Case of Meredith Meredith is a 17-year-old high school junior who has been

2022-05-29 07:43:10Case of Meredith
Meredith is a 17-year-old high school junior who has been
Place your order now for a similar assignment and have exceptional work written by our team of experts, At affordable ratesFor This or a Similar Paper Click To Order NowCase of MeredithMeredith is a 17-year-old high school junior who has been seeing you for major depressive disorder, recurrent (moderate) for the past year. Meredith has a history of two recent suicide attempts (swallowing of various medications found in the home). She started seeing you following inpatient, partial hospitalization, and intensive outpatient phases of mental health care. You recently uncovered in a session that for over the past four months Meredith admitted to drinking alcohol (whiskey, vodka, and beer) and snorting crushed Adderall tablets. She states that both the alcohol and Adderall help her cope with the depression, just in different ways. Meredith says “drunk or high on Adderall beats depressed or dead” and she refuses to cease either substance.Major Depressive Disorder and Suicide HistoryMeredith reports she believes that her depression began sometime in her “tweens.” She just recalled always being “down” and not being able to get “as happy” as her friends. Around age 13, Meredith experienced her first serious and long-lasting depressive episode where she recalls nearly one month of increasingly worsening depressed mood, feeling “worthless and ugly,” and an inability to sleep, eat, or do her schoolwork. At age 14, she first attempted suicide by swallowing approximately 10 regular-strength (325 mg) Tylenol pills. Though this amount of acetaminophen was below the dosage where overdose issues may occur (~4000 mg total), Meredith was convinced (from reading online) this dosage was lethal. She incurred some bad symptoms but did not die. Meredith recalled being angry that the Tylenol did not kill her. However, she never informed her parents and it was not discovered until Meredith was admitted to an inpatient mental health facility following her second suicide attempt about 18 months later where she swallowed a handful of Zoloft. The attempt was uncovered by her parents when she was found vomiting and shaking while reporting being dizzy. Again, Meredith reported feeling “overwhelming” depressed mood in the weeks leading up to her second suicide attempt. The attempt was not planned. Meredith stated to you that she “did not go into the bathroom to kill myself, it just sort of overtook me all of a sudden.”Meredith currently reports feeling moderate depressive symptoms that can sometimes border on severe. She reports that she “got nothing” out of her inpatient and more intensive outpatient treatments. She reports feeling just as depressed as when she was admitted, with the only difference being now she knows more about what she experiences. Meredith is currently in a depressive episode that seems to have lasted for approximately the past three weeks. Meredith reports still having suicidal thoughts occasionally (usually when under duress) but they lack any plan or intent.Since she started outpatient treatment with you (two times per week) about one year ago, Meredith seems to have experienced a few depression episodes. She currently also works with a psychiatrist who has her on a low dose of Lithium daily.Alcohol Use HistoryMeredith reported two “types” of drinking. One drinking “type” is a typical pattern of alcohol use for a high school student where she reports drinking at parties and sometimes getting drunk. This may happen one to two times per month. At the parties, she drinks beer because that is usually the most available alcoholic beverage.The other “type” of drinking that has you concerned is her use of alcohol as a coping mechanism for the depression and suicidal thoughts.You ask me how I cope with stuff? Well, the tools I learned in the other treatment places were the usual bullshit of deep breathing, focusing, positive self-talk, blah blah blah. They don’t help. Neither it seems does the lithium. So, I drink. There. In my room, at night, I drink. I don’t think you can tell my parents that. I drink to cope. Vodka, whiskey, beer. It helps. I feel less sad. I don’t have to think about stuff. If it helps me not be depressed and not have the depression cause me to harm myself, how is this bad?Meredith reports drinking alone in her room 3–4 times per week when she is experiencing depressed mood and/or suicidal thoughts. When not having a depressed episode or suicidal thought she will not drink alone in her room. Though she is unable to quantify the number of standard drinks, it does appear to consist of a combination (in some manner) of several “shots” of vodka or whiskey and/or 2–3 cans of beer. Over the past four months, Meredith was able to identify that it seems she now needs “a little more” alcohol to achieve her same desired effect. She also states that over the past two weeks, she experienced her first instance of going to school with a “major hangover.”Adderall Use HistoryApproximately two months ago, her friend turned Meredith onto snorting Adderall. Meredith states she would snort Adderall almost once daily (usually in the morning) over the past several weeks. She stated it helped her to “focus” and be able to do well in school.The depression makes me drag. I can’t think well. Plus, I get wrapped-up in my own pity party in my head. I snort some Adderall and I feel a buzz in just a few moments. I’m up. I see it as a counter to the depression. I would snort at night but then I’d be up till 5am. No good. It helps. I’d be a wreck in school without it when I am depressed. Isn’t that what everybody wants? Me doing well in school, not being depressed?Meredith’s PresentationMeredith presents to sessions (over the past year) as either depressed or not currently in a depressed episode. When depressed, Meredith presents as sullen with limited eye contact, minimal engagement in the session, and irritability and defensiveness about the value of counseling. Her attire tends to be more drab (sweatpants and a sweatshirt, hair brushed but not styled). This runs counter to when you see her in a period of not having a depressive episode. She is engaged in the session, maintains eye contact, and comes more stylishly dressed and groomed. However, she still discusses the limited value of counseling. Meredith denies ever coming to session drunk or high. Your observations support that claim.Questions to Consider:Drinking and snorting Adderall are clearly not healthy coping skills, but they are the only coping skills Meredith seems to believe in due to their effectiveness of removing her negative affect/mood/thought (even though it is only temporary). Considering her poor perception of typical coping skills imparted in treatment and her reluctance to see counseling as a helpful strategy, how do you discuss and deal with the need for Meredith to cease her substance use?Meredith has only been using alcohol and Adderall for approximately four months. Does this limited time period impact your DSM-5 diagnostic decisions and/or options?Alcohol is a depressant whereas Adderall is a stimulant. How and why do you think each of these substance classes assist Meredith in coping with her depression?Based on your thinking in answering question #2, what would be the appropriate level(s) of care for Meredith? Does her required major depressive disorder-related level of care differ from her required substance-related level of care?Considering Meredith’s case, which counseling orientation(s) would be the best fit and why?For This or a Similar Paper Click To Order NowRelated
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