He explains that he was caring for his elderly mother after being diagnosed with dementia.  He reported he was her sole caregiver and struggled with watching her deteriorate.

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Case 2 –

M.G. visits your office requesting a consultation.  He explains that he was caring for his elderly mother after being diagnosed with dementia.  He reported he was her sole caregiver and struggled with watching her deteriorate.  He expresses concern that he isn’t grieving properly because he feels relief that she passed.  He recounts that as her disease progressed, she became aggressive when she no longer remembered who he was.  He tells you that during that time he prayed often that he would behave differently if only she could show improvement.  He also tells you that he was angry he had no help and was sacrificing years of his life to care for her.

· Review the DSM-V and determine if there is an appropriate diagnosis for M.G., providing rationale.

· Using a minimum of two scholarly sources, describe the stages of grief and if this patient is exhibiting abnormal grief.

· Reviewing what you have learned so far, which type of therapy would be of most benefit to this patient?

 

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· Answer:

· M.G’s symptoms meet the criteria for a diagnosis of major depressive disorder, specifically episode with mixed features.  He meets the criteria because he is experiencing both depressive and manic symptoms.  Specifically, M.G. has depressed mood which is present most of the time, as evidenced through his exploration of what he perceives to be inappropriate feelings following his mother’s passing.

· He feels guilty regarding what he expresses as his inability to properly grieve unless those feelings are tinged with sadness, and goes on to express his relief that she passed away during a time in which her condition had deteriorated significantly and she was no longer herself.

·   This represents both appropriateness for the diagnosis of major depressive disorder, as well as considerations for an episode with mixed features.  Manic/hypomanic symptoms include increased energy or activity expressed in goal directed ways, increased sociability (or wanting more social interaction), talkativeness, decreased need for sleep although impaired concentration and attention due to short sleep duration may exist.

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