[Client’s name]
[Institutional Affiliations]
There were several tests made to test the patient’s neuropsychological and personality state. And there are several moments that may look like a situational stress reaction. Since, there were several aspects in the test that make to stop and think. Actually, in the given case stress in not a diagnoses, it may be one of the reasons of some possible disorders. For example, although the patient has average superior level of Perceptual Reasoning (Lichtenberger & Kaufman, 2013), she has troubles with “reading” cards of the test. Judging from the facts, listed by the patient, she is more likely to have features of anxiety disorder.
All in all, the patient has a lot of features of anxiety disorder, they are fear, anxiousness, bad and interrupted sleep, earlier attacks of aggression against her and her husband. Also tests showed some features of social anxiety disorder. For example, in Rorschach test there was no evidence of seeing “human” images, but instead a lot of “dead” images and blood, that may mean aggression and disability of normal interpersonal and social relations, according to table III of Rorschach test (Psychwatch.blogspot.com,n.d.)
All in all, features of anxiety disorder are visible in the conduct of the patient, her mentality and her dissociative anxiety. Since there was evidently stressful situation in her life, that could make the situation more serious. He husband stated that she was aggressive earlier. The stress because of the divorce and worries about children could make everything more serious and turn into general anxiety disorder.
Is there evidence in the test data of Bipolar Disorder? Depression? Generalized Anxiety disorder? Acute stress disorder? Paranoia?
Bipolar affective disorder is a severe, relapsing mental illness characterized by alternating episodes of depression and mania with intervals of the normal state. Bipolar disorder can be diagnosed in 0.2% to 1.5% of the population (Lambert, 2004).
Bipolar affective disorder is badly diagnosed. On average, the correct diagnosis of bipolar affective disorder takes 8 years from the start of the patient observance. The frequency of relapse in bipolar affective disorder is most patients with 1-2 episodes in 1-2 years. However, there are people experiencing mood swings repeatedly in one day (Lambert, 2004).
Bipolar affective disorder affects millions of people worldwide, affects their quality of life and limits the ability to work. Emotional instability, sudden mood swings are serious enough signs of bipolar disorders. An important task in the treatment of such conditions is to prevent the repeated manifestations of the disease. The patient is in a state of depression in bipolar disorder is no different from the actual patient's depression. He has the same symptoms of depression that are typical for patients with unipolar depression
Sadness
Insomnia
the futility of existence
inability to concentrate
loss of energy
the reduction of interests
suicidal ideas
social dysfunction
change appetite
anger/irritability (Lambert, 2004).
According to the test results, there were some moments that could state the bipolar disorder, but they were very few and were not enough to state the disease. Insomnia was stated by the patient, while stress in evident from her state. The picture 3BM from the TAT test shows that she is stressed because of the men (Murray, 1943). She must have inner conflict because of the cheating and broken heart, and that divorce. Actually, man’s cheating is often seen as her fear and her negative attitude to it. According to 4th picture, she again sees the picture of cheating. Picture II and VII of Rorschach test show that the patient has troubles relating to people and may often receive pain from them (Deltabravo.net, 2016). Although patient has very high coefficient of perceptual reasoning, she could not see anything on the picture IX of Rorschach test, that may signal about inability to concentrate. Social dysfunction was noticed from the test result of picture III of Rorschach test picture number 2 of TAT (Murray, 1943). Anger was noticed in the visions of “dead” symbols, like in table 2 of Rorschach test (Deltabravo.net, 2016). They were also stated by the evidence of her husband.
On the other hand, there was no notice of suicidal ideas, appetite change, and the futility of existence. That is why, there were only features, but there are not enough facts to say that the patient has a diagnosis Bipolar Disorder, only based on the test results.
Depressive disorders can appear at any age and representatives of all social groups. This is primarily due to the fact that the values of modern society have a significant pressure on the person. People aspire to social welfare, professional success, visual appeal. If we cannot achieve this, a person can fall into despair, it is hard to survive failure, and, as a consequence, become depressed. To depressive disorders may also result and severe psychological trauma such as death of a loved one, family breakdown, breakup with a loved one, a serious illness. The depression because of the loss of husband could be a reason. Also the fondness of the other men is not a sin, but the patient cannot think about being attractive because of the low self-esteem (Lambert, 2004).
