Case Study: Tina's Story

Pages: 9 (2559 words)  ·  Bibliography Sources: 9  ·  Level: College Senior  ·  Topic: Psychology  ·  Buy This Paper

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[. . .] In Tina's case we see that she thinks of suicide but she does not feel that she is at a point where she must decide for suicide. Yet, as she is hopeless because of her broken relationship with her husband Joe and she does think that she will not find a good relationship so there is a possibility of her deciding suicide if not provided with proper treatment.

The Importance of Accurate Diagnosis

Because depression causes such a tremendous degree of pain and suffering, a prompt and accurate diagnosis is essential for the patient to receive optimal clinical care. Researchers have indicated that under or over-diagnosis of depression is often a detriment to the type and timing of treatment received, as well as the utilization and costs of additional services (Eaton, Neufeld, Chen, & Cai, 2000; Tiemens, VonKorff, & Lin, 1999). In addition, because depression presents a significantly increased risk for suicidality clinicians need accurate tools to evaluate for suicidality, both for the protection of the patient and to reduce the clinician's liability (American Psychiatric Association [APA], 2000; Sadock & Sadock, 2003).

Unstructured Diagnostic Interviews

The American Psychological Association describes an unstructured interview as "an interview that imposes minimal structure by asking open ended (rather than set) questions and allowing the interviewee to steer the discussion into areas of his or her choosing" (APA, 2007, p. 970). Considered "diagnosis as usual" the unstructured clinical interview is currently considered the standard of practice for the assessment of psychopathology (Miller, 2001; Zimmerman, 2003;).

Structured Diagnostic Interviews

The American Psychological Association describes a structured interview as "an interview consisting of a predetermined set of questions or topics" (American Psychological Association [APA], 2007, p. 901). Used extensively in research settings, numerous studies have indicated that structured interviews are often more through, accurate and reliable than unstructured interviews in determining clinical diagnoses. Several studies examining diagnostic accuracy found that when patients were simultaneously diagnosed with both structured and unstructured interviews, the structured interviews both revealed more co-morbidity and, missed fewer diagnoses (Hilsenroth & Segal, 2004)

Screening Instruments

In addition to the interviews and self reported measures there are other screening instruments. Screening measures generally do not include the more extensive diagnostic criteria found in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR). Criteria frequently includes the length of time the respondent has experienced their symptoms, the degree of their overall impairment, and the potential presence of any co-morbid psychiatric or physiologic disorders. As there are multiple disorders that have symptoms that are common to depression (e.g. Schizophrenia, Bi-Polar Disorder, Substance Dependence, and Schizoid Personality Disorder, as well as hypothyroidism, and pancreatic cancer), without additional DSM-IV symptom criteria being ruled out, the symptoms and severity of depression alone are not sufficient to provide an accurate diagnosis of Major Depressive Disorder (Sharp & Lipsky, 2002).

Treatment

In addition to medication there are many types of treatments such as counselling, stress management courses, group therapy, exercise. In my opinion Tina need medication in addition to counseling. Because she can't sleep more than four times at a time that is why she need medication. Also she feels lonely and there is no one with whom she can share her grief there is a need of group therapy involving some of her friends of colleagues.

References

American Psychiatric Association [APA]. (2000). Diagnostic and statistical manual of mental disorders, Fourth Edition, Text Revision. Washington, D.C.: American Psychiatric Publishing, Inc.

American Psychological Association [APA]. (2007). APA dictionary of psychology. Washington D.C.: American Psychological Association

Burns, D.D. (1999b). Feeling Good: The New Mood Therapy. New York: Avon Books.

Eaton, W.W., Neufeld, K., Chen, L.-S., & Cai, G. (2000). A comparison of self-report and clinical diagnostic interviews for depression: Diagnostic interview schedule and schedules for clinical assessment in neuropsychiatry in the Baltimore Epidemiologic Catchment Area follow-up. Archives of General Psychiatry 57(3), 217-222.

Fleming, J.E., Offord, D.R., & Boyle, M.H. (1989). Prevalence of childhood and adolescent depression in the community: Ontario Child health Study. British Journal of Psychiatry, 155, 647-654.

Hankin, B.L., Abramson, L.Y., Moffitt, T.E., Silva, P.A., McGee, R., & Angell, K.E. (1998). Development of depression from pre-adolescence to young adulthood: Emerging gender differences in a 10-year longitudinal study. Journal of Abnormal Psychology, 107, 128-140.

Hilsenroth, M.J., & Segal, D.L. (2004). The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II). In Comprehensive handbook of psychological assessment, Vol. 2: Personality assessment. (pp. 134-143): John Wiley & Sons, Inc.

Jamison, K.R. (1999). Night falls fast: Understanding suicide New York: Vintage Books

Kessler, R.C., Patricia, D.B., Demler, O.D., Jin, R., Merikangas, K.R., & Walters, E.E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey replication. Archives of General Psychiatry, 62(6), 593-602.

Kessler, R.C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K.R., Rush, A.J., Walters, E.E., & Wang, P.S. (2003). The epidemiology of Major Depressive Disorder: Results from the National Comorbidity Survey Replication (NCS-R). JAMA, 289(23), 3095-3105.

Lewinsohn, P.M., Clarke, G.N., Seeley, J.R., & Rohde, P. (1994). Major depression in community adolescents: Age at onset, episode duration, and time to recurrence. Journal of the American Academy of Child and Adolescent Psychiatry, 33(6), 809-818.

Miller, P.R. (2001). Inpatient diagnostic assessments: 2. Interpreter reliability and outcomes of structured vs. unstructured interviews. Psychiatry Research, 105, 265-271.

Murray, C.J.L., & Lopez, A.D. (1997). Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. The Lancet, 349 1436-1442.

Sadock, B.J., & Sadock, V.A. (2003). Kaplan & Sadock's synopsis of psychiatry, behavioral sciences/clinical psychiatry (Ninth ed.). Philidelphia: Lippincott Williams & Wilkins.

Sharp, L.K., & Lipsky, M.S. (2002). Screening for depression across the lifespan: A review of measures for use in primary care settings. American Family Physician, 66(6).

Solomon, A. (2001). The noonday demon: An atlas of depression. New York: Touchstone.

Substance Abuse and Mental Health Services Administration. (2005). The National Survey on Drug Use and Health: The NSDUH Report. Retrieved December 30, 2011, from http://www.oas.samhsa.gov/2k5/depression/depression.htm

Tiemens, B.G., VonKorff, M., & Lin, E.H.B. (1999). Diagnosis of depression by primary care physicians vs. A structured diagnostic interview: Understanding discordance. General Hospital Psychiatry, 21(2), 87-96.

Twenge, M.M., & Nolen-Hoeksema, S. (2002). Age, gender race, socioeconomic status and birth cohort differences on the Children's Depression Inventory: A meta-analysis. Journal of Abnormal Psychology, 111(4), 578-588.

Venes, D. (2007). Tabers… [END OF PREVIEW]

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