Running Head: CASE STUDY OF AN ADOLESCENT 1

A Case Study of an Adolescent with Developmental Challenges

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CASE STUDY OF AN ADOLESCENT 2

A Case Study of an adolescent with major depressive disorder (MDD)

Introduction

Major depressive disorder (MDD) is a common, impairing, and recurrent condition that

predicts future interpersonal problems, delinquency, unemployment, suicide attempts, substance

and abuse (Kessler & Walters, 1998). Further, MDD accounts for more than two-thirds of the

30,000 reported suicides annually (Beautrais et al., 1996). Given this enormous outcome at

individual and societal levels, there is a clear need to develop and broadcast effective treatments

for this disorder. MDD is a disorder that has become a rather prevalent disorder in United States.

This disorder can cause drastic impairments to the patients diagnosed with it due to the cognitive

impairments related with MDD. The cognitive impairments, particularly cognitive dysfunction,

can lead to suicidal thoughts that make MDD a disorder that needs to be taken seriously (Philip,

Gregory, & Ronald, 2003). Many people experience depressive episodes that differ in severity.

Some experience depressive episodes that cause impairment in their daily functions. These

impairments are linked with symptoms of major depressive disorder (MDD). MDD is a mood

disorder that is marked by the symptoms of guilt, sadness, remorse, and worthlessness. Suicidal

thoughts, fatigue, agitation, appetite change, psychomotor retardation and impaired cognition are

also some common symptoms of MDD. The essay will provide a case report of the adolescent at

various stages of development and include a theoretic analysis of intervention measures that

would be administered to the patient.

A Case Report of Lydia with Major Depressive Disorder (MDD)

Mary is a 17 year-old, white female admitted to hospital because of active suicidal

attempts manifested by thoughts of hanging herself by wrapping a telephone cord around her
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neck. This was accompanied by holding a knife to her arm that morning. Mary has a history of

suicidal ideation and has attempted to cut herself in the past, but reported that the knife would

not pierce her skin. She was worried that she would not be able to stop herself again.

Mary reported depression for the past three years and an obsession with death since 8th

grade. She is an obese female that appeared sad, lonely, making poor eye contact and

demonstrating poor social skills. Her affection was apathetic. Mary reported decreased energy,

difficulty sleeping, trouble with her appetite, and irritable mood. She also reported significant

feelings of hopelessness, worthlessness, and helplessness. In addition to the above symptoms,

Mary spoke about her imaginary friends that she has had since seven years of age. The characters

are from movies and television, and she acts out their voices and argues with them. She identifies

that they are not real, but she will avoid her friends to spend time with her imaginary ones. She

reported one auditory hallucination, five days before her admission, as a voice speaking to her

telling her to get out of bed to feel better.

These symptoms suggest psychotic depression that MDD accompanied by mood

incongruent or congruent hallucinations. In adolescence these may be auditory delusions and

hallucinations. Patients presenting with psychotic depression usually have more severe

depression, a family history of psychotic and bipolar, depression greater long-term morbidity,

and increased resistance to antidepressant monotherapy. Environmental factors are also

associated with to MDD (3). Mary related that her depression had worsened in the past 2 weeks

since her sister was living at home again. Her sister is abusive towards her (she started choking

Mary for using her television), and Mary believes her mother does not punish her sister properly.

Symptoms

Depressed mood
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Based on the The Kiddie-Sads-Present and Lifetime version (K-SADS-PL) which is a

semi-structured diagnostic interview designed to evaluate severity ratings of symptomatology

current and past episodes of psychopathology in adolescents according to DSM-IV criteria

(Kaufman et al., 1997). One of the main symptoms of MDD exhibited by Mary is a depressed

mood. This can be described as feeling hopeless and sad. She complains of irritability in addition

to a depressed mood. It is important to observe the effect of the patient, paying close attention to

facial expressions, posture, and tone of voice. This is particularly important if the person is in

denial about his/her feelings.

Loss of interest in her activities

Using the K-SADS-PL Mary was no longer interested in things previously enjoyed. Mary

describes it as not looking forward to anything, or being unable to experience joy.

Weight changes

Using the K-SADS-PL, appetite changes resulting in significant, unintentional weight

change was seen in MDD. This was manifested as a loss of appetite.

Sleep changes

Using the K-SADS-PL, Insomnia was evident in MDD. Mary found herself waking up in

the middle of the night and was unable to fall back asleep. She also lay awake, unable to initiate

sleep.

Fatigue

Using the K-SADS-PL, excessive fatigue was a noticeable symptom that greatly

impacted Mary. She lacked the energy to perform the daily tasks of living. Tiredness is common.

Feelings of worthlessness
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Using the (K-SADS-PL, Mary had harbor intense feelings of guilt and worthlessness.

guilt. She felt undeserving of the things in their life. She obsessed and experienced intense guilt

over present or past events. She also negatively misinterpreted things said or done by others.

This perpetuates the guilt and feelings of unworthiness.

Indecisiveness and concentration problems

Mary also experienced difficulty concentrating on tasks. This was a change from normal

functioning.

Recurrent thoughts of death and/or suicide

The main concern with MDD is that of suicide. Mary demonstrated thoughts of death.

These thoughts may vary depending on the severity of the depression. It was more serious since

she has made a plan of how she would commit suicide.

