Chronic Fatigue Syndrome -- A Case Study Case study 'Monique.'

Case presentation and history

Monique, a female aged 30, possesses a history of depression and chronic fatigue syndrome, starting at the age of 16 to 17, together with suicide attempts (entailing overdosing), in addition to a long record of anxiety. During baseline evaluation, she reported continuous constant fatigue as well as anhedonia. She also expressed dense retrograde amnesia following a 12-week program of bi-weekly electroconvulsive therapy early in 2006 (she asserts that has no memory of any occurrences preceding this). In late 2006, Monique was also diagnosed with ADHD, however, trusts that she has had continuous problems with distractibility and vagueness. At one point, dexamphetamine was experimented on her, which, even though enhanced her attention, also reduced her mood and hence it was discontinued. Monique also reported that when she was 2 years old, she cracked her skull consequent to falling from the balcony of a second storey building. She was, however, not capable of giving details on the effects of this particular accident. In addition, she reported that her mother suffered from preeclampsia and this resulted to her being born at 31.5 weeks. In 2007, a brain MRI was conducted on her and it showed no abnormalities.

Symptoms

Depression

Fatigue

Amnesia

Anhedonia

Treatments

Antidepressant medications are normally utilized for the treatment of depression. They balance various natural chemicals, called neurotransmitters, which are contained in our brains. Neurotransmitters influence our emotional reactions and mood. Examples of neurotransmitters worked on by antidepressants are serotonin, dopamine, and norepinephirine. The most common kids of antidepressants are referred to as selective serotonin reuptake inhibitors (SSRIs). Examples are:

Fluoxetine

Sertraline

Escitalopram

Citalopram

Paroxetine

Apart from treatment of depression, antidepressants also assist individuals having anxiety disorders. Common prescriptions for panic disorder, PTSD (Post Traumatic Stress Disorder), OCD (Obsessive- Compulsive Disorder) and social anxiety disorder are SSRIs like fluoxetine, sertraline, escitalopram, paroxetine, and citalopram. GAD (Generalized Anxiety Disorder) is normally treated using venlafaxine. In the treatment of anxiety disorders, antidepressants are begun with minimal doses and gradually increased. Various tricyclic antidepressants function quite appropriate for anxiety. Imipramine, for instance, is prescribed for GAD and panic disorder while clomipramine is prescribed for OCD. Tricyclics are also begun at minimal doses and then gradually increased (National Institute of Mental Health, 2015).

Clinical staging assessment & provisional hypothesis

The patient was found to be suffering from anxiety, mood and psychotic disorders based on the clinical data at baseline and follow-up.

Mood disorder

Almost 10% of the population is affected by mood disorders. We all encounter "highs' and "lows' in life, however, individuals with mood disorders face them with more intensity and for longer durations. The most regular mood disorder is depression; an individual suffering from depression feels "very low." Symptoms are: feelings of hopelessness, modifications in sleep and eating patterns, continuous fatigue, and suicidal thoughts. Individuals with bipolar disorder experience instances of depression and on the other extreme, instances of feeling unusually elated. The "highs' become uncontrollable and the individual might act in a wild way; at times to the extent of financial damage or even as far as getting into trouble with the law. Though we might consider low mood as adult issues, they actually affect individuals of any age. It might be hard for adults to understand similar challenging issues faced by children since we view their issues through the eyes of an adult. It is essential to remind ourselves that while children's problems might appear insignificant to us, they are overwhelming to them. It is essential to take depression in the young ones seriously ( Canadian Mental Health Association, 2015)

Anxiety disorder

Anxiety is normally a usual part of life. One may feel anxious when experiencing a problem at work, prior to taking a test, or during making a vital decision. Anxiety disorders, however, entail more than just temporary fear or worry. For an individual suffering from this disorder, the anxiety does not disappear and might get worse with time. These feelings might meddle with day-to-day activities like job performance, school work and even relationships (National Institute of mental Health, 2015). This disorder is different from normal feelings of anxiety and entails excessive anxiety or fear. It is the most common mental disorder and over 25 million Americans are affected by it. Anxiety disorders are, however, reversible and the treatments assist individuals to lead normal and useful lives (APA, 2015).

Psychotic disorder or Attention disorder

These are mental disorders whereby an individual's personality is severely altered and that individual loses contact with reality. In case of a psychotic incident, an individual may cease to differentiate between reality and imaginary. Two of the major symptoms are hallucinations and delusions. Delusions are basically false beliefs, such as thinking another person is actually plotting...

