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Dr. Castellani

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Maladaptive Behavior
& Psychopathology/ FP6005 A01


of client:

                         Major Depression (Major Depressive Disorder)


signs and/or symptoms associated with Major Depression

to the DSM-5 is feeling hopeless or depressed most of the day, psychomotor
agitation or retardation regularly, having excessive feelings of guilt or
worthlessness. The person or patient haven’t encountered a manic or hypomanic
state, symptoms have lasted for at least two consecutive weeks (Reynolds, and
Kamphaus, 2013, p. 1)


this diagnosis, the client is a Caucasian female, and she’s been battling
depression since she was 17 years old. She currently works as a drug abuse
counselor. Throughout the years she has gone through multiple suicide attempts
and even hospitalizations. She expressed than since small, around four years
old she has experienced hatred and anger towards her teachers, friends and even
family. When in high school she went through the horrible experience of the
death of her boyfriend. She is not part of any extracurricular activities and
says is not interested in a romantic relationship either. She doesn’t have what
we call a social life, and she feels even though she frequently communicates
with her family that they don’t understand her. 
She hides her emotional pains by fake smiling and going shopping to
cope. She feels guilty for the shame this disorder brings to her family.

there any predisposing factors?

would say one of the most significant factors was the coping with the tragic
death of her boyfriend in high school even though mourning of a loved one
doesn’t account for is a definite sign of MDD (McGraw-Hill, 2007). Also,
another factor is the worrisome behaviors she’s had since she was in elementary
school. But genetically speaking, I don’t think any factors predisposed the


any symptoms observed during diagnosis?

of the significant signs was her smile; it was too consistent as if she was
hiding her real emotions, it’s like she put on a façade. She even said, “how
she feels guilty for the shamefulness that has been brought upon her family for
her disorder.” She is also doing suggestive behavior that correlates with
psychomotor agitation. The client has been hospitalized with or without
consent, and she has a long history of isolation and self-harm by even sleeping
22 hours out of the 24 of the day.

any symptoms or behaviors inconsistent with diagnosis

most situations those who suffer from this are not functional, they don’t go
anywhere or do anything, they just stay at home. Tara, on the other hand, is
entirely functioning. She can keep her job, get up, get dressed; she even
maintains her excellent hygiene. Nobody would know what she suffers from at
work since she separates her feelings from what she deals with at work.

relevant to the developing of the disorder

Depressive Disorder is closely similar to Dysthymic Disorder but is a bit more
severe due to that Major depression has suicidal or homicidal thoughts and or
tendencies. Dysthymic Disorder is very functional but does not have the ideas
or trends for suicide or violent actions. Statistics show that 24% of females
and 15% of males suffer from or will suffer from depression (McGraw-Hill,


there any medical conditions observed that might indicate the diagnosis?

the aspect of dealing with depression, there are no physical medical conditions
that contribute to the diagnosis. Just like other mood disorders, it is a
neurological factor that it can’t only be fixed surgically but also requires
the potential use of antidepressants to help stabilize the neurotransmitters
sent from the brain to the body.

there any psychosocial or environmental are factors contributing to the

notice if there is any neurological condition just like in other symptoms it may
need a CT scan to determine it. She does remains isolated other than with her
family she does not have friends. The only things she does is to shop and go
home to watch tv then go to bed. She does have experience the loss of a
boyfriend in high school.

is the safety of the client overall? (Suicidal or homicidally)

is at high risk of committing suicide. Other than her history of attempting
suicide and her hospitalizations, she expresses she would like to die, it’s
just not right for everyone else and she just “shouldn’t.” I believe she is at
high risk of exhibiting unsafe behaviors due to her history of anger and
isolation with her long history of suicidal attempts.

there any cross-cultural issues that affect the differential diagnosis?

closer it gets to dealing with the diagnosis, cultural psychology should not be
seen as a psychiatric treatment of ethnicities (Alarcon, 2009, pg. 134, para.


are the short-term goals?

should go out more than just shopping for clothes this way she could start
developing a social network. She could also do like a log of her emotions kind
of like a journal and maybe even visit a psychiatrist.

are the long-term goals?

importantly she needs to express or communicate with a psychiatrist or her
family about her feelings or any issues she faces while taking her medications.
She should start family therapy so she can finally see how supportive her
family is even though she can’t understand it right now. She can’t miss any of
the bilateral or individual therapy sessions. 

appropriate strategy and why?

