Читать книгу Dynamic Consultations with Psychiatrists - Jason Maratos - Страница 64

Margaret presented with low mood with suicidal ideas. She was new to the mental health service. She delivered a baby girl on November 19, 2017, via vaginal delivery with no complications. She had multiple stressors from before her daughter's birth. These included her husband indulged in gambling and, recently, even online gambling; he would disappear for a few days a month in the past 3 years. The debt had increased to the point that the debt was paid using credit cards, and the debt now totals about US$30,000. The second source of stress was her son's problematic behavior since she became pregnant. The third source of stress is the crowded living environment. She had decided to live in the city because this would enable her son to attend kindergarten year 1 from January 2018. Margaret has limited support from her family of origin.

Margaret developed low mood, with a sense of worthlessness and helplessness. She would look at her children and become worried about their future; she felt that they were poor. Since giving birth, her mood further deteriorated, with her experiencing reduced energy and poor concentration at work. Her sleep was also disturbed by childcare. Margaret experienced appetite loss and lost 1–2 kg. She does not enjoy activities, feels the lack of money, and has no time for any entertainment; they do not even have a television set at home. Previously, she had fleeting suicidal ideas of jumping from heights, but these became less frequent since she moved to the city. In the city, her husband tended to stay at home most of the time. Margaret denied having a concrete suicide plan, had not acted on any suicidal impulses, was remorseful, and still cared about and worried for her children. Margaret denied alcohol or substance use and denied the existence of any psychotic symptoms. Occasionally, she would hit her son with bare hands or with a hanger; however, she would feel remorse afterward. There were no previous hypo‐manic or manic episodes.