Depressive Disorder In John's Vignette

After reading this week’s vignette, I have determined that John has major depressive disorder (MDD). The symptoms that I am taking into consideration for the diagnosis of MDD are not enjoying life, feeling down, self-deprecating thought of inadequacy, inability to cope with responsibility that effected employment, thoughts of inadequate job performance, inability to adequately deal with work pressure, difficulty focusing, chronic fatigue, inescapable feeling of gloom, low self-confidence, and pessimistic attitude.

In order to be diagnosed with MDD, criteria A-E must be met (American Psychiatric Association, 2013). In order to meet criteria A, patients must have five (or more) of nine possible symptoms. In John’s case, he met the criteria for

John expressed symptoms of depression by referring to himself as a “professional pessimist”, recurring thoughts of inadequacy associated with employment and family, as well as by reporting that he feels down. It is evident that john experienced these symptoms, with little time without experiencing them, by saying that “most of the time he just felt down”, he is “often distracted by thoughts [of inadequacy]”, and by stating that he has always been that way. Symptom 2 is defined by a diminishment of pleasure in almost all activities, the majority of the time (American Psychiatric Association, 2013). John expressed that only his marriage and birth of his sons relieved his symptoms temporarily. Symptom 6 is defined by fatigue and loss of energy (American Psychiatric Association, 2013). John expressed that his efforts to live up to the pressure, that he perceived was placed on him at his job, causes him to be chronically tired. Symptom 7 is defined by feelings of worthlessness and guilt. John expressed such symptoms by stating that he feels guilty for having to

In order to rule out a possible diagnosis of bipolar disorder, or manic episode with irritable mood or mixed episodes, it would be necessary to ask John the appropriate questions to determine if he has ever experience mania or hypomania (American Psychiatric Association, 2013). Assuming that there is no history of manic symptoms that the vignette is leaving out, then bipolar disorder and manic episode with irritable mood or mixed episodes can be ruled out. In order to rule out a diagnosis of mood disorder due to another medical condition, it is necessary to look at Johns medical history. Also, it may be necessary for John to see a physician to rule out a diagnosis of mood disorder due to another medical condition. In order to rule out substance/medication-induced depressive disorder, it may be necessary to do a urine toxicology screen and ask john if he has been taking any medication. Although a urine toxicology screen could provide useful information, it is unlikely that John’s symptoms are caused by substances, due to the early age of onset (i.e., age 18) of his depressive symptoms and his current age (i.e., 40) with the same symptoms. A diagnosis of attention-deficit/hyperactive disorder is easily ruled out by the lack of prevalence of low frustration tolerance in John’s case—further questioning for the occurrence of low frustration tolerance could further