Case Study of Molly
Instructions: Read the following case, and follow the instructions in u02a1 in the courseroom to complete the assignment.
Molly, a 29-year-old unmarried woman, comes to the clinic complaining of a depressed mood, sleep problems, lack of concentration, loss of interest and pleasure in things, irritability, nervousness, lack of sex drive, no appetite, and undesired loss of 15 pounds in two months. She looks tired, sad, and gaunt. She moves slowly and occasionally tears up during the interview. She reports feeling this way for about two and a half years, since losing a job in a high-pressure computer start-up company. She had been a “shooting star,” rising fast in the dot-com world.
Prior to her collapse, she had never experienced failure of any kind. The collapse on the job seemed to be precipitated by a sexual affair she initiated with a coworker. As soon as this affair became known, she was criticized by coworkers and threatened by her supervisors with termination unless she ended the affair. Her lover was fired, and in his anger he refused to see her anymore. Thus, she lost her lover and the respect of her coworkers at the same time, and within six weeks was so depressed she could not function. She was then fired.
Since that time, she has taken a number of similar jobs, but has been unable to overcome her doubts that her “luck” would hold. She was afraid that her depression would impair her ability to concentrate and that she would either quit or be fired. She has moved back home with her parents, who are very supportive. Molly’s mother brought her to the interview.
During her love affair, Molly says, she began using cocaine with her boyfriend. After losing her job, she did not give up drugs, but switched to marijuana because it was much cheaper. Although she says that she preferred the rush of cocaine, she could not afford it, and now relishes the calm and numbness that marijuana brings. She smokes at least two marijuana cigarettes per day, often more. She had had one smoke earlier on the day of the interview. Her parents disapprove, though they give her the money for it, since “it helps me relax.” Molly also says that she drinks ” two to five” glasses of white wine each evening. “Wine helps me sleep,” she reports.
Molly has no medical problems to speak of. Difficult ovulation has always been a problem, but “nothing I can’t live with.” During ovulation, she tends to become more irritable than normal, and often snaps at people. But after 48 hours, she says, this dissipates. “It’s predictable as the trains,” she says. Her menstrual periods are uneventful.
Molly has had no accidents or illnesses besides the normal ones of life. No surgeries and no medications complicated her health picture. She has never needed or been to a therapist or psychiatrist prior to this visit. She feels ashamed of coming now.Use this outline to structure your case assignments.
1. Case Summary
Provide a brief summary of what you have learned about the individual reviewed in the case. Include information about the individual in terms of demographics and general history, and the sources of that information, and the reason that the individual was referred, and by whom.
Summarize any information you may have about evaluations that have been conducted, including the results.
2. Clinical Impression (Diagnosis)
Write the clinical impression in the DSM-5 format:
XXX.xx (Yyy.yy) Primary Diagnoses (list in order of salience).
(DSM-5 Code is first, as in XXX.xx, and ICD-10 codes next, in parentheses.)
Use the V and Z codes, or simply appropriate descriptors to psychosocial and contextual factors of importance to the diagnostic case. These replace the DSM-IV-TR Axis IV & V used to address these concerns.
Explain any recommendations for interventions, treatment, and/or disposition.
Address the specific questions that were asked in the instructions for this assignment.
Here is a sample assignment question and an appropriate brief response:
Question: Describe what further information you would need to accurately diagnose this case.
Response: To diagnose this case accurately, I would also need to review any pertinent medical records. I would want to interview this client’s mother, with whom he lives, to corroborate the clinical interview data supplied by the client, and to learn more about his developmental history. I would also want to