Training Title 28
Name: Mrs. Ada Carson
Gender: female
Age: 54 years old
T- 97.6 P- 94 R 22 162/84 Ht 5’5 Wt 144lbs
Background: Currently living in Sioux Falls, South Dakota, working full-time as a contract
negotiator in a financial company. Has an MBA. Lives with her husband and two teenage twin
sons. Born and raised in Trenton, NJ, with her father and two brothers, her mother deceased
when she in MVA when she was 12 years old. Brother has depression; mother has history of
being a “functioning alcoholic”. Recently informed by her PCP she has a “fatty liver.” Allergies:
codeine
Symptom Media. (Producer). (2016). Training title 28 [Video].
https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/wa
tch/training-title-28

1. Introduction
Patient: Mrs. Ada Carson, 54‑year‑old female.

Context: Case study from Symptom Media video (2016).

Clinical Focus: Mood disorders in middle‑aged adults, diagnostic reasoning, treatment planning.

Importance: Mood disorders in midlife often intersect with medical comorbidities, family stressors, and occupational demands.

2. Demographics and Background
Age: 54 years old.

Gender: Female.

Vitals: T 97.6, P 94, R 22, BP 162/84 (hypertensive).

Height/Weight: 5’5”, 144 lbs (BMI ~24 → normal).

Occupation: Contract negotiator in a financial company, full‑time.

Education: MBA.

Family: Married, lives with husband and teenage twin sons.

Childhood: Born and raised in Trenton, NJ. Mother deceased in motor vehicle accident when Ada was 12. Raised by father with two brothers.

Family Psychiatric History: Brother with depression; mother described as a “functioning alcoholic.”

Medical History: Recently diagnosed with fatty liver disease. Hypertension noted.

Allergies: Codeine.

Legal History: None.

3. Psychosocial Stressors
Family Responsibilities: Parenting teenage twins, marital dynamics.

Occupational Stress: High‑pressure role as contract negotiator.

Medical Concerns: Fatty liver disease, hypertension.

Trauma History: Loss of mother at age 12, unresolved grief.

Family Psychiatric History: Depression and alcoholism increase vulnerability.

Midlife Transition: Balancing career, health, and family responsibilities.

4. Clinical Presentation (Mood Disorder Features)
Possible Symptoms (from case context):

Sadness, irritability, fatigue.

Sleep disturbance.

Difficulty concentrating.

Loss of interest in activities.

Feelings of guilt or hopelessness.

Risk Factors:

Family history of depression and alcoholism.

Medical comorbidities (fatty liver, hypertension).

Trauma history (loss of mother).

Occupational stress.

5. Mental Status Examination (MSE)
Appearance: Appropriate grooming, normal weight.

Behavior: Cooperative, may appear fatigued.

Speech: Normal rate/volume, possibly slowed tone.

Mood: Reports sadness, irritability, stress.

Affect: Constricted or flat.

Thought Process: Logical, coherent.

Thought Content: Denies psychosis, denies substance use.

Cognition: Alert, oriented ×3.

Insight/Judgment: Fair, recognizes medical issues but may minimize psychiatric symptoms.

6. Differential Diagnosis
Major Depressive Disorder (MDD): Persistent sadness, anhedonia, fatigue, family history.

Persistent Depressive Disorder (Dysthymia): Chronic low mood ≥2 years.

Adjustment Disorder with Depressed Mood: Symptoms linked to occupational/family stress.

Generalized Anxiety Disorder (GAD): Worry and stress may overlap with depressive symptoms.

Alcohol Use Disorder (Family History): Must assess personal use, though patient denies.

Medical Causes: Fatty liver, hypertension, thyroid dysfunction.

7. Diagnostic Considerations (DSM‑5)
MDD Criteria: ≥5 symptoms for ≥2 weeks, including depressed mood or anhedonia.

Persistent Depressive Disorder: Depressed mood most days for ≥2 years.

