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Dr. Daniel Gray bill [ ] Chapter 7: Case Study for Depression Sally Jone was a 16 -year-old African-American female referred to the adolescent unit of an inpatient psychiatric hospital. She was referred by her mother, Mrs. Jone, who had discovered her bleeding from her wrists in her bedroom. The amount of blood was not substantial, but Mrs. Jone had brought Sally to an emergency room anyway for treatment.
The attending physician had said that Sally was not seriously injured but recommended that the teenager to be committed to an inpatient psychiatric hospital for evaluation. Given Sally's recent depressive behaviors, Mrs. Jone consented to a short-term commitment of her daughter. The next day, Sally was interviewed by a psychiatrist who specialized in adolescent behavior disorders. Sally was initially hesitant about talking and quite angry at her mother for committing her. After some initial discussion, however, she was more forthcoming.
Sally said she had recently moved to a new school in the area following her mother's divorce, and that no one in school seemed to like her. In particular, she was upset about being in the racial minority and at having developed few friendships. When asked if a specific recent event had upset her, Sally said she felt that other teenagers were making derogatory remarks about her weight as she ate alone during lunch (Sally was quite overweight). Sally could not be more specific, however, and it was unclear whether any remarks had actually been made about her.
Sally stated further that the past thirteen months had been difficult ones. Her parents, following a period of marital conflict, had separated and eventually divorced. For reasons that Sally did not completely understand, her mother had moved out of state with Sally, thus separating her from her father and 13 -year-old brother. This was traumatic for Sally, as she had been close to her father and brother but was no longer allow contact with either one. Sally enrolled in her new school in August and began attending in September. However, she missed about one-third of school in the first 2 months, and had not gone at all in the past two weeks.
Sally complained that she was quite lonely because her mother was often working and because she had not developed any new friendships Over the past 2 weeks, Sally reported that her mood was becoming worse. She greatly missed having her entire family together and lamented not being able to spend Thanksgiving with her father and brother (her mother had already said it was impossible). As a result, she had become less active, lying around the house, watching television, and surfing the Internet tomcat with others. In the pastmweek, she had gone out of the house only twice, and she was overeating and oversleeping. He mother was at work a lot and hadn't talked to Sally much in the past 2 weeks. When she did converse, it was usually to try to persuade Sally to go back to school.
The psychiatrist also raised the topic of Sally's injuries from the day before. Sally said she was feeling bad and wondered what it would be like if she committed suicide. In particular, she wondered how her family would feel and who would come to her funeral. She said she was not optimistic about the future and that suicide sometimes seemed preferable to living. Sally insisted, however, that her behavior was not an actual suicide attempt. Instead, she claimed she made a few scrapes with a butter knife to see what would happen.
She did get herself to bleed to some extent but did not feel that the injuries were serious (the medical report confirmed Sally's statements). Sally said her mother came into her room, saw the blood, and "freaked out. " Sally was then ordered to get into the car and go to the emergency room. The attending physician had asked about her injuries, and Sally told him truthfully what she had done. she was then transferred to her current unit with a person sitting outside her room to watch her. The psychiatrist asked Sally if she had any current thoughts about harming herself, and Sally said no. She reiterated that she had not wanted to kill herself the day before and she now wanted to leave the unit.
She also, asked to see her mother, and was told she would see her that evening. Sally promised the psychiatrist not to harm herself on the unit and to speak with him immediately should she have any suicidal thoughts or impulses. Sally was then placed on a mild sedative and slept for the remaining afternoon. The psychiatrist also interviewed Sally's mother, Mrs. Jone, who provided more information about the family situation. Mrs.
Jone said that she and her husband had had many arguments in the past about several issues, most notably his alcohol use and the family's financial status. She also reported that her husband had had several bouts of depression, and had been hospitalized often. He typically, though, refused recommended treatment. The last straw came, however, when Mrs. Jone caught her husband Leaning over Sally as she slept in her bed. Although neve proven, Mrs.
Jone suspected that Sally was sexually abused by her father. Sally denied this in conversations with her mother, but Mrs. Jone felt it was best that she and Sally leave the state. Mrs. Jone indicated she had parted company with her son as well because he was unruly and because the had a poor relationship. With respect to recent events, Mrs.
Jone confirmed some of Sally's reports. For example, she confirmed that she was quite busy at work and not able to devote the kind of attention to Sally that her daughter was used to. However, the two did share time together on the weekends, though not in the last 3 weeks, and they had good rapport. Mrs.
Jone also confirmed that she and Sally had little contact with Sally's father and brother. this would include, she said, the upcoming holiday season. Mrs. Jone also verified that Sally had missed a lot of school in the past 2 months and did not seem too successful at making new friends.
Both women were concerned about Sally's weight, and Mrs. Jone knew this was a major source of embarassment and frustration for her daughter. Despite these situations, however, Mrs. Jone said she was shocked to find Sally bleeding in her bedroom.
The possibility of suicide had never been considered by Mrs. Jone, but the apparent seriousness of the situation led her to agree to the inpatient commitment. With Mrs. Jone's permission, the psychiatrist also spoke with Sally's guidance counselor at school.
The counselor, Mrs. Deetz, was quite upset about Sally's condition and revealed that Sally had made a comment about suicide one month earlier. Apparently, Sally had come to Mrs. Deetz's office and complained that several students in her physical education class were making fun of her weight.
Sally began to cry, complained that she was unable to make friends, and said "I wish I was dead. " Mrs. deetz then changed Sally's schedule so that she wouldn't have to attend that particular physical education class. She also made several recommendations regarding extracurricular activities, but Sally dismissed them because she was in the racial minority. Mrs.
Deetz insisted, however, that Sally's concerns about social rejection were unfounded. She remained concerned about Sally and offered to assist the psychiatrist in whatever way possible. The psychiatrist interviewed Sally again the next day and confirmed that she had no current suicidal thoughts or impulses. He placed her on a low dose of antidepressant medication and asked her to attend group therapy sessions that morning and evening. Sally agreed, and the psychiatrist noted that her mood was somewhat improved from the day before.
However, given the information received so far, the psychiatrist suspected that Sally had just experienced a major depressive episode and should be kept on suicide watch.
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Research essay sample on Attending Physician Suicidal Thoughts
