Simulation 1 Flashcards
(35 cards)
Annette, an 18-year-old female, is brought to your office by her parents.
She is the eldest of three children. They note that she has been having
marked difficulty with insomnia following the start of her new
summertime swing-shift job (of about six weeks) as a clerk at a
convenience store. She works from 4:00 p.m. until 1:00 a.m.
Wednesday through Sunday, arriving home around 2:00 a.m., after the
cash register check at shift change and the drive home. She has not
been sleeping well; her appetite has been decreasing; and she seems
uninterested in doing anything with her friends, with whom she used to
be very socially active. As an aside, they also mention that she recently
broke up with her boyfriend of two years just after she started the job.
Annette, an 18-year-old female, is brought to your office by her parents.
She is the eldest of three children. They note that she has been having
marked difficulty with insomnia following the start of her new
summertime swing-shift job (of about six weeks) as a clerk at a
convenience store. She works from 4:00 p.m. until 1:00 a.m,
Wednesday through Sunday, arriving home around 2:00 a.m., after the
cash register check at shift change and the drive home. She has not
been sleeping well; her appetite has been decreasing; and she seems
uninterested in doing anything with her friends, with whom she used to
be very socially active. As an aside, they also mention that she recently
broke up with her boyfriend of two years just after she started the job.
What is the main issue Annette is facing?
Insomnia due to new swing-shift job
Annette has been experiencing insomnia following the start of her job as a clerk at a convenience store.
What are the working hours of Annette’s new job?
4:00 p.m. until 1:00 a.m., Wednesday through Sunday
This schedule contributes to her insomnia and sleep disruption.
What significant life event occurred just after Annette started her job?
Broke up with her boyfriend of two years
This breakup adds to her emotional distress and may contribute to her depressive symptoms.
Which of the following is an indicated element for diagnosis: Current stressors, Educational history?
Current stressors
Current stressors are important to consider in Annette’s assessment.
What symptom indicates Annette’s potential depression?
Loss of appetite and interest in social activities
Annette has shown a decrease in appetite and a lack of interest in activities she once enjoyed.
How much weight has Annette lost in the past month?
Approximately 5 lbs.
This weight loss is linked to her loss of appetite.
What is a major complaint voiced by Annette’s parents?
Insomnia
The parents express concern about Annette’s sleep difficulties.
List three factors contributing to Annette’s insomnia.
- Noise levels in the home
- Distress over new adult life pressures
- Despair over the loss of her boyfriend
What tool is indicated for assessing Annette’s level of depression?
The Beck Depression Inventory-II
This inventory helps identify the severity of depression.
What score did Annette achieve on the Beck Depression Inventory-II?
22
A score of 20-28 is considered moderate depression.
True or False: Annette has a history of substance abuse.
False
There are no identified substance abuse issues.
What aspect of Annette’s family relationships is noted?
Some tension due to parents pressuring her to find employment
This pressure may contribute to her stress.
What is a notable symptom of Annette’s depression?
Anhedonia
Annette avoids friends and recreational activities, preferring to stay alone.
Fill in the blank: Annette’s primary sleep problem is an inability to _______.
fall asleep
What is the primary diagnosis being considered for Annette?
Circadian Rhythm Sleep Disorder - Shift Work Type
This diagnosis is considered due to her new work schedule affecting her sleep.
What is indicated about Annette’s current level of functioning?
Not indicated as a concern
Annette maintains her responsibilities in her job and daily activities.
What are Annette’s feelings regarding social activities post-breakup?
She feels it will be awkward to attend social events alone
This feeling contributes to her isolation and reluctance to engage socially.
What is the primary diagnosis indicated for the client’s condition?
Adjustment Disorder, With Depressed Mood (F43.21)
This diagnosis is indicated due to emotional symptoms in response to identifiable situational factors.
What are the symptoms that led to the consideration of Major Depressive Disorder, Single Episode, Mild (F32.0)?
Symptoms include:
* Anorexia
* Insomnia
* Anhedonia
* Tearfulness
However, the severity of these symptoms does not meet the criteria for ‘major’ depression.
What is a key criterion for diagnosing Circadian Rhythm Sleep Disorder - Shift Work Type (G47.26)?
Must be due primarily to a mismatch between sleep-wake schedule and circadian pattern
This diagnosis is not applicable if sleep disturbance occurs exclusively during another mental disorder.
Why is Bereavement (Z63.4) not indicated as a diagnosis for this client?
It is intended for loss due to death, not the end of a significant relationship
The client’s loss is related to a breakup, not a death.
What is a significant factor that complicates the diagnosis of Other Depressive Episodes (F32.8)?
Presence of multiple potential precipitants for depression
Factors include swing-shift work, isolation, and loss of a romantic relationship.
What is not an appropriate treatment method for the client at this stage?
Psychiatrist Referral to Evaluate Medication Needs
The client needs further evaluation and treatment initiation before considering medication.
