After reading the case of "Still a Student", you will write a report for psychoevaluation (see and follow the psychoevaluation handout) and write a letter for medical referral (indicated what specialist/physicians she needs and what you would for them to focus on.
Still a Student (Jan Davis), with treatment discussion
Ellen Waters's psychotherapist referred Jan Davis (client) for a medication consultation because of her continuing depressed mood and panic attacks. She is a 37-year-old part-time graduate student who lives alone and supports herself by working as a home health aide. She completed the course work for a Ph.D. in sociology 3 years ago but has not yet begun her thesis.
Ellen is indeed an unhappy-looking woman, and she describes herself as being unhappy through much of her life, with no long periods of feeling really good. Her father had a history of alcohol problems, and there was always a great deal of strife in her parents' marriage. She denies sexual or physical abuse but feels that her parents were "emotionally abusive" to her. She was first referred for treatment after she made a suicide attempt at age 14, and there have been many times over the years during which her usual low-level depression has become considerably worse, but she has not sought treatment.
Two years ago, when she had been seeing her current boyfriend for about 4 years, it became clear to her that he was unwilling to marry her or live with her. She began to get more depressed and to experience acute panic attacks; it was at that time that she entered psychotherapy.
Ellen says she was depressed most of the time during the month before the consultation. She had gained about 10 pounds because she was constantly nibbling on chips or cookies or making herself peanut butter sandwiches. She often awakened in the middle of the night, was unable to go back to sleep for hours, and then overslept the following day, often sleeping up to 18 hours. She says she feels like dead weight, her legs and arms are heavy, and she is always tired. She ruminates about her own failures and cannot concentrate on any serious reading. Although she often wishes to be dead, she has not made any recent suicide attempts.
Ellen's mood is clearly reactive to favorable events. Small attentions from her therapist or her boyfriend can cause her to feel really good for hours at a time. She has an equally extreme reaction to any sort of rejection. If a friend does not return a call, or if someone appears romantically interested and then withdraws, then she feels devastated to the point where she cannot work. She then stays at home, overeats, and avoids people.
Ellen's academic and vocational histories have been erratic. She has a master's degree in psychology and worked as a counselor for a while but found this work too upsetting. She then began a Ph.D. program in sociology and completed her course work but interrupted her studies to train in physical therapy. She has never worked in one job for more than a few years and has spent much of her adult life as a student. Her current romance is the longest she has sustained. She lived with a man once, but this relationship was brief and tumultuous. Boyfriends have described her as "needy and clinging," and it appears that her current boyfriend fears her neediness.
Although Ellen reports chronic depression, when she is asked about "high" periods, she describes many episodes of abnormally elevated mood that have lasted for several months. During these times, she would function on 4 or 5 hours of sleep a night, run up huge telephone bills, and feel that her thoughts were racing. She was able to get a lot done, but her friends were obviously concerned about the change in her behavior, urging her to "slow down" and "calm down." She has never gotten into any real trouble during these episodes.
She is clearly potentially suffering from bipolar depression. She shows signs of depression and also periods of euphoria. She obviously needs to see a psychiatrist who specializes in mood ...
Example psychoevaluation case study of a 37 year old student with depression and anxiety disorders.