Friday, February 21, 2014

Integration Case Report

Introduction

This case report describes the psychiatric behavior and primary care activities of a married 46 year old female diagnosed with major depressive disorder, severe in type, without psychotic features. What is perhaps most important to glean from this case is the benefit that the integration program, including primary care and behavioral health care, has had in the recovery experience evidenced by the patient.

Case Description & Discussion

The patient began experiencing depressive symptoms and was diagnosed with MDD in 2011, shortly after experiencing a spontaneous abortion of her first and only pregnancy. The patient was hospitalized and began a course of antidepressant therapy treatment— fluoxetine hydrochloride, 20 mg/day for 38 weeks. Meantime, the patient began participating in a weekly DBT group as well as attending individual psychotherapy of the psychodynamic type.

In 2012, the patient enrolled in the integrated services program through which she now obtains her medical care. The patient weighs 165 lbs and is 5’1 inches tall. Although she is not morbidly obese, the patient has been encouraged by the PCP to eat more nutritiously, exercise more regularly and lose approximately 20 lbs. The patient has gone to check out the gym and has been thinking more about how she wants to proceed long-term. She is feeling more stable and positive, but is worried about SI returning at some point. She agrees to get rid of anything she has held on to with which to hurt herself. According to the PCP, “she seems more hopeful overall.”

Through the integrated services program, the patient began, in 2013 ,to participate in an ongoing therapeutic writing workshop. In the workshops, the patient provides supportive dialogue and orients new members to the group. Her writing is strong and descriptive. She writes mostly about hopeful things, but she did, however, present one poem about the loss of someone close to her, which could well have been veiled reference to her miscarriage.

The patient will continue with weekly psychotherapy and DBT, as well as art therapy and writing therapy. While it is impossible to say for sure what trajectory her recovery would have taken without the integrative services program, it is clear that the patient has benefitted from the therapeutic and physical health care offerings she has received in one setting.

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