CASE STUDY: CRYSTAL SMITH Crystal Smith, a 33-year old African American homemake

Question

CASE STUDY: CRYSTAL SMITH

Crystal Smith, a 33-year old African American homemaker, cake to an outpatient clinic seeking “someone to talk to” about feelings of despair that had intensified over the previous 8-10 months. She was particularly upset about marital conflict and an uncharacteristic mistrust of her in-laws.

Ms. Smith said she had begun to wake before dawn, feeling down and tearful. She had difficulty getting out of bed and completing her usual household activities. At times, she felt guilty for not being her “usual self.” At other times, she became easily irritated with her husband and her in-laws for minor transgressions. She had previously relied on her mother-in-law to assist with the children, but she no longer entirely trusted her with that responsibility. That worry, in combination with her insomnia and fatigue, made it very difficult for Ms. Smith to get her children to school on time. In the past few months, she had lost 13 pounds without dieting. She denied current suicidal ideation, saying she “would never do something like that,” but acknowledged having thought that she “should just give up” and that she “would be better off dead.”

Two months previously, Ms. Smith had seen a psychiatrist for several weeks and received an anti-depressant. She reluctantly gave it a try, discontinuing it quickly because it made her feel tired. She had also dropped out of therapy, indicating that the psychiatrist didn’t seem to understand her.

Ms. Smith lived with her husband of 13 years and two school-age children. Her husband’s parents lived next door. She said her marriage was good, although her husband suggested she “go see someone” so that she would not be “yelling at everyone all the time.” While historically sociable, she rarely talked to her own mother and sister, much less her friends. A regular churchgoer, she had quit attending because she felt her faith was “weak.” Her pastor had always been supportive, but she had not contacted him with her problems because “he wouldn’t want to hear about these kinds of issues.”

Ms. Smith described herself as having been an outgoing, friendly child. She grew up with her parents and three siblings. She recalled feeling quite upset at age 10-11 when her parents divorced and her mom remarried. Because of fights with other kids at school, she met with a school counselor with whom she felt a bond. Unlike the psychiatrist she had recently consulted, Ms. Smith felt the counselor did not “get into my business” and helped her recover. She said she became quieter as she entered junior high school, with fewer friends and little interest in studying. She married her husband at age 20 and worked in retail sales until the birth of their first child when she was 23 years old.

Ms. Smith had not used alcohol since her first pregnancy and denied any use of illicit substances. She denied past and current use of prescribed medications, other than the brief trial of the antidepressant medication. She reported generally good health.

On the mental status examination, Ms. Smith was a casually groomed young woman who was cohere and goal-directed. She had difficulty making eye contact with the white middle-aged therapist. She was cooperative but mildly guarded and slow to respond. She needed encouragement to elaborate her thinking. She was periodically tearful and generally appeared sad. She denied psychosis, although reported occasionally feeling mistrustful of her family. She denied confusion, hallucinations, suicidality, or homicidality. Cognition, insight, and judgment were all considered normal.

List complete DSM-5 Diagnosis along with Codes

Explanation / Answer

The patient is suffering from stress,depression,aggression and troubled environment in childhood.The patient environment at home was not good and constructive for her education and upbringing.At a very early age,her mother and father separated and divorced each other with mother getting remarried.This futile and harmful situation has left her in a deep impact with false deceptive thinking and imagination.This imagination of not believing in others even parents and husband has developed in the patient with chances of reoccurence of the situations which have occured in the past in her life.The extremely bad situations in her childhood has distrupted her thinking,her imagination with lack of support,care and love from her parents although she was married with a child at an early age.She has developed skeptical attitude and has a tendency to perceive everything suspiciously which has been considered seriously by her husband.In such a scenario there will be an increased tendency of marital discord and lack of harmony between the thinking and relationship with her child and the upbringing of her child will also get affected.She will develop a sort of false negative imagination, that such a perturbed scenario has occured with her only and she has lacked the love,care and emotions of her parents due to facing constant aggression and argument between her parents in their personal and private lives.The diagnosis code of patient is V61.11 for ICD-9 and Z69.11 for ICD-10.

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