Emotional manifestations of depression are very diverse. These include anxiety, despair, low self-esteem. This may be noticed from the test result of 3BM, 4 and 13 MF (Murray, 1943). They are oriented at men cheating, and bad attitude towards it. Maybe, the patient experience it or had fears of it, that is why was aggressive towards her husband. That could be a result of low self-esteem. A person suffering from depression, experiencing constant fatigue, sadness. This may be noticed in the interpretation of cards number 3 BM, 14 (lack of energy, fatigue, need of changes and relief) (Murray, 1943). She ceases to be interested in what previously brought her joy, becomes indifferent to others. Changing the behavior of patients, depression may be suspected if a person loses the ability to purposeful actions, can't focus, like in case of VI and IX of Rorschach test (Deltabravo.net, 2016). Outgoing and cheerful by nature, people, falling into a depression begins to avoid contact with friends, family, locks themselves in four walls.
Patients with depression also are characterized by some peculiarities of thinking. Thoughts about themselves become negative, the person is fixed on the negative aspects of her life, feels unnecessary, useless, a burden for the relatives. The notes of it were visible from the II, III, VI and VII (Psychwatch.blogspot.com,n.d.). They have a notice of pain and bad social interrelation experience and its disability. There were actually no “human” images while the test. That is an indicator of troubles while taking the test.
In addition to changes in the emotional sphere, for depression is also characterized by physiological (somatic) manifestations. Most often disturbed sleep and wakefulness, insomnia occurs, as it was stated by the patient Appetite may disappear completely or, conversely, to increase and lead to overeating. Patients complain of pain in the heart area, stomach, suffer from constipation. Markedly reduced energy reserves of the body, patients quickly wear out even with a small physical and mental stress. Often there are disorders of sexual sphere, that may show thoughts and suspicions of male cheating in TAT testing (Murray, 1943).
All in all, the patient has enough evidence from the test to conclude that she has depression, based on the situation. But it is not her only problem. The other one is Generalized Anxiety Disorder. It is an anxiety disorder when the person experiences almost constant anxiety, nervousness and tension. Unlike phobias, the fear in phobias is associated with a particular subject, the object, anxiety experienced by people with Generalized anxiety disorder (Gad) is distributed fully on all aspects of his life. This anxiety is not as intense as panic attacks (panic attacks), but it is much longer, thus making human's life very difficult and painful (Lambert, 2004). Generalized anxiety disorder is not distinguished by special fear or experience, people with Gad can worry about normal things, for example: health, money, work, family and many others. But this anxiety (anxiety) is much more intense than normal anxiety (anxiety). The patient stated that she became anxious and stressed because of the fate of her children and possible strife with her ex-husband according the fate of children. She has an obsession that he is going to take them away.
The difference between "normal" anxiety and the anxiety experienced by people with Generalized anxiety disorder (Gad) is that the trouble with GAD has the following characteristics:
Excessive;
Sustainable;
Intrusive;
Debilitating.
Anxiety interferes with work, everyday life, interferes personal relationships. The patient can't control his anxiety. He or she concerns causes severe tension and stress. A patient is worried about various things, and foresee only the worst development of the situation. She feels restlessness and anxiety almost every day, for at least 6 months.
Actually, based on it, there are all the features of the GAD, except one. During the test, there was seeing of the worst situation, but in most of TAT cases there were hopes for better future (Murray, 1943).
There was no evidence of acute stress disorder. They were noticed neither in the case description nor in the test results interpretation. The symptoms are depersonalization, muteness, amnesia and so on. None of it was notices via testing or interviewing (Lambert, 2004).
On the other hand, there were evident features of paranoia, a kind of mental disorder that is characterized by impaired thinking, delusions of persecution and grandeur, and a tendency of suspicion (Lambert, 2004). Develops mental diseases and brain lesions. Pathological jealousy is a disease characterized by an insatiable jealousy of a patient who constantly accuses relatives in betrayal or treason. This may be fixed in the TAT test results of cards number 3 BM, 13 MF, 4 (Murray, 1943). The patient herself started that she has a strong feeling that her husband stalks her. the patient is sure that they are under surveillance.