Intervention Measures

There are various treatments for MDD that have empirical support showing that the

treatment is effective for the treatment of depression.

Pharmacological Treatment

Several classes of medications are used to treat depression. Three main types of

antidepressant medications include serotonin-specific reuptake inhibitors (SSRIs), monoamine

oxidase inhibitors, and tricyclic antidepressants, (MAOIs). There are some current antidepressant

medications that do not fit neatly into these categories since they have different mechanisms of

action (e.g., nefazedone and venlafaxine). The efficacy rates for these antidepressant treatments

are similar to the efficacy rates of SSRIs (Stahl et.al. 2002).

Psychological Treatments

Interpersonal Psychotherapy (IPT)

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There is ample evidence that IPT is an effective treatment for depression. It is usually

recommended as an acute treatment for MDD by numerous guidelines and panels (e.g.,

Depression Guideline Panel, 1993). IPT has been proved to be equally effective as acute

antidepressant treatment with amitriptyline for the reduction of depression symptoms (Weissman

1979).

Marital Therapy

Even though there is sufficient evidence that marital therapy can be used to effectively

treat marital discord (Beach et al., 2009), there is developing evidence that martial therapy can

treat depression effectively. Behavioral marital therapy is equally effective for treating

depression as cognitive therapy (Beach & OLeary, 1992).

Family Treatment

Family-based treatment is another type of intervention that seems to be effective for

depression. For example, severely depressed patients that received family treatment were more

likely to improve and report less suicidal ideation than patients that did not have family treatment

(Miller et al., 2005). This treatment takes a systems approach to understanding dysfunction

within the family. It assumes that: (a) the family is interrelated; (b) one family member cannot be

completely understood in isolation from the rest of the family; and (c) family organization,

structure, and interactions influence family members behavior (Miller et al., 2005).

Behavioral Treatment

Behavioral treatment attributes MDD as a disorder that happens due to learned and

unlearned responses in which treatment is specific to the behavior. The clients report of MDD

episodes and symptoms are valid and the treatment goal is to change the maladaptive behavior

and replace it with adaptive behavior. Behavioral treatment studies relationship of contingencies
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and cues and reinforcement or lack of reinforcement, focused on changing contingencies and to

change behavior. Behavioral therapy has been confirmed to endogenously increase the

production of 5-HT, that is shown through the comparison of behavioral treatment paired with

placebos to pharmacological treatment (David-Ferdon and Kaslow, 2008).

Cognitive-Behavior Therapy (CBT) is a behavioral treatment that focuses on changing

the thoughts of the person diagnosed with MDD to treat the behavioral symptoms

MDD. CBT focuses on irrational thoughts of people with MDD in which the individual produces

a negative blame-scheme and identifies events to be extremely negative. The main goal of CBT

is to substitute rational thoughts for irrational thoughts (Beck et.al, 1985). Regarding one of the

main symptoms anhedonia, CBT works to launch a stronger reward system by disrupting the

cognitive irrational thought process that take place with learned helplessness and lack of purpose.

CBT focuses on changing the dysfunctional attitude in individuals diagnosed with MDD and

substituting it with a more functional attitude (Friedman, et.al, 2004).

Psychotherapy is another type of behavior treatment that focuses on the individual

solving problems that were established previous in life. Its main assumption is that the disorder is

caused by unconscious conflicts and childhood problems. The therapist acts abstinent,

anonymous, and ambivalent when engaged with client that is diagnosed with MDD, to enable the

client to resolve the conflict internally on his/ her own (Friedman, et.al, 2004).

Becks Cognitive Theory Depression

Aaron T. Beck developed a cognitive theory that initially focused on depression and has

been expanded to other areas of psychotherapy and psychopathology. Beck became dissatisfied

with his psychodynamic training since he felt it did not sufficiently account for clinical and

research phenomena he was seeing. Becks (1972) theory defined depression in cognitive terms.
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He saw the crucial elements of the disorder as the cognitive triad: (a) a negative view of the

world, (b) a negative view of the self, and (c) a negative view of the future. The depressed

individual views the world through an organized set of depressive schemata that misrepresent

experience about the world, self, and the future in a negative direction (Beck, 1972).

According to Dr. Aaron Beck, negative thoughts, generated by dysfunctional beliefs are

naturally the main cause of depressive symptoms. A direct relationship takes place between the

amount and severity of the individuals negative thoughts and the severity of their depressive

symptoms (Beck et.al, 1979). Hence, the more negative thoughts the patient experiences, the

more depressed he/she will become. The theory can be used to understand Marys problem her

behavioral characteristics were characterized by the feeling of being inadequate or defective, all

of her experiences result in failures or defeats, and her future is hopeless. Together, these three

themes are described as the Negative Cognitive Triad in Marys case. When these beliefs are

present Marys cognition, depression is very likely to occur.

Conclusion

This paper aimed to provide a case report of the adolescent at various stages of

development and include a theoretic analysis of intervention measures that would be

administered to the patient with MDD. It observed that many people experience depressive

episodes that differ in severity. Some experience depressive episodes that cause impairment in

their daily functions. These impairments are linked with symptoms of major depressive disorder

(MDD).
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References

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depression (2nd ed., pp. 624641). New York, NY: Guilford Press.
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Beach, S. R. H., & OLeary, K. D. (1992). Treating depression in the context of marital discord:

Outcome and predictors of response of marital therapy versus cognitive therapy.

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