Psychiatric Interviews for Teaching: Depression
Summary
TLDRIn the video script, Alison Wells visits Dr. Taylor, expressing feelings of being 'fed up' and overwhelmed by life, as noticed by her sister. Alison discusses her low mood, lack of energy, disrupted sleep, and diminished appetite, which have been affecting her ability to cope with daily life and her children. She reveals a past suicide attempt and current fleeting thoughts of self-harm, but denies any plans or actions towards it. Dr. Taylor identifies Alison's symptoms as indicative of depression and suggests exploring treatment options to improve her condition.
Takeaways
- 😔 Alison is experiencing persistent feelings of being fed up and miserable, which have been ongoing for a few months.
- 🏠 She mentions that her sister noticed her condition and encouraged her to seek medical help.
- 👨👩👧👦 Alison's responsibilities with her children and the recent changes at her workplace, including wage cuts, have added to her stress.
- 😴 Alison is struggling with sleep, taking hours to fall asleep and waking up in the middle of the night, which affects her energy levels.
- 🍽️ Her appetite has decreased, and she's lost weight without consciously trying, indicating a potential loss of interest in food.
- 🧠 She's having difficulty concentrating and remembering things, which affects her daily life and work.
- 😢 Alison has had episodes of tearfulness over minor incidents, which her sister has also noticed.
- 🤔 She questions the point of activities she used to enjoy, such as going out with friends, indicating a loss of interest in pleasurable activities.
- 💊 Alison has a history of a depressive episode four years ago, during which she overdosed on paracetamol after having a few glasses of wine.
- 🏥 Despite her current struggles, Alison feels she can keep herself safe and hasn't made any plans to harm herself, unlike in the past.
- 🤝 She acknowledges having a support system in place, including her sister, friends, and partner, although she feels her relationship with her partner is strained.
Q & A
What is the reason Alison Wells came to see Dr. Taylor?
-Alison came to see Dr. Taylor because she has been feeling fed up and overwhelmed, as noticed by her sister who suggested she should come to the surgery.
How long has Alison been experiencing these feelings?
-Alison has been experiencing these feelings for a few months.
What does Alison describe her daily life as feeling like?
-Alison describes her daily life as feeling like swimming in treacle, indicating a sense of struggle and difficulty in coping with everyday tasks.
How has Alison's mood been affecting her interactions with her children?
-Alison mentions that she used to do a lot with her kids, like going swimming and playing, but now she spends most of her day on the sofa unless she has to go to work, indicating a decrease in her engagement with them.
What is Alison's occupation and how is it related to her current situation?
-Alison works in a supermarket, and she has been struggling with work due to the supermarket being taken over, wages being cut, and her feeling exhausted.
What difficulties is Alison facing with her sleep?
-Alison is having trouble falling asleep, which takes her a couple of hours, and she wakes up around 4 o'clock in the morning and cannot get back to sleep.
How has Alison's appetite changed during this period?
-Alison's appetite has decreased; she used to have a weight problem, but she has lost weight over the last couple of months and doesn't bother eating much.
What impact has Alison's current state had on her memory and concentration?
-Alison's memory and concentration have been affected; she has forgotten important things like the swimming money and parents' evening, and she finds it hard to focus even on activities she used to enjoy, like watching TV.
What past episode did Alison mention that is relevant to her current state?
-Alison mentioned an episode four years ago when her husband left, and she felt very low, leading her to take an overdose of paracetamol after having a few glasses of wine.
How does Alison's relationship with her partner, Dave, seem to be affected by her current state?
-Alison's relationship with Dave appears to be strained as he is getting fed up with her not wanting to go out and is pressuring her in other ways. She also mentions that she doesn't think he will be around for much longer.
What does Alison think about the possibility of seeking help and discussing treatment options with Dr. Taylor?
-Alison is open to discussing treatment options and believes it is sensible to explore ways to improve her situation, indicating her willingness to seek help.
Outlines
😔 Initial Consultation and Expression of Emotional Struggles
In the first paragraph, Alison Wells visits Dr. Taylor for a consultation. She expresses feeling 'fed up' and overwhelmed by life's challenges, which she has been experiencing for a few months. Alison mentions that her sister encouraged her to seek help. Dr. Taylor inquires about her mood, energy levels, and coping mechanisms. Alison describes her days as dark and exhausting, with episodes of tearfulness triggered by minor incidents. She also admits to reduced activity levels, spending most of her day on the sofa, and feeling too exhausted to engage with her children or maintain her job at the supermarket, which has been affected by wage cuts and increased financial stress.
