1. What symptoms suggest a depressive disorder, and how severe are they? Include the diagnosis.

• F33.2 Major Depressive Disorder, severe

• Symptoms

  • Sad all the time and crying every day

  • Hopelessness and feelings of worthlessness

  • Recurrent thoughts of dying (suicidal ideation)

  • Social withdrawal

  • Fatigue, low energy, and difficulty achieving restful sleep

  • Anhedonia

• Symptoms are severe. They significantly impact her daily functioning.

2. How do environmental stressors impact the client’s mental health?

• Housing instability/living conditions: Fear of safety and attributes to difficulty sleeping and chronic stress.

• Financial insecurity: Causing great stress, can’t find better living environment, and fuels feelings of helplessness.

• Chronic Illness: Makes it so she can’t work which leads to feeling worthless or stressed.

• Social Isolation: Cannot attend religious or social functions. Does not have support from family or friends.

3. What are potential differential diagnoses?

• F12.24 Substance/Medication induced depressive disorder

• F34.1 Dysthymia

4. What evidenced-based interventions might be appropriate?

• Cognitive Behavioral Therapy

• Interpersonal Therapy

• Trauma-informed care

• Trauma-focused CBT

• Group therapy

• Pharmacological Interventions

• Psychoeducation

• Case management

5. How would you assess for suicidality and ensure safety planning?

• Columbia-Suicide Severity Rating Scale (C-SSRS)

• Beck Scale for Suicide Ideation (BSS)

• SAFE-T

• We would collaborate on creating a safety plan that includes appropriate supports, important contacts, safety measures, and skills that she can use when distressed.

Symptoms

·      Use of substances to cope with social/emotional issues. Moderate severity, she uses marijuana every other day. However, she used prior to her mental health issues due to her chronic condition.

·      Isolation due to estranged relationship, severe. Has no close relationships or support system.

·      Feelings of hopelessness surrounding her chronic condition, moderate severity. She continues her physical therapy and has goals for her MS.

·      Hypersomnia, moderate severity. She is still able to get out of bed for her physical therapy.

Diagnoses

F33.1 Major Depressive Disorder, moderate, recurrent episodes, with anxious distress

2. How do environmental stressors (e.g., job loss, grief, discrimination) impact the client’s mental health?

Tammy’s housing situation is a source of significant stress for her. She feels unwanted in her friend’s home yet scared to leave due to lack of other options. She also is unable to keep a job which causes her to rely on minimal government benefits. These factors are negatively impacting Tammy’s mental health.

3. What are potential differential diagnoses (e.g., dysthymia, adjustment disorder, bipolar depression)?

F12.2 Cannabis Use Disorder, mild

4. What evidence-based interventions might be appropriate (e.g., CBT, interpersonal therapy)?

We would use CBT in order to provide the client with coping skills for her stress. Her stress causes her MS symptoms to worsen, therefore better her coping skills would be our first girl.

5. How would you assess for suicidality and ensure safety planning?

We would utilize a suicide assessment and create safety plan with her if necessary.

1. What symptoms suggest a depressive disorder, and how severe are they? Include a diagnosis.

F33.1 Major depressive disorder, Recurrent episode, Moderate

Tammy presents with clear symptoms consistent with Major Depressive Disorder, Recurrent, Moderate. Over the past several weeks, she has reported crying daily, feeling hopeless, and experiencing thoughts of wanting to harm herself, though she denies intent or attempts. She remains in bed most of the day, either sleeping or watching television, demonstrating withdrawal from meaningful activities and social engagement. She reports significant fatigue, loss of motivation, and social isolation. These symptoms reflect changes in mood, behavior, and functioning that exceed the typical grief or situational stress response. Given her history of psychiatric hospitalizations and previous antidepressant use, her depression appears recurrent. Symptoms are serious and impairing, though she maintains some basic functioning through physical therapy appointments and awareness of her emotional state, placing her within a moderate severity range.