All in all, based on the test result interpretation, there are features of several disorders. Although there is no 100% reliability of the test, but nevertheless, there are a lot of moments that can’t be ignored.
Comment on possible Axis II (personality disorder) features?
People with personality disorder are rigid and tend to react inappropriately to problems, to the point that I can't build relationships with family members, friends and colleagues. Usually personality disorders appear during adolescence or early adulthood and do not pass with time. Personality disorders vary in severity. More common personality disorder in the form of light, and much less heavy.
Most people with personality disorders are dissatisfied with their lives and have relationship problems at work or in social situations. Many also suffer from mood disorder, anxiety (Lambert, 2004).
There are possible features of the Axis II. For example, the anxiety and bad mood may be a result of personal disorder. Moreover, the patient is not able to build a relationship with men, she is suspicious of them. She is divorcing, and had already got her new “prince”. That doesn’t let her look for a new one in case of bad luck. She shows some immoral personality features. Like in Card 2 of TAT (Murray, 1943), were underage schoolgirl is attracted by adult man and does not show her disapproval of such sympathy and dreams. That may show her early own wished, that doesn’t match with her will of self-improvement (Card 1, TAT).
All in all, there are several features, but the patient needs full long-term observance additionally to the testing.
What recommendations would you make for this woman?
The woman is clever and mature, she sees her life and must believe in herself. There are several things that she may do in case of low self-esteem and bad mood. First of all, it is better for her to realize her particularity. She is mature and very clever woman, that may be seen from her IQ test results (Lichtenberger & Kaufman, 2013). They are mainly superior or average high. She managed to get Master’s degree and has two beautiful children. It is better for her to concentrate on future and try to avoid thinking about the past. Building long-term targets and pending more time with children and new boyfriend must help to become more optimistic. The realization of her feminine power may help to be more self-confident. New hobby or inspiring journey must help forget about depression or worries and fears.
Of course, there are some measures to be made, that are far more serious than just some recommendations. First of all, to reduce anxiety, depression and other painful symptoms sometimes used drug therapy. Drugs, such as selective inhibitors of serotonin reuptake (SSRI) prescribed for depression, and impulsivity. Anticonvulsant drugs reduce impulsivity and outbursts of anger. Other drugs, such as Risperdal are used to fight depression and feelings of depersonalization in people with borderline personality disorders (Lambert, 2004).
Because personality disorders are particularly difficult to treat, psychotherapy is the cornerstone and usually must continue for more than a year to change inappropriate behavior and interpersonal well-established structure of the person. Psychotherapy can help people with personality disorders to understand their actions and behaviors that lead to interpersonal problems such as dependency, distrust, arrogance and manipulative.
First and foremost, everybody must know that with depression you need to fight.If the patient is diagnosed with depression, her family members need to support, try to cheer her up, even if she is not interested in it. The patient's relatives need to understand that depression is a transient condition in which the need to provide psychological help, not plunging in the disease themselves. They should try to convince the patient that there is no his fault that he had depression. Together they will cope with this severe condition.
And finally, there is a nice thing like relaxation. Going through some relaxation therapies, meditations and massages may help to relax and find the point of lightness. It is good for the patient to start practicing yoga and concentrate on her motherhood and feminine beauty. Attending of SPA-salons will help to relax and look better. That will also result in the reevaluation of own beauty and self-esteem. Watching some nice and light movies and cartoons with children will provide common time and remembering about the carelessness and light mood of the cartoons.
References
Lambert, M.J. (2004). Bergin and Garfield's Handbook of Psychotherapy and Behavioral Change. New York: Wiley
Lichtenberger, E. & Kaufman, A. (2013). Essentials of WAIS-IV assessment. Hoboken, New Jersey: John Wiley & Sons.
Murray, H. (1943). Thematic apperception test manual. [Cambridge, Mass.]: [Harvard University Press].
Psych Watch: How to Interpret Your Rorschach Ink Blots. (2009). Psychwatch.blogspot.com. Retrieved 2 May 2016, from http://psychwatch.blogspot.com/2009/07/how-to-interpret-your-rorschach-ink.html
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