Answers for Week 1: Sarah ✅ ❌

Answers for Week 1: Sarah ✅ ❌

Narrative Practice: Sarah’s Story

Presenting Problem: Sarah, a 32-year-old middle school teacher, reports experiencing persistent sadness, fatigue, and difficulty concentrating over the past six months following the unexpected end of a seven-year romantic relationship. She describes a sense of loss and betrayal, as her ex-partner ended the relationship without clear explanation. Sarah feels stuck, often replaying events from the relationship in her mind, and questioning her self-worth.

She also reports significant changes in her day to day life. Sarah has been struggling to maintain her responsibilities at work, frequently calling in sick due to exhaustion and lack of motivation. Her classroom performance has declined, with colleagues noting she seems withdrawn and less engaged with her students. At home, Sarah has difficulty completing basic household tasks, often leaving laundry and dishes undone for days. She finds it difficult to fall asleep, wakes up multiple times during the night, and rarely feels rested in the morning. Sarah’s appetite has significantly decreased, leading to unintentional weight loss of approximately 10 pounds over the last three months. Sarah has limited contact with friends or family. Since moving to a new city two years ago for work, she has struggled to build a supportive social network.

During the intake session, Sarah expresses feelings of hopelessness, guilt, and worthlessness. She worries that her emotional state is permanent and that she will never find a fulfilling relationship again. While she denies active suicidal ideation, she admits to fleeting thoughts such as, “I wouldn’t mind if I didn’t wake up tomorrow,” which she says she has never acted upon.

History:

  • -No significant medical history; denies substance use. She does reveal that she drinks a roughly 6oz glass of wine at night to help relax.

    -Family history of depression in her mother, who was hospitalized twice for major depressive episodes.

    -Minimal social support; Sarah moved to a new city for work and feels isolated.

Initial Observations/Mental Status Exam:
Sarah appears tearful, with a flat affect. She has sporadic eye contact and is dressed in wrinkled clothing. Her speech is fluent. Sarah's mood is sad. She denies any hallucinations or delusions. Memory is slowed but she is a good historian. Sarah's thought content is spontaneous. No preoccupations are noted. She is very cooperative during the intake process and exhibits good social skills. Sarah's behavior is indicative of being withdrawn from present. At times she stares off as if to find the words she is meaning to convey. She denies suicidal ideation but admits to fleeting thoughts of hopelessness. Sarah is oriented x4 (she knows who she is, where she is, when she is [the date and time], and why she is seeing you).

Answers and Explanations

Assessment and Diagnosis

1.  What assessment is most appropriate to administer?

  • A) Beck's Depression Inventory ✅ Correct. The BDI is a validated self-report tool used to assess the severity of depressive symptoms, making it highly appropriate for Sarah’s presenting problems.
  • B) The Patient Health Questionnaire-9 (PHQ-9) ❌ Incorrect. The PHQ-9 is not as comprehensive as the BDI. It is more of a general questionnaire that would not survey the range of symptoms Sarah is presenting.
  • C) Hamilton Depression Rating Scale ❌ Incorrect. The Hamilton Depression Rating Scale would not be appropriate at this time because it is for patients who are already given a depressive diagnosis. 
  • D)Life Satisfaction Inventory ❌ Incorrect. This is for geriatric patients 50 and older. 
  1. What is the most likely diagnosis for Sarah?
    • A) Adjustment Disorder with Depressed Mood - ❌ Incorrect. Adjustment Disorder is typically diagnosed when symptoms occur within 3 months of a stressor and do not meet the criteria for another mental disorder. Sarah’s symptoms exceed the threshold for Major Depressive Disorder.
    • B) Major Depressive Disorder, Moderate - ✅ Correct. Sarah’s persistent symptoms (lasting 6 months) meet the diagnostic criteria for Major Depressive Disorder, including depressed mood, anhedonia, sleep disturbance, low energy, and feelings of worthlessness.
    • C) Persistent Depressive Disorder (Dysthymia) - ❌ Incorrect. Persistent Depressive Disorder requires symptoms to last at least 2 years, which is not the case here.
    • D) Bipolar II Disorder - ❌ Incorrect. There is no evidence of hypomanic or manic episodes, which are required for a diagnosis of Bipolar II Disorder.

Treatment Planning

  1. Which treatment goals should be prioritized in Sarah’s case?
    • A) Rebuilding a social support system
    • B) Establishing a sleep hygiene routine
    • C) Improving energy levels and motivation
    • D) All of the above - ✅ Correct. Each of these goals addresses key areas of functional impairment in Sarah’s life, making them all appropriate for her treatment plan.
  1. Which intervention would be most effective for Sarah’s presenting problems?
    • A) Cognitive Behavioral Therapy (CBT) - ✅ Correct. CBT is evidence-based for treating depression and focuses on challenging cognitive distortions (e.g., feelings of worthlessness) while encouraging behavioral activation.
    • B) Interpersonal Therapy (IPT) - ❓ Partially correct. While IPT is helpful for addressing isolation and role transitions, Sarah’s symptoms are more broadly related to depression, which CBT may address more comprehensively.
    • C) Mindfulness-Based Cognitive Therapy (MBCT) - ❌ Incorrect. MBCT is effective for relapse prevention in depression but may not be as immediately impactful for Sarah’s acute symptoms.
    • D) Psychoeducation about antidepressant options - ❌ Incorrect. While antidepressants might be a consideration, psychoeducation alone is not sufficient as a primary intervention for Sarah’s depression.

Next Steps

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