Major Depressive Disorder (MDD) UNFOLDING Reasoning STUDENT, Marilyn Smith, 28 years old. Primary Concept
Mood and Affect
Interrelated Concepts (In
... [Show More] order of emphasis)
1. Stress
2. Coping
3. Clinical Judgment
4. Communication
5. Collaboration
6. Patient Education
History of Present Problem:
Marilyn Smith is a single, African American 28-year-old female who presents to the emergency department
with complaints of “feeling crummy” for the past six months. She reports that she no longer feels like doing
any of the things she used to enjoy. “It all seems so pointless.” She can’t even bother to eat most days and has
lost weight recently. Although she has no energy, she finds it difficult to both fall asleep and stay asleep. Even
when she does manage to fall asleep, she never feels rested when she awakes. She reports having difficulty at
work as a computer support person because it is so hard for her to concentrate. Last week she called in sick and
spent the day in bed crying off and on all day. Last night she found herself crying again and this time she also
thought about suicide, which scared her and prompted a visit to the ED. “I don’t want to live like this anymore.
I feel like I will never be happy again.”
Personal/Social History:
Marilyn graduated from high school and obtained an associate degree in computer science. She enlisted in the
Army to have an adventure and hoped the GI bill would pay for further education once she completed her
service. She reports she still feels guilty about making the decision to enlist instead of marrying her high
school sweetheart. She was deployed to Iraq and returned home a year ago. She enjoyed her time in the
service because she felt she was doing something useful for her country. She did not see combat and did not
experience any significant problems while in Iraq. When she returned home, she found out her old boyfriend
had married. She recently attempted to contact local universities to explore completing her baccalaureate
degree but found the process too overwhelming and just gave up.
When questioned about use of alcohol or drugs, Marilyn reported that she is an occasional drinker, but recently
has been drinking more in an attempt to sleep. Denies other drug use. Marilyn has no history of clinical
depression. Her grandmother had periods of becoming withdrawn and not leaving the house for days. [Show Less]