2. How do environmental stressors impact the client’s mental health? Tammy’s depressive symptoms are directly influenced by substantial and chronic environmental stressors. She lives in an unstable and emotionally hostile environment where the young men in the household harass her and cause sleep disruption. Her inability to safely use the bathroom and history of falling increases feelings of vulnerability and helplessness. Extreme financial stress, reliance on SSI and food stamps, and the threat of homelessness heighten her anxiety and sense of hopelessness. Social isolation is profound, with estranged family relationships, loss of church community due to relocation, and minimal supportive connections. Her chronic medical condition, MS, further compounds stress, as she fears disease flare-ups triggered by emotional strain. These cumulative environmental pressures create a persistent stress response, intensifying her depressive symptoms and limiting coping capacity.

3. What are potential differential diagnoses? Several alternative diagnoses warrant consideration. Adjustment Disorder with Depressed Mood may appear possible given recent stressors, but her symptoms exceed the expected intensity and duration for adjustment disorder and include suicidal ideation and significant functional impairment. Persistent Depressive Disorder (Dysthymia) is less likely because Tammy’s symptoms appear episodic and severe rather than chronic and milder. Bipolar II Disorder is unlikely, as there is no evidence of past hypomanic or manic episodes. Substance-Induced Depressive Disorder is also considered given her marijuana use, but cannabis appears to be a coping mechanism rather than the cause of her depressive symptoms. Finally, Depressive Disorder Due to Another Medical Condition (MS) is relevant, as MS can contribute to depression physiologically; however, the psychological, social, and historical components point to Major Depressive Disorder as primary, with MS acting as a compounding factor.

4. What evidence-based interventions might be appropriate? A multi-modal approach is recommended. Cognitive Behavioral Therapy (CBT) can help Tammy challenge beliefs of hopelessness, build coping strategies, and gradually re-engage in meaningful activities. Interpersonal Therapy (IPT)would support her in processing grief, relationship loss, and social disconnection. Behavioral Activation could help her increase activity level and strengthen a sense of accomplishment and control. Psychopharmacological intervention should be revisited with her psychiatrist, as she previously benefited from antidepressants before discontinuing them. Social work interventions are essential, including advocating for safer and accessible housing, helping her navigate public benefits and disability supports, and connecting her with MS support groups or faith-based communities to rebuild social connectedness.

5. How would you assess suicidality and ensure safety planning? A thorough suicide risk assessment should be conducted, asking directly about intent, plan, means, past attempts, and protective factors. Tools such as the Columbia Suicide Severity Rating Scale (C-SSRS) would support structured assessment. Safety planning would involve identifying personal warning signs, coping strategies Tammy can use independently, social supports she can contact, and crisis resources (such as 988 and local mobile crisis services). Because she is physically limited and socially isolated, additional monitoring through case management and coordination with medical providers would be essential. If risk escalates, voluntary hospitalization or temporary medical respite housing should be considered.

Karina, Sydney, Yolanda, Nancy, Evan

Tammy has been exhibiting the following: frequent crying, feeling hopeless, thoughts of self-injuorus behaviors, isolation, persistent feelings of fatigue, and difficulty sleeping. Her symptoms most closely resemble moderate symptoms levels, but could potentially become severe without proper care and treatment. 

 F33.1 Major Depressive Disorder, Moderate, Re-occuring

2. How do environmental stressors (e.g., job loss, grief, discrimination) impact the client’s mental health?

Tammy experiences loss of employment, no family support system, unstable housing, financial instability, hostile living environment, unstable transportation (makes social engagement difficult), and a history of trauma. 

3. What are potential differential diagnoses (e.g., dysthymia, adjustment disorder, bipolar depression)?

• Persistent Depressive Disorder

• Depressive Disorder due to another Medical Condition 

• Substance-Induced Depressive Disorder

4. What evidence-based interventions might be appropriate (e.g., CBT, interpersonal therapy)?

• Cognitive Behavioral Therapy

• Support Groups 

• Pharmaceutical Intervention (Medication)

• Case Management 

• Mindfullness Techniques

• Motivational Interviewing (MI)

5. How would you assess suicidality and ensure safety planning?

A suicide risk assessment would be conducted to assess the potential of suicide. THe Columbia Suicide Severity Rating Scale would be used. Additionally, Tammy should work alongside the clinician to create a tailored safety plan identifying triggers and warning signs, including healthy coping strategies, emergency contacts, and removal of any objects that could be used to self-harm.