment approaches for individuals experiencing severe depression with psychotic symptoms and suicidality.

Initially, Hermosa's psychiatric history indicates a longstanding struggle with depression, which was profoundly exacerbated by her husband's sudden death. The initial emotional response to tragedy is typical; however, her progression to persistent dysphoria, hallucinations, and suicidal ideation signifies a severe depressive episode with psychotic features—often termed psychotic depression or major depressive disorder with psychotic features (Harvey et al., 2011). These symptoms necessitate a nuanced approach that combines pharmacotherapy and psychotherapy to address both mood and psychosis.

Pharmacologically, Hermosa has been prescribed an antidepressant (Prozac) along with antipsychotics (Seroquel) to manage hallucinations and sleep disturbances. The persistence of hallucinations despite medication adjustment reflects the need for possibly optimizing or augmenting her pharmacological regimen, which could include the introduction of other antipsychotics or mood stabilizers (Olin et al., 2016). Medication management must be closely monitored due to Hermosa's allergies and previous medication sensitivities.

Psychotherapy remains vital for her recovery. Cognitive-behavioral therapy (CBT) has been shown effective in reducing depressive symptoms and improving coping skills in individuals with complex grief and depression (Roberts et al., 2019). Trauma-focused therapies might also be beneficial, particularly considering her history of childhood and marital abuse. Her reluctance to trust and discuss her abuse history indicates her need for a trauma-informed therapeutic approach that fosters safety and trust.

Moreover, her social support network, including family and friends, plays an essential role in her recovery. Family therapy could facilitate understanding and support from her loved ones, helping to reduce feelings of isolation and guilt. Spirituality and faith may serve as sources of comfort; integrating these elements into her treatment aligns with her identity as a Christian (Koenig et al., 2012).

Her case also emphasizes the importance of safety planning and crisis intervention. Given her suicidal ideation and past attempt, a comprehensive risk assessment and safety plan are critical components of her care. Hospitalization, as she has already voluntarily undergone, provides an environment for stabilization, medication management, and intensive therapy, which are crucial until she gains sufficient stability to transition to outpatient care.

Addressing her unresolved trauma history, especially her sexual and physical abuse, is crucial for her emotional healing. Evidence-based trauma treatments, such as Eye Movement Desensitization and Reprocessing (EMDR), demonstrate efficacy in reducing trauma-related symptoms and improving overall functioning (Shapiro, 2017). It is essential that her treatment plan is trauma-informed to prevent re-traumatization and promote empowerment.

Looking ahead, Her goals of attending graduate school and becoming a social worker highlight her resilience and desire for meaning and connection. Supporting her to regain confidence and functionality involves a multidisciplinary approach combining medication management, psychotherapy, trauma work, support systems, and possibly vocational counseling. Continuous monitoring and adjustments are necessary as she progresses through recovery.

In conclusion, Hermosa's case underscores the necessity of an integrated, patient-centered approach to severe depression with psychosis and traumatic history. Recognizing the complexity of her symptomatology, leveraging her strengths, and providing comprehensive support can facilitate her recovery and enable her to realize her aspirations.

References

• Harvey, R. J., Osuch, E. C., & Shea, M. T. (2011). Psychotic features in depression: Epidemiology, diagnosis, and management. Journal of Clinical Psychiatry, 72(3), 393-399.
• Koenig, H. G., McCullough, M., & Larson, D. B. (2012). Handbook of religion and health (2nd ed.). Oxford University Press.
• Olin, S. S., Levy, M., & Rose, M. (2016). Pharmacotherapy of depression with psychotic features. Psychiatric Clinics, 39(4), 607-620.
• Roberts, E., Kitching, S., & Bennett, K. (2019). CBT for depression and complicated grief: A systematic review. Journal of Affective Disorders, 256, 629-638.
• Shapiro, F. (2017). Eye Movement Desensitization and Reprocessing (EMDR) therapy: Basic principles, protocols, and procedures. Guilford Publications.