The Consumer with Psychotic Depression - Jenny Case Study - Nursing Assignment Help

Assignment Task:

Case Study: The Consumer with Psychotic Depression (Jenny)

Preliminary Information

Identifying Information:

Jenny is a 52-year-old married woman referred to your AMHS unit by her GP [Dr Cook]. She is a practising Catholic and has worked as a teacher’s aide for 18 years at various schools in the State School System. Jenny lives with her husband, Maurice, in their own home. They have a 28yo daughter, Charlotte who is recently married.

Presenting Complaint:

Jenny describes a 20 year history of recurrent depression with moderate-severe episodes every 2-3 years. These are difficult to manage as they seem to have no clear catalyst most of the time. Jenny states, “My husband is tired of me crying all the time, and so am I. I have no energy and sleep all the time and I can’t see things ever getting better”. Jenny has also started to become quite preoccupied with her throat, stomach and bowels and states “they are not working properly”.

Details of the Present Problem:

Jenny states that over the past 7 months, she has experienced gradually increasing dysphoria, anhedonia, feelings of guilt and worthlessness, intense crying, social isolation, and inadequate work performance. More recently [last 1 month] her thinking has become fixated upon her throat, stomach and bowel function. She has expressed the belief that they have stopped functioning and she is worried that their contents are leaking into her abdominal cavity.

Jenny sleeps 10 to 15 hours per night. Over the last month, she has found it difficult to get to sleep as she states “I can’t turn my thoughts off”. Once asleep she has no difficulty staying asleep.

Her appetite has diminished during the past month, with a reported weight loss of 16 kilograms, though this is in part due to her reluctance to eat due to her fears about her throat, stomach and bowel. She eats erratically, usually snacks, and meals are prepared by her husband and sometimes by her daughter.

She has not been able to work, cook, sew, or do household chores and generally spends the day in bed. She has had no sexual interest or activity for the past year. Jenny describes no interests or involvements outside the home, except for weekly attendance at Church.

Mornings are the most difficult for Jenny — she feels increased anxiety, has difficulty breathing, and cries a lot. She admits to occasional suicidal ideation in the form of a passive wish to be dead in hopes of relieving her emotional pain. She denies a history of suicide attempts or current suicidal plan. She denies a history of excessive alcohol or drug use though over the last month she has started to drink increasing amounts of alcohol [up to a bottle of wine a night] to help her “relax”.

Current life stressors reported by Jenny include:

• The unexpected death of Maurice’s sister [Mavis] from a stroke nine months ago. She and jenny had been very close and this has been a huge shock for Jenny who reports ongoing sadness and a sense of ongoing grief.

• Maurice needing knee reconstruction surgery; although Jenny appreciates that this is not life threatening she ruminates about the things that could ‘go wrong’. Jenny is fearful that she will die in the near future.

• Moving house to a smaller home in a new suburb [as they no longer needed the space after Charlotte moved out] 12 months ago. Jenny has struggled to settle into her new community, has not made any new friends and says she’s very homesick for her old home.

• A reduction in contact with her daughter Charlotte as Charlotte has become increasingly focused on her life with her new husband. Jenny doesn’t want to be seen as a burden but at the same time she also fears that she will be even lonelier as her daughter becomes more focused on her own life and future.

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