Substanc Patient's Psychotic Model

A 49 year-old divorced Iranian woman presented to an outpatient Manly Hospital in Sydney after a 3-year history of prolonged hospitalizations due to recurrent major depressive disorder with diagnosed psychotic features and chronic impulsive suicidality. Except for brief periods of partial recovery lasting less then 2 weeks, the patient reported several years of chronic sadness, anhedonia, tearfulness, psychomotor retardation, suicidality, guilty ruminations, decreased sleep and appetite, interest, energy, and concentration. She also suffered from restlessness, “nervousness,” trembling, increased startle, anguish, and severe headaches. Patient’s “psychotic” diagnosis was due to the following during her affective decompensations: hearing her name called when alone, glimpsing a darting shadow, and “feeling” someone behind her. Despite past traumas (physical abuse, husband’s murder) she denied many of the symptoms of posttraumatic stress dis- order. There was no history of …show more content…
Her father developed substance abuse while working as a seasonal agricultural migrant in Iran from Afghanistan. He was verbally abusive and physically threatening to the patient’s mother when intoxicated. The patient denied witnessing overt physical or sexual abuse or being the object of childhood trauma, but did complain of her mother’s cold distance. Patient married at 16 and had 6 children, one of whom died of pneumonia at 3 months of age. Husband also developed alcohol problems and became physically and emotionally abusive towards her. After an escalation of his abuse, patient ended the marriage by migrating to the Iran at age 31 with the man who became her second husband. She left four of her children behind with relatives, a decision that resulted in her parents’ rejection. Five years later she returned to Iran after the murder of her second husband in a street fight. The son who had migrated with her to NSW entered a