Family Assessment – Comprehensive Psychiatric Evaluation

 

SUBJECTIVE:

CC (chief complaint): “My daughter and I are experiencing significant conflicts due to our stark cultural differences. While she strives to assimilate into American society and adopt its norms, I strongly desire her to uphold and respect the cultural traditions of our Iranian heritage. We disagree over matters such as her choice of clothing, her decision to live independently without being married, and the amount of time she dedicates to our family. It has become crucial for us to seek assistance in effectively navigating and resolving this complex predicament” (“Mother and Daughter: A Cultural Tale”, n.d.).

HPI: M.K. is a 23-year-old Iranian female who presents for psychotherapeutic evaluation with her mother, S.K., to address significant conflicts arising from their divergent cultural perspectives. M.K. does not currently take any medications and is here voluntarily. The evaluation aims to explore and address the challenges they face in reconciling their desires and cultural expectations. M.K. desires to conform to American societal norms, seeking acceptance and fitting in with her friends. However, S.K., the mother, emphasizes the importance of adhering to the cultural norms of their Iranian heritage. The conflicts primarily revolve around M.K.’s dress style, her decision to live independently while unmarried, and her time devoted to the family. The referral reason is to seek professional guidance and assistance in navigating this intricate cultural predicament, finding a harmonious balance between the desire for personal freedom and the preservation of cultural traditions.

Need help with your assignment ? Reach out to us. We offer excellent services.

Past Psychiatric History:

 	
General Statement: M.K. and S.K. have not sought previous psychiatric treatment together. However, the conflicts arising from their cultural differences have significantly impacted their relationship and necessitated the current evaluation.
 	
Caregivers (if applicable): Not Applicable
 	
Hospitalizations: Neither M.K. nor S.K. has a history of psychiatric hospitalizations
 	
Medication trials: M.K. has not undergone any previous psychotropic medication trials.
 	
Psychotherapy or Previous Psychiatric Diagnosis: K. has not engaged in psychotherapy before this evaluation. There are no documented previous psychiatric diagnoses for either M.K. or S.K. related to the conflicts arising from their cultural differences.

Substance Current Use and History: M.K. denies current use or history of substance abuse. She reports no use of caffeine, nicotine, illicit substances (including marijuana), or alcohol. There are no documented withdrawal complications related to substance use, such as seizures, Delirium Tremens, or tremors. M.K. affirms her commitment to maintaining a substance-free lifestyle.

Family Psychiatric/Substance Use History: M.K. reports a family history of psychiatric illnesses, substance use disorders, and family suicides. M.K.’s mother has a history of depression and anxiety disorder. She has received treatment but has not disclosed specific details regarding her substance use history.

Psychosocial History: M.K. was born in Iran and was raised by her mother, S.K., and her father. She has one younger brother. M.K. currently lives independently in her apartment and is not married. She does not have any children. M.K. completed her education up to the bachelor’s level, graduating with a degree in business administration. She is pursuing a marketing career and works as a marketing associate at a local company. M.K. enjoys reading, painting, and playing the piano in her free time. These hobbies provide her with a creative outlet and a sense of relaxation. M.K. is currently employed and actively working in her chosen profession. She does not have any disabilities or significant gaps in her employment history. She is not retired or unemployed. There is no mention of any legal history or current legal issues for M.K. There is no specific information about M.K.’s concerns or issues related to safety, violence, or sexual history.

Medical History:

 	
Current Medications: K. does not currently take any medications. No specific details regarding over-the-counter or homeopathic products are provided.
 	
Allergies: K. reports no known medication, food, or environmental allergies.


 	
Reproductive Hx: The date of M.K.’s last menstrual period (LMP) is not provided. M.K. reports that she is not currently pregnant. M.K. reports that she is not currently nursing or lactating. There is no mention of M.K. using any specific contraceptive method. The specific types of intercourse are not disclosed. No specific sexual concerns are mentioned in the given information.

ROS:

 	
GENERAL: M.K. denies fatigue, weight loss, or fever. She reports her overall general health as good.
 	
HEENT: No complaints of headaches, visual changes, hearing problems, or throat pain.
 	
SKIN: M.K. denies rashes, itching, or lesions. She describes her skin as generally healthy.
 	
CARDIOVASCULAR: She denies chest pain, palpitations, or shortness of breath.
 	
RESPIRATORY: M.K. denies cough, wheezing, or difficulty breathing. She denies any history of respiratory conditions.
 	
GASTROINTESTINAL: No complaints of abdominal pain, nausea, vomiting, or changes in bowel habits.
 	
GENITOURINARY: There are no reports of urinary frequency, urgency, pain, or changes in menstruation.
 	
NEUROLOGICAL: M.K. denies headaches, seizures, dizziness, numbness, or tingling.
 	
MUSCULOSKELETAL: She denies joint pain, stiffness, or limitations in range of motion.
 	
HEMATOLOGIC: No complaints of excessive bruising, bleeding, or history of blood disorders.
 	
LYMPHATICS: No complaints of swollen lymph nodes or recurrent infections.
 	