Adjustment Disorder: Emotional/behavioral symptoms within 3 months of stressor.

Ada’s Case:

Symptoms consistent with MDD or adjustment disorder.

Family history and medical comorbidities increase risk.

8. Assessment Tools
PHQ‑9: Depression severity.

GAD‑7: Anxiety screening.

Columbia Suicide Severity Rating Scale (C‑SSRS): Suicide risk.

Medical Labs: Liver function tests, thyroid function, metabolic panel.

Alcohol Screening: AUDIT‑C, given family history.

9. Treatment Plan
Pharmacological:

SSRIs (sertraline, fluoxetine) → first‑line for depression.

Monitor for side effects, liver function given fatty liver.

Antihypertensive adherence.

Psychotherapy:

Cognitive Behavioral Therapy (CBT).

Interpersonal Therapy (IPT).

Grief counseling for unresolved trauma.

Lifestyle Interventions:

Nutrition counseling, weight management.

Stress management, mindfulness.

Sleep hygiene.

Supportive Measures:

Family therapy to involve husband and sons.

Coordination with primary care for medical comorbidities.

Crisis planning given family suicide history.

10. Monitoring and Follow‑Up
Weekly therapy sessions initially.

Medication monitoring every 2–4 weeks.

Suicide risk reassessment.

Liver function monitoring.

Collaboration with family and healthcare team.

11. Challenges
Medication adherence: Must balance psychiatric and medical treatments.

Comorbidity: Fatty liver, hypertension.

Family Trauma: Loss of mother, brother’s depression.

Occupational Stress: Demanding career.

Stigma: Mental health stigma in professional women.

12. Ethical and Cultural Considerations
Confidentiality: Respect patient privacy.

Consent: Informed consent for treatment.

Cultural Sensitivity: Address stigma and family dynamics.

Safety: Suicide risk management.

13. Case Summary
Mrs. Ada Carson: 54‑year‑old professional woman presenting with depressive symptoms amid medical and family stressors.

Likely Diagnosis: Major Depressive Disorder vs. Adjustment Disorder.

Treatment: Combination of psychotherapy, possible SSRI, lifestyle interventions, medical monitoring.

Outcome Goal: Symptom reduction, improved functioning, resilience building, long‑term health management.

📝 Quiz (15 Questions)
Multiple Choice – Select the best answer.

What is Ada’s age? a) 50 b) 52 c) 54 d) 56

What is her occupation? a) Teacher b) Contract negotiator c) Librarian d) Nurse

Which family history is relevant? a) Brother with depression, mother alcoholic b) Father with diabetes c) Sister with anxiety d) Uncle with hypertension

What recent medical diagnosis did Ada receive? a) Diabetes b) Fatty liver c) Asthma d) Thyroid disease

Which diagnosis involves ≥5 symptoms for ≥2 weeks? a) MDD b) GAD c) Adjustment disorder d) PTSD

Which tool screens for depression severity? a) PHQ‑9 b) GAD‑7 c) AUDIT‑C d) MMSE

Which therapy targets negative thought patterns? a) CBT b) DBT c) IPT d) Psychoanalysis

Which risk must be monitored given family history? a) Suicide b) Diabetes c) Asthma d) Cancer

Which antidepressant class is first‑line for Ada? a) SSRIs b) TCAs c) MAOIs d) Benzodiazepines

Which lifestyle intervention is appropriate? a) Sleep hygiene b) Smoking cessation c) Alcohol detox d) Dialysis

Which diagnosis involves chronic low mood ≥2 years? a) Persistent Depressive Disorder b) Adjustment Disorder c) Bipolar II d) Schizoaffective Disorder

Which lab should be considered for medical causes of depression? a) Liver function b) Thyroid function c) Metabolic panel d) All of the above

Which challenge is unique to Ada’s case? a) Fatty liver and hypertension b) Parenting stress only c) Financial stress only d) Substance abuse

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