Case Presentation

Case presentation
Name
Institution
Case presentation
Identifying information
Paulina is a 30-year-old female client who is also married with one kid. She was referred for evaluation by the family physician who she has been regularly consulting. Currently, she works as a doctor in one of the state level hospital in Texas. She has been under pressure due to the high demand for her job and the stress she undergoes when carrying out her duty as a medical practitioner. First, she had the passion for her job, and she used to achieve very high evident in the many lives she saved and a large number of patients who could see her on a daily basis. Contrary, of late her performance has been deteriorating, and she longer performs the way she used to do something that has caused her recent feeling of worthlessness. She lately feels ashamed and is worried about her future career as a medical practitioner.
Her strange feeling has made it difficult to settle at her place of work because she claims she feels tired whenever the time for her duty comes. In fact, her unusual behavior has caught the attention of her co-workers who have become concerned about what she might be going through. She could spend most her time at her house either sleeping or just watching television. Unlike what she used to do, Paulina often makes a phone call at her place of work and inform the management that she would not turn up for the job as she feels sick. The husband back at home has become worried too as Paulina has of late shown very little interest in sex.

She rarely falls asleep, and she could stay long for the night either making phone calls to her family members while crying. The husband has also become worried since Paulina never wants to share with him what is bothering her so much.
Presenting concerns
As a result of her current situation, Paulina has found herself having a completely different feeling about her life. She feels much dissatisfied with what she is doing in her life, and she often could think of death. Her health condition has disoriented, and she longer appears beautiful the way she used to be at the time she was starting her career as a doctor. What becomes more concerning is that her wishing of being dead has driven her to think of committing suicide. Paulina’s current situation is not her true position as a professional doctor who is resourceful. She has all the reason to live a happy life with a happy family while saving the lives of the many patients who would need her service. It is concerning that her expertise as a doctor is being wasted and something has to be done to salvage her current situation.
Diagnosis
The diagnosis for Paulina involves Major Depressive Disorder.
The rationale for diagnosis: Paulina meets the required criteria for the major Depressive Disorder as she is having the feeling of worthlessness and ashamed of her work. It is this that has brought her a lot of stress, and she is depressed of her life. Her failure to report to work daily and her condition to lack sleep is enough evidence that Paulina is depressed and would never want to meet her coworkers (Krugten, Kaddouri, Goorden, Balkom, Bockting, Peeters, & null, 2017). The depression that she has does not allow her to have some sleep or feel comfortable to have sex with her husband. The situation gets worse at night when the time for sleeping comes. She feels she is lonely and has to make phone calls to the family members just to give her some comfort. By undergoing depression, Paulina’s normal functioning has greatly been affected to an extent she feels of committing suicide. Though Paulina’s feeling of unworthiness and shamefulness comes after her performance drops; the depressive feelings cannot be connected experience related problems like Posttraumatic Stress Disorder, PTSD.
Differential Diagnosis
The differential diagnosis of Paulina could be General Anxiety Disorder (GAD) and Posttraumatic Stress Disorder (PTSD). It could be possible that Paulina having trained as a doctor was ambitious and often anxious about better performance throughout her career. However, her drop in performance can cause her worry for her future being a professional doctor as well the welfare of her children. The feeling alone is enough to cause her worry thus feeling restless, tense and tired to go to work (Zimmerman, Sheeran, & Diane, 2004). However, this disorder is ruled out based on the fact that Paulina does not feel restless, tense or tired. Her feeling is only based on her recent poor performance which is against her passion for high achievement. The other possible diagnosis could include Posttraumatic Stress Disorder, PTSD which comes after the worst experience at her place of work. The worst experience can be attributed to her turn out poor performance. It is possible that such a worst experience can cause Paulina quite her job. However, the disorder is ruled out based on the fact that Paulina has not yet quitted her job as a doctor. She is still willing to work only that she does not find a lot of value in her career the way she used to.
Theory-Based Case Conceptualization
For the case of Paulina, the Cognitive behavioral theory can best help her solve the disorder she is undergoing. For Paulina to suffer from Major Depressive Disorder, then her actions have to go hand in hand with her feelings, thoughts and her physical sensations and they are the negative feeling and thoughts that are making her continue feeling depressed. Using the Cognitive Behavioral theory, Paulina will be able to deal with her existing problem by developing the positive approach with the help of a therapist (Huguet, Rao, McGrath, Wozney, Wheaton, Conrod, & Rozario, 2016). The therapist will be able to help Paulina breaks her current problem into smaller parts and shown how to manage the smaller negative parts to improve her way of feeling. Ultimately, she will know how to manage her problems by changing the way she thinks and behaves. The advantage accorded with the Cognitive Behavioral theory is that it only examines Paulina’s current problem and looks for ways of improving her minds on day to day basis.
Treatment plan
After evaluation and diagnosis of Paulina, she was found to have Major Depressive Disorder. This was evidenced by her having unworthiness and shameful feeling to an extent she could not report to work and remain indoor the whole day. She also had developed low morale for sex and could rarely sleep at night. It is for this reason that Paulina has to see an occupational therapist for intensive treatment in a restrictive environment possibly welcome the therapist at her home. The occupational therapist will focus on two measurable goals. The first goal will involve Paulina having the decreased signs of depression and seems less bothered by negative feels. She will also start calling back to her coworkers to find out about the work.
The treatment objectives will include Paulina opening up about her problem to the concerned people including her husband, coworkers and family members in less than two weeks’ time. Paulina will start appearing in public accompanied by her husband or coworkers. She will also within few weeks start reporting on her duties at least five days in a week which will ultimately lead to her reporting to the job on daily basis. The treatment interventions will include the occupational therapist breaking the problem Paulina is facing into smaller parts while identifying the negative effects the parts have. The therapist will as well show Paulina how her negative thoughts and feeling are causing her depression. The therapist will finally recommend Paulina to share her experience at work with the management and the husband at home for further support.
References
Huguet, A., Rao, S., McGrath, P. J., Wozney, L., Wheaton, M., Conrod, J., & Rozario, S. (2016). A Systematic Review of Cognitive Behavioral Therapy and Behavioral Activation Apps for Depression. Plos ONE, 11(5), 1-19. doi:10.1371/journal.pone.0154248
van Krugten, F. W., Kaddouri, M., Goorden, M., van Balkom, A. M., Bockting, C. H., Peeters, F. L., & … null, n. (2017). Indicators of patients with major depressive disorder in need of highly specialized care: A systematic review. Plos ONE, 12(2), 1-15. doi:10.1371/journal.pone.0171659
Zimmerman, M., Sheeran, T., & Diane, Y. (2004). The Diagnostic Inventory for Depression: A self-report scale to diagnose DSM-IV major depressive disorder. Journal Of Clinical Psychology, 60(1), 87-110.