Identifying Information
- Date of initial assessment – 2/15/2021
- Client’s name – John
- Employment status – Unemployed
- School status – Elementary school
- Age – 7
- Gender – Male
Presenting Concern
John asked for clinical help and doctor’s counseling with parental agreements to get medical assistance, check-up, and further support. He reported several deviations in his mood during the winter period in the midst of the Coronavirus pandemic. He complained about his feelings of loneliness and said that he tried to keep aloof from his peers so as not to be interrupted from his innermost contemplations. He attempted to commit suicide several times as he could not find sensible reasons to continue his existence. He reported that he was overwhelmed by negative emotions caused by repetitive and consecutive arguments and disputes between his parents during the doctor’s seeing.
Background, Family Information, and Relevant History
During the pandemic, John’s family had several financial straits. The family breadwinner, his father (Tom, 45 years old, employed as a bank account), started to fail financial deals, as a custom flow willing to obtain new paper bonds and stakes decreased. Due to this situation, John’s father stopped getting salary fringes and bonuses as he did not manage to fulfill the sales plan dictated by the facility he worked in as a bank account. All this entailed the mental breakthrough that made Tom dump down all his negative emotions on his wife. John’s mother (Katherine, 35 years old, a housewife), occupied only household chores, and her son’s upbringing, got anxious and worried as she was afraid of ending up their happy life in tatters. They were in a devastating position and started to argue daily, blaming each other. Sometimes, their disagreements had highly aggressive shades as they got the blind alley in mutual understanding. This unprecedented situation was a shock for John, who was used to a calm environment full of harmony and serene love.
Witnessing constant verbal arguments, John took everything so close to his heart and started to get panic attacks at night that intensified and were difficult to control. John decided that he was to blame that his family having enough money for a decent living and decided to commit suicide by gulping pills he had stolen from his grandfather. Academically, John manifested problems in his school progress, as he did not excel in subjects due to his mental undermining. Historically, John did not know his life destination, and while attending a school psychologist, he reported that he did not plan to graduate from school, as he was going to pass away. John stated that the only way to distract his attention from groom thoughts was to resort to computer games that assisted him to be in nirvana for several hours of playing in a row. John did not report any physical health problems and concerns.
Problem and Counseling History
John had not previously had a medical history of mental health concerns, as he had always lived in friendly surroundings and was blanked with love on his parents’ behalf. Just after his parents started having family issues, his mental health began to worsen. It was not an overnight result; it was escalating for several months in the midst of the Coronavirus pandemic. Referring to the DSM-5 level 1 cross-cutting symptom measure, John displayed more than three scores as his mental disorder developed during three winter months. Based on the DSM-5 level-2 (PROMIS Emotional Distress—Depression), the boy was evaluated, and he got an increased t-score(t=76.2), meaning severe depression during the psychiatrist’s sessions which lasted one week. The elevated items (approximately 5) were “I could not find reasons to live when my parents are not happy anymore because of me,” “I felt rejected by my parents,” “I want to die.”
The Beck Depression Inventory-II (BDI-II) evaluated his depressive condition and rated it 39 scores, which is high for the seven-year-old boy. His elevated scores (4 on the BDI-II) were “I felt aloof all the time,” “I was to blame for everything bad that had happened in my parents’ lives,” “I can hold down on my rage.” John stated that he could not get a wink at night as he felt panicked and anxious. The DSM-5 Cultural Formulation Interview (CFI) detected that John took guilt on his shoulders; he stated, “I was the only one reason why my dad and mom could put things behind them and live loving each other, as it had been several months ago”. He was also afraid that his parents might divorce, and he would be a reason for mocking and teasing on his classmates’ sides. All his friends lived in complete families, and his parents’ divorce might have made his classmates stick his reputation in the mud.
It was tough for John to bear all the burden of the circumstances, and repetitive parental arguments exhausted him. The psychiatrist counseling the client during consecutive sessions wanted to detect other reasons for John’s vulnerable mind. The proposition was that his parents had underestimated him and abused him physically and verbally. During the “investigation,” John reported that he had never been a victim of domestic abuse, and his parents had always treated him well, indulging all his whims. By means of an MSE, it was detected that the client was able to react sanely to the person he talked to, the place he was located in; all this proved that his receptors were normalized. However, he avoided eye contact and spoke in a muffled voice.
Diagnostic Impression
- F33.42 Unique depressive disorder, single episode, severe (principal)
- Z63 Issues, including problems with relatives; family circumstances
- Z61.2 Alternation in the order of things in the family frame
Discussion of Diagnostic Impression
It was the first unique depressive episode experienced by John. According to the DSM-5 criteria, he got a specific depressive disorder, single episode, the severe type. His mental deviation lasted during the winter months. On the PROMIS-Depression and BDI-II of 23 scales, he got an elevated score (t=76.2), stating that he had no reason to continue his life when his parents were unhappy (Criteria A.1) (Loring et al., 2021) He also noted the absence of motivation to build up bonds with his relatives as he wanted to be separated from them (Criteria A.2). During the clinical interview, he confirmed, “I wanted to fix their relationships, but I could find a solution how to do it” in the PROMIS-Depression instrument. His physical changes manifested problems with indigestion and the lack of appetite (Criterion A.4). His body agility decreased due to the lack of sleep found in the PROMIS-Depression and BDI-II (Criteria A.6). John stated that he was to blame for all problems experienced by his parents (Criteria A.7).
Z63 implying issues, including problems with relatives; family circumstances, were assigned due to repetitive conflicts between his parents that, in his opinion, was his guilt. Z61.2 meaning the Alternation in the order of things in the family frame, applied for drastic changes in all family members, the changes that he could not bear. The clinical examination stressed that John required urgent medical help to recover his mental health are regular family phycologist sessions.
Reference
Loring, D. W., Block, C., Staikova, E., & Miocinovic, S. (2021). Patient-reported outcomes measurement information system (PROMIS) assessment of non-motor features in deep brain stimulation candidates: relationship to the Beck depression and anxiety inventories. Archives of Clinical Neuropsychology, 36(4), 632-637.