😞 Deepening Discussion on Depression Symptoms and Impact on Life
The second paragraph delves deeper into Alison's symptoms of depression. She talks about her difficulty sleeping, waking up at night, and feeling tired the next day. Her appetite has decreased, and she's lost weight without intending to. Alison also struggles with concentration and memory, forgetting important events and responsibilities related to her children. Her enjoyment of activities like watching TV and going out with friends has diminished. She expresses feeling 'useless' and her relationship with her partner, Dave, is strained due to her lack of interest in social activities and intimacy. Alison recalls a past episode when her husband left, leading her to take an overdose of paracetamol after drinking wine, although she did not seek medical help afterward.
🤔 Assessment of Current Mental State and Consideration of Treatment Options
In the final paragraph, Dr. Taylor summarizes Alison's symptoms, which indicate severe depression, and discusses the broader impact on her life, including her relationships and self-care. Alison acknowledges her struggles and agrees that she needs help. Dr. Taylor reassures her that there are treatment options available and suggests they discuss these to start improving her condition. Alison expresses a desire to change her situation and agrees to explore treatment options. The conversation also touches on Alison's past suicide attempt and her current suicidal ideations, highlighting the seriousness of her mental state and the need for immediate support.
Mindmap
Keywords
💡Depression
💡Coping
💡Tearfulness
💡Energy Levels
💡Sleep Disturbances
💡Appetite Changes
💡Concentration
💡Enjoyment
💡Relationship Strain
💡Self-Harm
💡Support System
Highlights
Alison expresses feeling 'fed up' and 'miserable', prompted by her sister to seek medical help.
Alison describes her daily life as overwhelming, with tasks 'piling up' and feeling unable to cope.
Dr. Taylor identifies Alison's mood as 'very black', with Alison confirming feelings of misery.
Alison experiences episodes of tearfulness over minor incidents, noticed by her sister.
Alison's energy levels are low, spending most of the day on the sofa and struggling with work attendance.
Work-related stress is highlighted by Alison due to wage cuts and increased financial pressures.
Alison's sleep pattern is disrupted, taking hours to fall asleep and waking up at night unable to return to sleep.
Alison reports a significant decrease in appetite and weight loss without specific measures.
Concentration and memory issues are affecting Alison's daily life and responsibilities.
Alison's enjoyment of previous activities has diminished, including social outings and hobbies.
Alison's self-care has suffered, with a lack of interest in personal grooming and appearance.
Relationship strain is evident as Alison's partner, Dave, shows frustration with her social withdrawal.
Alison discloses a past suicide attempt during a depressive episode four years ago.
Alison did not seek medical help after her suicide attempt, considering it a moment of being 'silly'.
Dr. Taylor confirms Alison's current symptoms align with depression and suggests available treatments.
Alison acknowledges the need for help and agrees to discuss treatment options to improve her condition.
Transcripts
- Hello, Alison Wells, do you want to come and have a seat? Hi I’m Dr Taylor one
of the GP’s at this surgery, what would you like me to call you?
- Alison will be fine
- Ok, so what’s brought you here today Alison?
- My sister's noticed, I’m just a bit fed up really. My sister said I should come.
- Right ok. Has this been going on for some time?
- Yeah, few months really.
- Ok, do you want to tell me a bit more about what’s been going on?
- Just things, things seem to be piling up. - Right - I just don’t seem to be coping with things,
- Right - the kids and things. - Right, ok.
Would it be OK Alison for me to ask you a few more detailed questions
about how you’ve been feeling?
- Uhuh
- Ok
Well if we start with asking you a bit about your mood.
How have you been feeling in yourself?
- I say a bit fed up. I get up in the morning, everything seems very black. - Right
- It’s like, it's just like swimming in, in treacle really and I just don't, I think by tea time when the kids get home,
I’ve been having fairly decent conversation with them but...
- Right, and can I just check Alison when you say things feel very black, do you feel very miserable?
- Fed up, miserable.
- Right, OK. And what about sort of feeling tearful? Has that been happening?
- I dropped some sugar the other day and I just burst into tears.
- Right, OK.
- Thanks
- So is it the slightest thing that will make you tearful, things that perhaps
wouldn’t ordinarily bother you?
- Yeah my sister's noticed it as well.
- Right, OK.
So you’ve been feeling very low with episodes of tearfulness, what about
other things, your energy levels are you managing to keep up with things?