best strategy for her is to maintain her medications, and slowly trying to go
out and meet new people to develop her social life. It is super talented that
her family remains by her side and be supportive by showing her they are not
ashamed of her or her diagnosis. Also with bilateral therapy is essential for
Tara to begin uncovering the causes for her condition.

to moderate strategy and why?

her isolation and suicidal tendencies with strict medication is the least
productive strategy. Medications may help reduce symptoms and increase
stability, but they cannot alter the environment or the client’s anti-social
behavior. Bilateral therapy helps find the leading causes to help them overcome
obstacles but cannot change the fact of being isolated. It makes it hard for a
person to continue making positive changes if they don’t get that positive
reinforcement by family, co-workers, etc. Positive encouragement helps heal,
negatives reduce the positive atmosphere and therefore the outcome.


of client:

        Dysthymic Disorder / Persistent
Depressive Disorder


signs and/or symptoms associated with Dysthymic Disorder

to the American Psychological Association in the current Diagnostic and
Statistical Manual of Mental Illnesses (DSM-5), the significant symptoms by
persons that suffer from Dysthymic Disorder are lack of proper hygiene,
depression for longer than two years, having a chronic low-leveled depression.
Indifference to Major depression they do not want or need to harm themselves,
difficulty maintaining employment (McGraw-Hill, 2007).


patient is a 32 y/o white male called Robert and who has been in a depressive
state for around two decades. He was raised in poverty and still sticks with
what he knows. Robert lives in a small apartment and its proud of working the
system for money and benefits. He also works part-time and doesn’t interact at
work; he is anti-social at work.

there any predisposing factors?

blames being bullied as a young child for lack of friends and hobbies for his
personal or unsolved conflicts. The client was raised in Poverty and claims he
has been depressed and having low self-esteem for as long as he can remember.
Even though he has a part-time job, he lacks in employment that is substantial
to help him have a healthier and more positive lifestyle. From being raised in
poverty, he instead keeps what he knows instead of seeking more and to do


the observed symptoms that support diagnosis

functions in society, but he is in that persistent depressive state due to his
lack of will to change his situation. Dysthymic Disorder lasts about for two
years or more plus, and one is non-self-harming and still functional.  He might often have the urges to get up and
clean but lacks the motivational aspect to keep going until he finishes to
maintain a decent home. His living condition is an image of his continuous
state of depression.

and or symptoms inconsistent with PDD diagnosis

said in his interview “I purposely make sure I keep my benefits and enjoy
ripping off the system.” When he works, he remains isolated rather than engage
with co-workers. Even though he can make conscious decisions to better himself
and his situation he father stick to what he’s always known.

aspects of Dysthymic Disorder or PDD

average, there is no exact cause as to what the definite purpose of a person to
develop PDD or Dysthymic Disorder is according to McGraw-Hill (2007). However,
it may have to do with neurochemical disturbances. Dysthymic Disorder is a
learned behavior as well. It is much recommended that one seeks a full medical
evaluation to be able to determine a reason for their mood change better


the case of Robert, it is concluded that he suffers from PDD based on the
significance of the persistent problems. Refunding to improve the situation he
is apparently able to change, being what he knows from his childhood and
because he can be functional and not harm himself, he lacks the major aspect of
Major depression.

of evidence of general medical conditions by the client

is clear that the client suffers from PDD but hasn’t been diagnosed with
medical which can increase the development or increase of dysthymic disorder.

there any psychosocial or environmental are factors contributing to the

has lived in fear of being bullied as a child causing him to develop
anti-social behaviors. The state is controllable, but he refuses to step-out
and overcomes it.

is the overall level of safety and or concern for the client? (suicidal/homicidal)

the client is moderately safe. Because PDD and Major Depression are nearly
identical, remaining isolated and refusing to get help can have some adverse
effects on him. He may become suicidal at one point or if pressured to change
it can lead him to harm others.


must remember that this disorder can last for years and even decades. The
psychologist should help adapt and overcome instead or just pushing in a manner
that can result in an adverse outcome or set back of any progress that’s been
made already.


of all, he should go through a full medical checkup that way any possibilities
of any other medical conditions affecting his disorder can be ruled out or
noted.  He could also see a psychiatrist
that can give him mood stabilizers or anti-depressants. Another thing that
would be good for him is to be part of cognitive therapy to help him change his
views on life and maybe help him want to get out of that shell he is in.


long-term goals with CBT are to change how outlook in life, this will be
accomplished by helping the patient extend his social network and make
friendships and be even involved in extracurricular activities. It will help
him move from what he’s known and been through during childhood to a better

strategy is most appropriate and why?

