Name:

Section:

For Faculty Only:

No. 1 2 3 4 5 6 7 8 9 10 Total
Points 6 5 5 7 4 2 2 2 1 1 35

Assessed Exercise 1 – Case Study

JD is a 19-year-old, otherwise-healthy, male 4th-year college student who

presents to the university health service in February 2015 with a 2-month history
of what his friends suspect are depressive symptoms. The healthcare
professional taking his personal information notes the referral request while
shouting out loud about how kids these days are weak and sensitive, making him
to feel shame and embarrassment on top of his existing problems. After grueling
through the red tape, JD is able to get an appointment with a psychiatrist, where
he then proceeds to try to piece together and explain his problems as best as he
can. He apologizes throughout the process as the psychiatrist listens on

JD has been feeling extremely down recently the past month. He traces his low
mood back to a history of domestic abuse (physical and verbal) from his parents,
which continued until he snapped in the last years of high school. Things peaked
during his 2nd year of college, where he was already experiencing bouts of
depressive states that were markedly worse when associated with his stressful
laboratory classes. Now, the episodes of low mood are back and worse than
before. Nothing his friends would say could cheer him up, and he feels bad for
taking all their time and feels like such a huge burden to them. He couldn’t stand
needing to ask his close friends for support. Workload was heavy and yet his
friends would allocate two hours of time on weekday evenings to try to talk JD out
of his slump, where he’d usually go on and on about how much he’s messed up
in his academics and his bothering his friends. Equally bad for him was during
their class breaks, when he recalls a petty incident of a misplaced notebook
triggered a depressive episode. He says he displaced some of the negativity and
frustration at his friends, before promptly isolating himself for the day (both in
person and on social media). He rationalized that if he were far away from his
friends, then whatever he was experiencing could not bother them anymore.

Both in the past and now once more, he has been having a difficult time falling
asleep, leading to a lot of daytime sleepiness in class. His decreasing ability to
maintain concentration during his lecture subjects was not helped by his poor
sleep quality. This has also begun to impact his grades, as he admits to being
G.C. (grade-conscious). His lowering performance provokes feelings of distress
and is a frequent trigger for his depressive episodes as well. This is in spite of
objective observation by the psychiatrist showing JD is doing better than many of
his peers, able to maintain regular class attendance, and is eligible to graduate
on time and with honors (GWA dropped from 1.4523 to 1.6188).

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When asked regarding coping, JD mentions food a lot. For the past year, his
increased appetite and utilization of eating as a coping mechanism for the
depressive episodes has resulted in a 20-lb weight gain over 6 months. The
psychiatrist also asks JD if he has had thoughts of death or killing himself, and
JD mentions he does. He is quick to add that he does not intend to go through
with it, but that he “wants to wants to die.” The difficult part for him was how the
suicidal thoughts tied in with his desire not to be a burden to his friends, even if
they’d always try to reach out. This further perpetuating a cycle of social
withdrawal and worsening thoughts during depressive episodes. Worse, he
worried his knowledge of and access to potent means of suicide via the school
laboratory might make him proceed to an attempt one day It was mainly the
strong suicidal thoughts and sudden, intense, adverse life events that made him
want to schedule the first appointment.

1. What signs and symptoms might raise suspicion for clinical

depression with JD? (6 points)

After JD tells his story, there is a pause. The psychiatrist asks permission to test
for his stretch reflexes, and explains they want to rule out certain non-psychiatric
causes of his concerns.

2. With regards to the patellar reflex:

(a) What device will JD’s psychiatrist use to test his patellar reflex? (1
point)

(b) How should JD be positioned before the test is done? (1 point)

(c) This test aims to rule out abnormalities in which area (no need to state a
specific disease/disorder)? What hypothetical result of JD’s patellar reflex
is expected to raise suspicion of a biological cause? (3 points)

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The psychiatrist completes the physical examination and finds nothing

remarkable. JD mentions he’s been feeling recurring pain in his back, even
though his posture is alright and he has no history of physical trauma or injury to
his back. There is also no observed swelling or redness in the area, according to
JD.

3. With regards to his back pain:

(a) Could what JD is experiencing be related to his depression? If possible,
how? If no, why not? (4 points)

(b) What kind of pain is JD most likely experiencing? (1 point)

JD reflects on the exchange with his psychiatrist so far. In between sniffles, he

asks what could be causing his symptoms if it does turn out he has clinical
depression. He mentions his mom’s side of the family was always hesitant about
his dad because some of his dad’s siblings were “baliw” (“crazy”), as he recalled
hearing as a kid.

4. What factor/s might be causing JD’s depression? Is there a single, main

cause that can be pointed to? (7 points)

5. Which protective factor against depression does JD have that can be

utilized in the long run? How do you observe this? (4 points)

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6. Besides the lab tests for possible physical conditions the psychiatrist
will order, what other causes of JD’s depression should the psychiatrist
ask about? (2 points)

7. What symptoms should be checked for to make sure JD’s suspected

diagnosis of depression is unipolar and not bipolar depression? (2 points)

8. Are there factors that might demonstrate JD’s symptoms of depression

are simply a result of being very sad and can be overcome by himself,
meaning he would not need to continue seeing his psychiatrist after the
next session? If yes, what are they? (2 points)

JD returns for his next appointment. The lab tests his psychiatrist ordered all turn
out normal, and JD notes no change in the symptoms he is experiencing. His
psychiatrist proposes they start a trial of an antidepressant. On asking for his
diagnosis, JD learns his psychiatrist has diagnosed him with major depressive
disorder of moderate severity.

9. Will an antidepressant possibly be efficacious for JD? (1 point)

10. What intervention will help further boost his response to an

antidepressant? (1 point)

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