- I used to do a lot with the kids I used to go swimming, playing but now I just spend
the day on the sofa unless I have to go to work.
- Right, just remind me, what is it you do for your job?
- I work in a supermarket.
- Right, so how have you been managing at work?
- I’ve not been going in as much cause I just feel so exhausted...
...but I'm just not...the supermarket's been
taken over and they’ve cut the wages - Right - and I’ve had problems with the bills
- Right - and it's like catalogues just writing me letters, - Uhuh
- you know the kids they want all these new games and stuff
- Yeah sure
- and it’s just y'know.
- Things are difficult all round then. With all this going on how are you sleeping Alison?
- It just takes me ages to go to sleep, I used to read a book - Right
- and just drop off, - Right - but now I just spend my time
looking at the clock as it goes round and round.
- So from actually getting off to bed and getting off to sleep how long is that taking?
- Couple of hours probably.
- Right, OK.
- Once you’re asleep are you waking up much during the night?
- I wake up about...last night I think it was about 4 o clock I woke up. - Right
- And can you get back to sleep from that time?
- No, no.
- And then you’re actually getting out of bed in the morning, are you still feeling tired at that point?
- I’m just exhausted, I feel like my brain's not been switched off. I'm just exhausted the next day.
- OK
- What about eating what’s your appetite been like while you’ve been feeling like this?
- I used to have quite a weight problem, but the last couple of months this is a bit looser.
- Right
- Er, I just...
- Do you know how much weight you’ve lost?
- No, no.
- The kids come in from school and they make their own stuff and I just don’t bother really.
- Ok, Ok so you’re appetite's gone down as well. What about things like concentrating and your memory
both when you’re watching TV at home or when you’re out doing your job.
- How have those things been?
- Well I mean pretty useless with the kids, I forgot the swimming money last week, PE
kit and parents evening even. - Right, ok. - I just start one job, and, I’m not explaining myself very
well. It's like the television, I used to like watching the soaps, EastEnders
or something and now 10 minutes later I’m thinking of something else.
- Ok, ok.
- And what about things Alison you used to enjoy, are there things in life that
you still enjoy at the moment?
- Nothing really, as I say, a bit useless with the kids. I used to enjoy going out, I used
to go out with my friends, the pictures and things, but of course now I can’t be bothered.
- Is it that you can’t be bothered and you don’t feel like it as well?
- What’s the point really? - Right, ok. - You know.
- And I was going to ask, how old are your children now?
- I had them a bit later in life, it's took a a long time to have them. I got a girl and
a boy, one's 11 and one's 9.
- And looking after children takes a lot of time and energy, how are you managing to keep
up with that feeling as low as you do?
- Well they’re a bit self-sufficient really the kids, they come in from school get their
own tea. I should be doing more for them really but I’m not I’m just a
bit useless at that at the moment.
- Ok, and what about looking after yourself?
- Well you can see I’m just a mess. Dave used to say, that’s my boyfriend,
- Right
- he used to, you know, not have much
money but I’d take a bit of pride in what I was doing. My hair and stuff but I can't
can't be bothered with that now, there's no point really.
- Ok, ok.
- And you mentioned Dave, that’s your current partner, how long have you and Dave been together?
About a year I met him at work.
- And how are things, because often when people feel
really down it has an impact on everything including their
relationships so how are things with you and Dave at the moment?
He’s not ringing as much, he used to text, he’s getting fed up with me not wanting
to go out and things.
- It’s a slightly embarrassing thing to ask about but I guess it's important, often when people are
really feeling very low it affects everything in the relationship including things like their
sex life. Have you noticed any changes there for you?
He’s always trying to pressure me a little bit - Right - and stuff,
but I’m really not into that at the moment.
- Right, ok. You just don’t feel like that at the moment.
- No. - Ok.
So can I just a recap Alison to check I’ve got this right, for the last few months you’ve been
feeling really down, no energy, problems with your sleeping and eating,
problems with concentrating,
not really enjoying things and actually struggling a bit with the kids and perhaps some difficulties
in your relationship with Dave. Have I got that right?
- Hmmmm.
- OK.
Can I ask Alison, in the past
have there ever been episodes where you’ve felt like this?
- When my husband left, I was always crying then for no particular reason. - Right
- I haven’t told anybody this before but I took some tablets.
- Right
So how long ago are we talking was this a few years ago?
- About four years ago.
- About four years ago.
Ok, so you took some tablets, - Yeah - Can you tell me,
is it alright to tell me a little bit more about that?