On the other hand, hallucinations are false perceptions, like feeling imagined presence of something that is not existent (National Institute of Mental Health, 2015).
Clinical stage in the clinical staging model for psychiatry

With regards to the provisional diagnosis, the patient stage in the clinical staging model for psychiatry is determined as Stage 3b. This stage is related with relapse or reappearance of a mood or psychotic disorder (Nasrallah, 2013).

Relating clinical findings to one or more provisional diagnoses

Generalized anxiety disorder (GAD)

This disorder is described by extreme anxiety. Those that suffer from Anxiety or worry disorders exhibit 3 or more of the following symptoms:

Restlessness or feeling on edge

Petulance

Sleep disturbance

Getting easily fatigued

Muscle tension

Suicidal ideation and completed suicide (Yates & Bienenfeld, 2014).

The above represent the clinical results of anxiety and they are associated with the provisional diagnoses of Monique in the baseline evaluation and follow-up.

Additional investigation

MRI

Research using imaging methods, specifically magnetic resonance imaging (MRI), have assisted in the identification of different regions of the brain linked with anxiety. An MRI of the brain comes up with a comprehensive image of the intricate structures of the brain. An MRI can provide a three-dimensional representation of the brain, making the spotting of issues like aneurysms and tumors more accurately. Particularly, research has concentrated on alterations in the amygdala, which is at times called the "fear center." This segment of the brain controls fear, emotion, and memory in addition to synchronizing these particular resources with blood pressure, heart rate, and other physical reactions to stressful occurrences. There is proof that implies that the amygdala in individuals suffering from anxiety disorders is extremely sensitive to unfamiliar circumstances and responds with a high stress reaction (Simon, 2013).

The Hamilton Anxiety Rating Scale (HAM-A)

The Hamilton Anxiety Rating Scale is a commonly utilized interview measure that evaluates anxiety. Even though it predates the conceptualizations of GAD, it evaluates a number of the symptoms related to GAD. The HAM -- an includes both the somatic and psychic anxiety subscales. The psychic subscale comprises of the issues that deal with the more subjective and affective constituents of nervous encounters (for instance tension, anxious mood, concentration difficulties, and fears). It is specifically significant in evaluating the gravity of GAD. On the other hand, the somatic subscale stresses on the GAD components which are not common, such as autonomic arousal, cardiovascular and respiratory symptoms. The HAM -- A has turned into an industrial standard in clinical assessments of psychotherapy and pharmacotherapy for GAD. Full-scale pre-treatment scores of 18 to 20 or more are a common guide of gravity assumed as necessary for admission into a clinical assessment. In addition, a 40% to a 50% decrease in the HAM -- A total score (i.e., a full-scale score in the extent of 8 to 10 or less) is basically a typical criteria for describing the treatment response. One significant restriction of utilizing HAM -- A to evaluate GAD gravity is that it is not capable of assessing extreme or hard-to-manage anxiety, which is identified as the essential aspect of GAD in recent conceptualizations (e.g., DSM-IV-TR) (Belzer & Schneier, 2006).

Treatment plan

Major Goals

1. An increased understanding of feelings related to anxiety

Come up with vocabulary meant for the description of fears or worries

Identify signs and symptoms

Identify the various regions of weakness which lead to anxiety

Identify the precise cause that prompts these areas

Identify the antecedents, prompters, and outcomes of acting out of anxiety

Counselor activity: Help the client to identify problems that are related to anxiety from the past, in addition to other sources of anxiety vulnerability, and thereby to present solutions or "letting go." The counselor ought to:

Confirm the emotional encounter of the client

Identify specific problems

Utilize the chances in individual and group counseling to assist the client practice acceptance of those regions that cannot be manipulated.

2. Actual irrational thinking

Recognize particular regions of cognitive distortion ('Sinking thinking").

Confront the irrational thoughts with reality

Establish suitable alternative self-statements and conducts for irrational ones

3. Enhanced management of anxiety and its associated symptoms

Recognize suitable reactions to the feelings of anxiety or worry

Learn relaxation methods so as to lessen anxiety ( thought switching, thought stopping, progressive relaxation of muscles, deep breathing, and creative visualization among others)

Come up with substitute responses to swap for the past "coping" choices

4. Enhanced insight

Increase the comprehension of the association amidst underlying vulnerability, feelings, triggers, choices, behaviors, or even thoughts

Increase the comprehension of the cycle…