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Axis III: Mood Disorders and Suicide

Please help with the following:

1. Diagnosis of the client in the case study. Transcript attached
2. Explain the rationale for assigning these diagnoses on the basis of the DSM-IV-TR.
3. Explain whether this person is at risk for suicide and how you might assess them for suicide. "Axis III: Mood Disorders & Suicide"

Program Transcript

FEMALE SPEAKER: I wanted to reconcile. I begged him to come home. I begged him . He was the one that had the affair. He said he couldn't stand to be around me anymore. The divorce was finalized six, seven weeks ago, and it's over. It's really over. But I just don't know what happened. I thought everything was OK.
I guess that's why I started drinking again. I know, I know. More than I should. I'll bet you I've gained 15 pounds. You know what would make me feel better? A raise. A big, fat one. Going from two incomes to one is just killing me.
THERAPIST: That must be really difficult for you.
FEMALE SPEAKER: You have no idea. I even lost my medical insurance in the divorce, so now I'm not taking my medications.
THERAPIST: What medication?
FEMALE SPEAKER: I forget the name. I have a history of hyperthyroidism, so I know I'm not supposed to stop taking them, but I can't afford them.
THERAPIST: Is there any way you can get insurance through your job?
FEMALE SPEAKER: They cut all medical benefits. Sliced that right along with my hours. I don't really, usually hate my job, but it's just all sort of mixed up right now. The people that I manage don't respect me, and the people I report to, they just take advantage of me, and it's just a nightmare there. I work in a department store. I'm the assistant manager there.
THERAPIST FEMALE SPEAKER: That must be a very demanding job.
FEMALE SPEAKER: It's not what I want. I went to school for fashion design. That's what I love. I want to be creative. But business so just so hard to break
into. Apparently, I'm the only one who thinks I'm any good at it. I just want to pull down the blinds and hide away from the world. I definitely feel myself going there again.
THERAPIST FEMALE SPEAKER: Going where again?
FEMALE SPEAKER: Feeling rejected, worthless, crying all the time.
THERAPIST FEMALE SPEAKER: So you've experienced something like this before, extreme feelings of sadness and depression?
FEMALE SPEAKER: You don't really talk about it in our family when I was growing up. You just keep things to yourself. When I was a junior in college, I went to a frat party, and I got pretty wasted. I mean, I was gone, but not completely. Because, I remember there was this guy and this girl. And we were drinking all night together, and then they took advantage of me.
THERAPIST FEMALE SPEAKER: Did they rape you?
FEMALE SPEAKER: Yes. No. I don't really know. It just all got mixed up. I ended up in the hospital for what they called a depressive episode. I was in there for six days. 40 milligrams of Prozac every day for breakfast.
THERAPIST FEMALE SPEAKER: Sounds like it was incredibly difficult for you. And how long did your symptoms of depression last?
FEMALE SPEAKER: I don't think they ever really went away. That's what happened last--it's just really hard for me to talk.
THERAPIST FEMALE SPEAKER: That's OK.
FEMALE SPEAKER: I always thought I was a good girl. You know, going to church and all that. But just the fact that I was with a guy and a girl. I just feel like I don't know which way to turn, you know?
THERAPIST FEMALE SPEAKER: Are you talking about your sexual orientation?
FEMALE SPEAKER: Yes. And it never really went away. Even after I got married, my husband used to complain that I was never really there when we had sex. Real boost for the ego, right? He wasn't wrong. I don't think I've ever really been there during sex. With anyone, even before college. It's not like I avoided it. It's just that whenever I did, I think I just went somewhere else. Sometimes I think I'm just afraid that I can't handle really connecting with someone.
THERAPIST FEMALE SPEAKER: What is it you think you can't handle?
FEMALE SPEAKER: I don't know. I do have one thing figured out.
THERAPIST FEMALE SPEAKER: What's that?
FEMALE SPEAKER: Details of my suicide. I have all the details worked out. I have a stash of Ambien. I have like 60 of them. It's going to be quick and painless. The only thing I haven't figured out is what day I'm going to do it.

Solution Preview

Because she speaks of her thyroid, I needed to bring in some outside research in addition to the DSM-IV-TR. Thyroid issues, depression, suicide and trauma are all related. In some studies, Prozac may actually harm the thyroid treatment.

Axis III is important not because it's connected to suicide, but the woman says she has a history of hyperthyroidism. This makes her mental problems at least, in part, a physical issue. And beyond that, she is no longer taking her medications. Both hypo- and hyperthyroidism can cause depression, though it is more common in the former than in the latter. It is also very possible that, as an autoimmune disease, hyperthyroidism can quickly morph into hypothyroidism due to the immune system slowly destroying the gland.

So we have several issues:
First, we can easily say that she has a mood disorder due to hyperthyroidism. Unlike HYPO-thyroidism, the former is more marked by anxiety, which of course, can easily turn into depression and vice versa.

Second, since she is a young woman, she might have Graves Disease, or a specific type of hyperthyroidism. This is an auto-immune disorder where the body forces the body to make thyroid-stimulating immunoglobulin. This forces the thyroid to make too much of its specialized hormone. Now, the symptoms of this are tremors, anxiety, heat intolerance and insomnia. Anxiety, of course, can lead to depression (Fukao, et al 2011). ...

Solution Summary

The solution discusses axis III of the DSM-IV-TR - mood disorders and suicide.

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