HPI: Patti, a 40-year-old female of Iranian heritage, has been undergoing individual and family therapy for the last 18 months. All five of her children are with her. Patti sought assistance at the clinic in response to the upheaval that ensued after her daughter returned to the family after a decade-long absence

CC (chief complaint): “Household chaos.”

HPI: Patti, a 40-year-old female of Iranian heritage, has been undergoing individual and family therapy for the last 18 months. All five of her children are with her. Patti sought assistance at the clinic in response to the upheaval that ensued after her daughter returned to the family after a decade-long absence. After an initial period of joyful celebrations, Shireen revealed distressing information to her family regarding the psychological, physical, and sexual abuse she had endured from her father. The patient ascribed culpability to her mother and had a sensation of abandonment. Patti had essential foot surgery after an accident, resulting in her current disability and ongoing agony. The surgical operation and resulting disability have heightened the degree of worry and tension inside the household. Patti lives with her two sons, while her daughters live independently. Shireen had just relocated to a new residence and married an individual unknown to her family, resulting in a shortage of communication. The mother often participates in casual discussions with Sheela and Sharleen. Patti’s sense of isolation, depression, despair, and lack of control has intensified as she wants her children to remain and assist her in the household. A psychiatric practitioner has been advised to do a comprehensive evaluation of medications.

Past Psychiatric History:

• General Statement: After Shireen returned after 12 years, Patti and her family began therapy 18 months ago. Her family felt guilt, sorrow, and humiliation as Shireen revealed a long history of abuse. Thus, these emotions increased family tension.
• Caregivers (if applicable): N/A
• Hospitalizations: Patti denies any prior mental hospitalizations or personal history relating to this problem. Patients received bilateral foot surgeries for arthritis, hammer toe, and severe plantar fasciitis. Despite these procedures, the patient has had symptoms for almost two years.
• Medication trials: None.
• Psychotherapy or Previous Psychiatric Diagnosis: The patient affirms their dedication to individual counseling and displays a current desire to participate in family therapy.

Substance Current Use and History: The patient denies any engagement in illegal drug or alcohol usage.

Family Psychiatric/Substance Use History: The woman and her oldest child were abused sexually and physically.

Psychosocial History: The patient is from Iran and has five children. Before she came to the United States, she had been abused both physically and sexually. In Iran, her husband married someone else again. Four of her five kids were born here in the US. Her children have decided to live a Western lifestyle, but she follows Islam and likes the old way of life better. She likes going to church and playing video games.

Medical History: She had surgery on both feet, which affected her movement.

• Current Medications: None
• Allergies: None

• Reproductive Hx: The patient has been pregnant five times and given birth to five children. She has never had an abortion or miscarriage. She has not been sexually active in 12 years. She has never had an STD and started having menstrual periods when she was 14, which have been regular ever since.

History of Abuse/Trauma: Patti said that while she was in Iran taking care of her oldest daughter, her husband abused her.

ROS: There is no need for a complete physical check on this patient.

Diagnostic results: Currently, this patient does not need any diagnostic tests.

Assessment

Mental Status Examination: The mother and daughter cooperated in the case. During therapy sessions, they engage in nonverbal communication through eye contact, smiling, and laughter. They were dressed in suitable attire for the current weather conditions. There were no observed psychomotor abnormalities. The effect displayed is comprehensive, aligning appropriately with the given situation. The patient’s speech is typical, with a rational, tangential mental process, while the thought content reflects feelings of Helplessness and despair. There is no evidence of suicidal or homicidal thoughts. The mother and daughter are both fully aware and clearly understand their situation. Ultimately, the Mother and daughter exhibit commendable focus and sound decision-making abilities.

Differential Diagnoses:

1. Adjustment disorder with depressed mood: Patti is experiencing a sense of being alone as her children mature. The individual expresses that they have a sense of powerlessness and despair during periods of alone. She struggles to adapt to her children’s reduced time at home and desires them to remain in her presence. She has undergone surgical interventions within the past four months and is currently transitioning to a reduced sense of self-reliance as a consequence of persistent pain and movement restrictions (Mazza et al., 2019). Patti is now experiencing feelings of melancholy and despair as a result of three distinct stressors: recent surgical procedures, her children’s departure from the household, and the sorrow and remorse connected to her daughter’s previous traumatic experience. The patient meets the criteria for a primary diagnosis.
2. Depressive disorders not due to another medical condition; grief, PTSD: Patti has a prior record of experiencing depressed episodes prior to her operations. Over the last 18 months, she has been receiving treatment to deal with traumatic situations, including abuse and bereavement (Heeke et al., 2022). It is essential to determine the possible connection between the health problem and depression.
3. Depressive Disorder Due to Another Medical Condition (chronic pain): After undergoing her surgeries, Patti experienced a deterioration in her mental well-being, characterized by feelings of hopelessness and an increased reliance on her daughter for help. Patti’s autonomy diminished, and she developed apathy towards activities that impeded her movement (Kremer et al., 2020). The pain experienced by an individual is influenced by the connections, interactions, and symptoms that cause discomfort.

Case Formulation and Treatment Plan:

• Include family-focused psychotherapy therapies that are contextually appropriate and culturally sensitive.
• It is crucial to request a thyroid panel laboratory test to exclude any alternative causes of melancholy in the patient.
• Collaborate with a nearby behavioral health organization to facilitate the patient’s access to therapies, including pharmaceutical therapy in psychiatry and group and art therapy via in-clinic peer expert exchanges (Fegan & Doherty, 2019).
• Physical therapy is recommended for patients to improve their mobility and prevent further deterioration. Referring someone to a nutritionist for weight management may increase their self-worth and motivate them to participate in the community (Fegan & Doherty, 2019).
• It is essential to have a comprehensive discussion with the patient on the risks, benefits, adverse reactions, alternatives, and desired effects of any medications.
• In three days, the patient is expected to see a psychiatric practitioner. In addition, the patient has an appointment with a primary care physician in seven days (O’Donnell et al., 2019).

Reflections: The Iranian female is a middle-aged mother who has five children who are traumatized and obstinate, which leads to chaos in her household. Her mistreated neonate was left behind during her escape from Iran. The PMHNP exhibited a high level of proficiency in collecting relevant information to facilitate the development of a diagnosis and a patient-centered treatment plan. In family therapy, it is advantageous to acknowledge each family member’s distinct perspectives and emotions and involve them in the decision-making process (Fegan & Doherty, 2019). This case study will examine legal and ethical issues, such as truthfulness, compassion, equity, and confidentiality. As directed by their allocated psychologist, Patti and her family must attend weekly family counseling sessions.

References

Fegan, J., & Doherty, A. M. (2019). Adjustment Disorder and Suicidal Behaviours Presenting in the general medical Setting: A Systematic review. International Journal of Environmental Research and Public Health, 16(16), 2967. https://doi.org/10.3390/ijerph16162967

Heeke, C., Franzen, M., Hofmann, H., Knaevelsrud, C., & Lenferink, L. (2022). A latent class analysis on symptoms of prolonged grief, Post-Traumatic stress, and depression following the loss of a loved one. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.878773