the use of Cognitive Behavioral Therapy, the client may overcome anxiety and
develop ways to cope and therefore become more social. With this process, the
patient will be able to change his views on life as well as improve social
networks, etc.

strategy is moderately appropriate and why?

would be advised that moderately having the client go through a full medical
evaluation, help better in ruling out any other potential medical conditions
influencing the disorder. Even though Medications like mood stabilizers and
anti-depressants work on a neurological level, they do not help in situations
that can be controlled through the development of coping skills and support

of client:

    Bipolar Disorder


signs and/or symptoms associated with Bipolar disorder

to the DSM-5, Bipolar Disorder symptoms consist of mania, hypomania, and
depression. Mania leads to increased energy amounts, poor judgment,
restlessness, and even hypersexual activities. 
Hypomania, on the other hand, does not typically affect a persons’ day
to day living. The state of depression affects the patient’s ability to act and
lack social interaction cognitively.


is currently unemployed even though he has a college degree and has previously
worked as a prison social worker. Bernie is a 38-year-old, African-American
male, who grew up in New Jersey in a middle-class neighborhood.

there any predisposing factors?

main factors for Bipolar disorder are life-changing events and genetic factors.
One of the main factors might be the fact that his immediate family has a
history of Bipolar disorder. Also, he noted that he went through several great
breakups while in college getting him into a deep state of depression. He has a
substance abuse problem of alcoholism,


any symptoms observed during diagnosis (behaviors or statements made by client)

though during the evaluation he didn’t show any significant signs or actions,
he mentioned that he has willingly continued to go to support groups, and can
determine when his cycles are coming up. He expressed that he usually has a
calm period of 1-3 weeks in between mania and depression. It needs to be noted
that while in college following a break up he became out of control finishing
up involuntarily committed to a psychiatric facility. During the interview
process, he seems calm.

any symptoms or behaviors inconsistent with the Bipolar diagnosis

can be noted that he does not exhibit practices which are incompatible with
Bipolar disorder.

factors of Bipolar Disorder

BD happens in the result of genetics, but significant life-changing situations
can also cause it. Even though having good and bad conditions is life is
healthy, it is known that BD is a reaction to the neurological transmitter
connection if it’s broken.


there any medical conditions observed that might indicate the development of
the diagnosis?

appeared healthy overall and did not show signs of medical issues.

there any environmental or psychosocial are factors contributing to the Bipolar

his immediate family members, there is a history of the Bipolar disorder.
Throughout his college years, he experienced very intense breakups with
girlfriends which lead him to buried depressions. He had years of up and downs
and went from being an All-Star in high school to just a regular student in
college, while also having issues of substance abuse in college.

is the overall safety concern for the client? (suicidal or homicidal)

though the client is not on medical insurance or medication and although he has
a reasonably healthy lifestyle he still poses a threat to himself and others
around him. HE admitted that through being depressive, he tends to drink
heavily and to create dangerous scenarios. These situations may result in both
suicide attempts or violent acts by driving intoxicated etc.

if any, cross-cultural issues affect the differential diagnosis?

many cultures, they do not look at his behaviors as being mentally ill but as
natural reactions to hardships in life. Gladly on average each time more
psychiatrists are exposed to people from all walks of life and different ethnic
or cultural backgrounds. By understanding cultural differences, it can reduce
unnecessary treatments and better understand and treat the disorder.


goal intervention

though the client has a productive and healthy lifestyle, he should get back on
health insurance. Having insurance will help that he can attend CBT and
individualized therapy to help monitor and be aware of any symptoms of a manic
or hypomanic state.

goal intervention

client should maintain medications and therapies that can help in reducing and
controlling the manic or hypomanic states. One of the long-term goals is to get
and keep stable employment and be insured to be able to get the treatment he

appropriate strategy and why?

feel the best strategy is to get help to get employment and attend CBT and
individual therapy as well. He should keep a healthy livid and get back on his

appropriate strategy and why?

best reasonable plan in this situation is to continue the monitoring of manic
and hypomanic states and continue the support groups.



Alarcon, R. D. (2009,
September 28). Special Report: Culture, cultural factors and psychiatric                     diagnosis: review and
projections. World Psychiatry, 8(3), 131-139. Retrieved from        

McGraw-Hill. (2007).
Faces of Abnormal Psychology Interactive. Retrieved from                             

Reynolds, PhD., C.
R., & Kamphaus, PhD., R. W. (2013). BASC 3: Major Depressive Disorder.              Retrieved from 3/basc3resources/DSM5_DiagnosticCriteria_MajorDepressiveDisorder

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