Name: S.Z

Age: 42

Examiner: Izza Wahab

Case No: 2

Identifying Information:

S.Z is a Muslim married, Urdu speaking, she has 1 brother and 3 sister and her birth order is middle. She belong to the middle socioeconomic status family with nuclear setup. Currently, she is residing at her mother’s house in Lahore.

Referral sources and presenting problems:
The client was referred by Dr Shabana Shahid (Psychologist) from Bahria International Hospital for the purpose of psychological assessment. Her current problems include: mild anxiety, panic attacks, fear of begin alone, insomnia and wakefulness.

Interview information:
The client reported that she has been suffering from the symptoms of anxiety for about 6 months and her first experience of the above mentioned symptoms was when she started having conflicts with her second husband, it was the time when she started experiencing panic attacks and muscle pain in left arm and insomnia. Since then this unexpected anxiety episode started occur in daily routines as well. She reported that the episode mostly occur to in night and when she is alone at home or sleeping alone. According to her the episodes lasts for 10 to 20 minutes. Furthermore, the client complained about the low blood pressure and anemia. According to client her divorce, which was very traumatic event for her and her cousin’s death due to cancer.

The client also mentioned about her marital problems, that her marriage life was miserable and she said that she was good in studies and was average student and enjoyed a lot.  According to her she was very fun loving and active in sports more than studies, she said that her teenage was the best part of her life, she enjoyed a lot, she used to have a lots of friend, she used to hang out and bunk classes .However, after her marriage she has no contact with her friends now she don’t have many friends. She reported that she has been married twice and the first marriage experience was miserable and last only 1.5 years .She has two twin daughters from her first husband who never took care of her and even her first husband did not come to hospital to see his daughters on their birth. However, after the divorced for the purpose of torturing her he claimed to get his daughters through court, At that time   daughters she was very depressive, but her brother used to support her a lot and currently he is   taking care of her daughters. Her brother and family members forced her for second marriage when her daughters were 9 years old, which she did due to family pressure she did second marriage. Unfortunately  second her  marriage was also unsuccessful , she was the second wife of her husband  and he used to spend most of the time with his first wife and visited her on weekends only  for few  hours or nights  and whenever she complained he start abusing . According to her   they have been separated and now she want to ask him about divorce. Due to all this her daughters suffered a lot and now she wanted to focus on her daughter only. However the past experiences cause panic attacks and sometimes sever anxiety but right now she is being treated by Dr Shabana, and   currently she is taking medicines for insomnia.

Tests Administered:

  1. Mini Mental Status Examination…………………………..………(MMSE)
  2. Bender Gestalt Test……………………………………….…………(BGT)
  3. Human Figure Drawing Test………………..…………….………..(HFD)
  4. Rorschach Inkblot Test……………………………………………..(ROR)

Behavior during testing sessions:
The client came in the session room with smile on her face but she was little confuse as well, firstly she   introduced herself very well and she started telling examiner about her problem .She was so concerned about her problem and wanted to be it cured, At first she was at first she was hesitating but after some time she become ok and started acting very friendly and cooperating with the examiner. She was continuously holding her hands and fingers but after some time get so much involve in talking and become friendly and followed all the instructions given to her by the examiner. She showed interest in performing in all the tests. She reported that it was not her first time visiting a psychologist, so it was easier for her being comfortable and answer all the questions attentively.

Psychological Evaluation:
Her score on MMSE shows that there is no cognitive impairment. She know about the day and dates, she able to give a correct response each question actively. However, she may have clinically significant symptoms, due to her emotional problems as her orientation is intact.

On BGT   a psycho neurological test, her score indicates that her visual motor coordination is intact, and she is not suffering from any brain impairment.  Her results indicate that her problems is of non-organic nature and therefore she needs psychological help.

Projective test revealed that she is aggressive and is suffering from feeling of inadequacy she is also sensitive to criticism and behaviors of others. She has anxiety over her sexual needs or repressed desires and is suffering from anxiety she is, emotionally fixated and has social dependency.

Analysis further revealed that client is in a state of disdain. She have fear of rejection due to which analysis reflects depression and shows her maladjustment to her environment. The client appear to being in   emotional turmoil and is unable to remove effect from negative experiences. Moreover she has creased look for meaningful emotional relationship due to insecurities and fears.  She withdraw and from forming any other relationships and has trust issues as well. Analysis indicated that she was depressed and has low level of consistency.

Projective analysis reflecting the degree to which a person perceives and reacts to the obvious aspects of the situations .Moreover  she  sacrifices the full use of her intellectual potential by merely focusing on the safe ,conservative, and social desirable response, furthermore  the responses also reflects depression  maladjustment, such as mental deterioration possibly related to brain damage moreover she have a good ability to deliberately suspend or control her emotions, due to emotional turmoil she was trying to remove the affect from her experiences. Analysis reveals the client is govern by her needs and urges and have difficult time in delaying gratification , there is also  indication of her poor emotional control that indicate  the anxiety state . Some cores reflects that she is self-absorbed and have an inflated sense of self-worth and self-pride. Moreover the analysis shows that the client may have a high level of intellectual strivings the client also has ceased look for the meaningful emotional. The findings has some evidence of depression, low level of empathy and withdraw from interpersonal relations. Analysis indicated that there anxiety interlinked with depressive symptoms.

Diagnosis:
296.22(F32.0) Major Depressive Disorder; Moderate

Prognosis:
On the basis of overall evaluation, intellectual level, available resources and severity of the problem the prognosis seems to be fair.

Recommendation:

  • The treatment of moderate to severe persistent depressive disorder is found to be the most effective when it includes both medication treatment and at least 18 sessions of talk therapy.
  • Cognitive behavioral therapy: CBT can also be effective. Several forms of psychotherapy are effective for the treatment of MDD.of these, cognitive-behavioral therapy (CBT) work to replace negative and unproductive thought patterns with more realistic and useful ones.
  • Medications can also be useful, symptoms of depression and anxiety disorders often occur together, and research shows that both respond to treatment with selective serotonin reuptake inhibitors.
  • Motivational Enhancement therapy: This therapy help individuals work through ambivalence about change and seeking treatment. Motivational Enhancement Therapy (MET) provides a powerful option for clinicians to help individuals with SAD work through their fears and uncertainties about treatment and anticipated judgment of others, which might improve treatment utilization

 

  • Adjusting to crisis   or other current situations and difficulties.
  • Identify negative beliefs and behaviors and replacing them with healthy positive ideas.
  • Exploring relationships and experiences and develop positive interactions.
  • Identify issues that contributes to the depression and anxiety.
  • Develop the ability to tolerate and accept the distress using healthy behaviors

Examiner:                                                                                        Internship supervisor:

Izza Wahab                                                                                        Dr. Shabana shahid Khan

BS Psychology Student                                                                     Clinical psychologist

Clinical Psychologist
CUI, Lahore Campus