ENDOCRINOLOGIC: She denies any significant changes in weight, temperature intolerance, or known endocrine disorders.

OBJECTIVE:

Physical exam (if applicable): Based on the provided information, a detailed physical exam is unavailable for M.K. The case study does not provide specific details regarding the need for or the results of a physical examination. Therefore, it is assumed that a physical examination has not been conducted or documented for M.K. at this stage.

Diagnostic results: No specific diagnostic results are provided in the case study for M.K. The information does not include any laboratory tests, imaging studies, or other diagnostic procedures that have been performed or are pending.

ASSESSMENT:

Mental Status Examination: M.K., a 23-year-old Iranian immigrant female, is cooperative and appropriately groomed. Her speech is clear and coherent, and her thought processes appear goal-directed and logical. Mood variability reflects conflicts related to cultural differences with her mother. Her affect is congruent with her mood, showing appropriate emotional expression. M.K. denies auditory or visual hallucinations and delusional thinking. There is no evidence of perceptual disturbances or immediate suicidal or homicidal ideation. Cognitively, she is alert and oriented and displays intact memory and concentration. Insight into her conflicts is evident, and she seeks assistance navigating these challenges. Overall, M.K. presents with emotional conflicts related to cultural differences but demonstrates intact cognition, insight, and absence of acute risk.
Differential Diagnoses:

 	
F43.21 Adjustment Disorder with Depressed Mood

The conflicts and difficulties experienced by M.K. concerning her cultural differences may contribute to an adjustment disorder. Pertinent positives include the onset of emotional symptoms in response to identifiable stressors, such as conflicts with her mother (Ebrahimi & Vahidi, 2020). The duration and impairment caused by these symptoms will determine if this diagnosis is more appropriate than Major Depressive Disorder (MDD).

 	
F32.0 Major Depressive Disorder (MDD)

This is supported by the patient’s variable mood, feelings of sadness, and frustration. Pertinent positives include changes in appetite, sleep disturbances, and difficulty concentrating, commonly associated with MDD (Clark et al., 2019).

 	
Z59.4 Cultural Identity Conflict

This differential considers the possibility of a conflict between M.K.’s cultural identity and her desire for assimilation into American society. Pertinent positives include the conflicts arising from dress style, living arrangements, and the time devoted to family (Hwang et al., 2023).

Primary Diagnosis Selection: F43.21 Adjustment Disorder with Depressed Mood

Given the temporal relationship between the conflicts and the onset of emotional symptoms, Adjustment Disorder with Depressed Mood (F43.21) is the primary diagnosis. While MDD (F32.0) is also possible, the presence of identifiable stressors and the subjective distress experienced by M.K. support an adjustment disorder diagnosis.

Case Formulation and Treatment Plan:

Based on the assessment, the primary diagnosis for M.K. is Adjustment Disorder with Depressed Mood (F43.21). The treatment plan will involve the following:

 	
Psychotherapy

The therapy will focus on exploring and addressing M.K.’s cultural identity conflicts, improving communication and understanding between M.K. and her mother, and developing coping strategies for managing stressors related to her cultural expectations and American assimilation (Zakhari, 2020).

 	
Patient Education

M.K. will be given resources and educated about cultural adaptation, managing cultural conflicts, and building resilience (Sadock et al., 2015).

 	
Referrals

Another plan is to refer M.K. to a cultural competency counselor or therapist who works with individuals from diverse backgrounds. Notably, collaborating with the therapist ensures a comprehensive and culturally sensitive approach to treatment (Zakhari, 2020).

 	
Follow-up

The plan will also include scheduling regular follow-up appointments every four weeks to assess M.K.’s progress, review treatment goals, and make necessary adjustments to the treatment plan (Sadock et al., 2015).

 	
Emergency Management

An additional plan is to provide M.K. with emergency contact numbers, including local emergency services and crisis hotlines, and educate her on when to seek immediate help if experiencing active suicidal or homicidal thoughts (Zakhari, 2020).

REFLECTIONS:

This case has reinforced the significance of cultural sensitivity in understanding and addressing mental health issues. I agree with the assessment of Adjustment Disorder with Depressed Mood for M.K. and recognize the impact of cultural conflicts on her well-being. I have learned the importance of tailoring treatment approaches to diverse backgrounds and involving family members in the therapeutic process. Considering legal/ethical aspects, social determinants of health, and individual factors is vital for holistic care. In the future, I would actively engage M.K.’s mother and collaborate with cultural competency experts. This case highlights the need for cultural competence, individualized care, and interdisciplinary collaboration in diverse populations.
References
Clark, D. A., Beck, A. T., & Alford, B. A. (2019). Scientific foundations of cognitive theory and therapy of depression. Hoboken, NJ: John Wiley & Sons.

Ebrahimi, N., & Vahidi, M. (2020). Adjustment disorder in Iranian adolescents: Prevalence, comorbidity, and predictors. Journal of Child & Adolescent Mental Health, 32(2), 155-166. https://doi.org/10.2989/17280583.2020.1744642