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Mental Health Care Web Case

Prepared by Rhonda Dawson, University of Southern Queensland

Daphne
Daphne is a 70 year old Caucasian female who first began experiencing symptoms of depression
at the age of 30 years, after the birth of her second child. She has a strong family history of
mental illness on her maternal side of the family, with her mother, and an aunt, being diagnosed
and treated for depression, and another aunt who had been diagnosed and being treated for
bipolar – all of who are now deceased.
Daphne has a history of smoking 40 x 12mg cigarettes per day, drinks alcohol on a social basis,
is mildly obese, suffers from hypertension and is prescribed the antihypertensive medication
Coversyl, as well as the antidepressant – Sertraline, for her depression.
She has required numerous admissions to hospital for her depression, and has received ongoing
treatment with antidepressant medications. Daphne’s husband, who had been very supportive to
her during her periods of acute mental illness, has passed away nearly three months ago. They
had moved to a small seaside town only two months before, to enjoy their retirement years,
fishing and painting, along with a warmer climate to assist Daphne with her arthritis, as well as
for a quieter lifestyle. Leaving family and friends from their city life, her two daughters were
concerned at the move, citing she would be further away from specialist medical care for her
depression, and family for support, and that the grandchildren would have less access to seeing
their grandparents.
The move proved to be stressful for Daphne and her depressive symptoms escalated, which
impacted upon her ability to increase her social connectedness within the local community.
Perpetuated by the death of her husband, Daphne’s mental state declined further, and a
subsequent presentation to the local hospital was the result of an overdose of her prescribed
antidepressant medications, added with alcohol misuse.
A neighbour had seen her lying in the back yard, and unable to rouse her, had called the
ambulance.
Following emergency intervention, Daphne was transported for ongoing care and further
evaluation and assessment at a regional hospital. The psychiatric assessment team were
contacted to review her in the emergency department, after she was medically cleared, where
Daphne voiced – “I don’t want to go on – just let me die, I have nothing to live for now that my
husband has died”.
A suicide risk assessment was undertaken, and Daphne was placed under the mental health act
for admission to the psychiatric unit. Gathering collateral information from Daphne, it was

identified that she had been feeling low in her mood since the move to the coast, and this was
despite the fact that she and her husband thought it would be a positive move.
Apart from feelings of hopelessness after the death of her husband, Daphne also stated that she
failed to find enjoyment in her painting; did not feel hungry; had trouble falling asleep and then
waking at about 4am each morning and could not get back to sleep, which resulted in her feeling
very tired; she preferred to stay at home lying on her bed most of the day. Her mood was low,
sad and teary and she had been experiencing fatigue, with little motivation to undertake normal
activities of daily living. Her concentration level was also impaired which made it difficult for
her to make decisions about her own mental and physical health. She also described ongoing
suicidal thoughts as she felt that she no longer had anything to live for after the death of her
husband.
During Daphne’s admission, despite an increase in her medications, her depressive symptoms
persisted and she was identified as a high risk of suicide.
Daphne’s treating team have given her a diagnosis of Major Depressive Disorder.
Discussion questions
From the case study, please answer the following questions:

1. As the admitting clinician, how would you assess Daphne’s risk of suicide based on her
comments – “I don’t want to go on – just let me die - I have nothing to live for now that
my husband has died,” and from the data presented in the case study notes. What level
of risk would you place Daphne at?

2. The DSM IV - Diagnostic and Statistical Manual Mental Health Disorders, fourth
edition, Axis 1 diagnosis given by the treating team for Daphne is Major Depressive
Disorder. Identify how you believe this criteria has been met.

3. Despite the use of antidepressant medications, Daphne’s depression is not improving.
Her treating team have decided that electroconvulsive therapy is required as a
biological treatment. Daphne has voiced that she has heard that electroconvulsive
therapy causes memory loss.
As her clinician, how would you respond to Daphne’s concerns?
4. Approaches to maintaining or supporting physical health for a person with depression
may include strategies to assist with symptoms of disturbed sleep pattern. Discuss how
you, as a clinician may be able to assist Daphne with this area of physical need.

5. Psychological therapies can be utilized as an adjunct therapy, along with the use of
antidepressants, in the treatment for depression. Identify and discuss two psychological
therapies which may be beneficial to engage with Daphne in with her clinician for the
treatment of her depression.

6. The Recovery Model / approach to care for Daphne has been discussed by her treating
team in view of her being discharged into the community following success with her
current treatment regime. Outline the principles of the Recovery Model, and how you
can, as the health professional in Daphne’s care, undertake this role to implement this
model.

Source: http://www.johnwiley.com.au/highered/hungerford1e/content/webcases/Daphne%20by%20R.%20Dawson.pdf