- You know what it’s like, the kids are in bed and you’re on your own and I had a few
glasses of wine and I just took these tablets.
- Right, OK.
Can you remember what you actually took at the time what sort of tablets they were?
- They were just in the bathroom cabinet, it was paracetamol.
- Right, OK.
So you took some paracetamol, can you remember roughly how many you took?
- About 2 strips, about 12.
- Right, OK.
- And you’d had a couple of glasses of wine; did you take anything else, any other tablets with it?
- No. - Ok.
Ok. And was this something Alison that you’d thought about for a while or was it a spur of the
moment that evening?
- As I say I was crying a lot but I think it was just the wine. - Right, ok.
- But you know, I’m just a bit of a burden to everybody really.
- And was there any other things that you did around the time, sometimes when people take tablets
they leave a note, or do other kinda final acts, get their affairs in order?
Did you do any of those things?
- No, I just thought, that you know, I'd take the tablets and I'd just go to sleep.
- Right, ok.
So did you have any thoughts about what taking the tablets would do? Did you..
- I just thought I’d go to sleep and not wake up, but I woke up a couple of hours later
and was sick everywhere. - Right, ok. God I was sick.
- Ok, so I actually just want to check I get this right because it's important.
You actually thought that they would kill you at the time?
- I just didn’t want to wake up, - Right, ok
- As I say, I’m just useless, I’m a useless mum now and I was then.
- Right ok, so you took the tablets and you were very sick in the night
did you seek any medical help at the time?
- No, no. - Ok.
And then were you OK the following day?
- Well, yeah, I just felt a bit of a twit really.
- Right, did you feel pleased you were still alive?
- Yeah, I think you know I realised it was me just being silly.
- Right, Ok, Ok.
So that was a few years ago, if we just come back to how you are feeling at the moment,
you talked about feeling very low… Have there been times currently when you’ve thought
about either taking an overdose or doing something else to harm yourself in any way?
- You know at night when, when you’re watching the clock and you know, you’re on your own -Yeah
- and the kids are in bed. It is, just everything’s so hard, and yeah I suppose, you know,
it just feels easy you know? - Right
And has that just been something you’ve thought about or have
you actually made any plans, got any tablets in or done anything else?
- No, no, - Ok - nothing like that.
Ok, and I guess it’s a difficult question to ask but one we would ask everybody in your situation.
Have things ever been so bad you felt so low that you’ve not only thought about harming
yourself or perhaps killing yourself but you’ve also wondered whether
the best thing might be to take the children with you?
-No, I’d never do anything with my kids I love my kids. No I wouldn’t hurt them.
- Ok.
- And what about the other side of that, positive things, things to live for...
...things that you feel good about?
- Not much at the moment I suppose, kids sometimes you know. They do things that make you think,
you know, what’s good about life - Right - and things but...
- And are there other things that help at the moment,
I’m thinking about people that could be supportive?
- My sister as I say she said to get down here and she’s always there, she comes down - Yeah
- and rings. I’ve got a couple of friends they’re quite good, - Right
- but and Dave when he’s in the mood of course. But I don’t think he’s not going to be around for much longer.
- Right.
And do you think, or do you feel able to keep yourself safe at the moment from hurting yourself?
- I think so yeah, I know I can come here now; you’ve been very good today
- Ok.
Do you think if that was to change so that you didn’t feel able to keep yourself safe,
you’d be able to let anybody know?
- All I know is what happened last time that was nothing
and I was silly then so I know to come here.
- Right, Ok.
OK Alison, well thanks for going through all that, I can appreciate it must be very painful. It does
sound to me that you are suffering from symptoms that strongly suggest that you are actually depressed
at the moment. Now I’m not sure how much you know about depression?
- Not much really, not much but I know I just don’t feel right at the moment.
- Ok, ok
Well I guess just briefly depression can cause a number of problems for people and traditionally
we think about people feeling very low and very miserable and often you know thinking
about hurting themselves. But it can also affect all other areas of life in terms of
problems with eating and sleeping and the other problems you’ve noticed is that concentration
and perhaps not really managing as well as normal. I guess the positive side is that you’ve done something
about it and you’ve come to talk to me about it today and I think there are almost certainly a
range of things we can put in place to help you and treatments that are available. So I guess
what I’m thinking is it might be worth us spending a few minutes just thinking about
those options for you so that we can start to improve things for you.
Would that be alright with you?
- I need to do this, yes; I think that’s sensible yeah. - Ok
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