Jane Sullivan Case Study

Answer

Jane Sullivan Case Study

            Jane Sullivan is suffering from adjustment disorder. The American Psychiatric Association (APA) (2013) defines adjustment disorder as the occurrence of behavioral or emotional symptoms in response to an identifiable stressor or stressors that occurred within a period of three months from the time of the observed symptoms. Symptoms of adjustment disorder include low mood, insomnia, worry, sadness, anxiety, difficulty concentrating, angry or disruptive behavior, loss of self-esteem, hopelessness, feeling isolated, and feeling as if trapped and have no other symptoms (APA, 2013). Jane manifests with similar symptoms such as poor personal care and hygiene, wearing of crumpled and ill-fitting shirt, low self-esteem, low mood, emotional outbursts – crying, hopelessness, and history of nightmares.

Jane seems not to have fully recovered from the loss of her husband, which occurred just a month ago. She is four months pregnant and has an 18 year-old son and does not what do; especially if they are expelled from the military base, where the family currently resides. She is worried that she may have no place to go ad worries that her children may have no memory of their father after they grow up. According to The memory of loss of her father during high school senior year and her mother only two years ago is still fresh in her mind. The loss of her father and mother tend to contribute to development of this disorder. She seems to meet certain criteria for adjustment disorder such presenting with distress that is out of proportion, which is primarily linked loss of her husband and the clinically significant symptoms, such poor personal hygiene and crying. In addition, her reaction is likely part of the normal bereavement and not an intensification of an existing mental health disorder (APA, 2013).

            Jane’s biggest concern is housing and accommodation over the fears that she might be expelled from the military base. She is worried of where she will live with her son should she be expelled from her current home. She is aware that her sister is undergoing a divorce and will soon have to take care of her three children as a single mother.  Loss of a loved one may put one in a sense of insecurity (Boelen, 2016). Since Jane’s spouse died in a traumatic event, she feels helpless, bewildered, intense sorrow, and devastated now that she does not know what to do with her son and her pregnancy (Boelen, 2016). She feels stuck on where to live next and this concern needs to be addressed first. The concerned persons at the military base should be notified of Jane’s concerns to assure her of accommodation or provide her with solutions to her concerns.

            Adjustment disorder can be treated using pharmacological interventions. Choice of the medications to be used in management of adjustment disorder should be need individual patient needs with consideration of all potential risks. Benzodiazepines may be useful in quick resolution of anxiety related to adjustment disorder but may cause impair fetal brain development (Stein, 2018; Vigod & Dennis, 2019).  Etifoxine may be considered in this case for management of Jane’s condition since it is superior to benzodiazepines and buspirone in management of adjustment disorder since it has not known withdrawal symptoms (Stein, 2018).

Psychotherapy is considered as an appropriate non-pharmacological treatment for adjustment disorder. Divergent interventions such as low-intensity psychological interventions and cognitive behavioral therapy have been proposed for management of adjustment disorder. Low-intensity interventions include mindfulness, support groups, bibliotherapy, relaxation therapy, self-help therapy, meditation, behavioral activation, and e-mental health interventions (Winter et al., 2020).  Cognitive behavioral therapy and low-intensity interventions can help individuals reduce the impact of the stressor and help enhance coping abilities (Winter et al., 2020). Psychotherapeutic interventions that have been identified as useful in treatment of adjustment disorder include self-help approaches, e-mental-health interventions, relaxation techniques, and behavioral activation. Self-help therapy can held address preoccupation with the stressor and failure to adapt. Talking therapies such as cognitive behavioral therapy and psychodynamic therapy can also be used for management of adjustment disorder symptoms (Domhardt & Baumeister, 2018).

Jane is four-months pregnant and this may influence treatment decisions regarding pharmacotherapy. Benzodiazepines could have helped her relieve anxiety symptoms; however, since this class of medications is associated poor fetal brain development then they will not be used in this case (Stein, 2018; Vigod & Dennis, 2019).  On the other hand, etifoxine may cause side effects such as angioedema, slight drownsiness, skin rash, and urticaria. Besides, there is no enough information regarding safety profile of etifoxine in pregnancy or breastfeeding women. Therefore, benefits and risks of using etifoxine should weighed before Jane is administered the drug (Pham, 2020).

James warrants some intervention. At the 18 month, he is at the trust versus mistrust stage of Erik Erikson’s theory of psychosocial development. This stage is critical since it shapes an infant’s view of the world (Cherry & Gans, 2018). James appears to lack trust on others apart from his mum. He rejects the toy and remains clinked on to her mother throughout the interview session. This is an indication of a problem. He may have developed mistrust to others since her mother has been shielding him from contact with others by staying in the house (Cherry & Gans, 2018). Jane should be advised to start exposing her child to others, especially to children of the same age in the neighborhood to help him develop a sense of safety and being secure amidst others. Jane should also be educated that at son’s age, infants tend to develop a long-term bond with her; hence, she should as much try to show him love and affection (Winston & Chicot, 2016). She has to try as much as possible to hide suffering and pain of losing her husband from him.

Several government and military resources are available to Jane as a military wife. Support networks help to provide long-term support for surviving family members of who lost a service member. Survivor Outreach Services can provide Jane and her family with comprehensive services, such as assistance with education, housing, and finances. Long Term Assistance Program is a Marine Corps’ resource that can help family members through the process of grief, may provide peer support as well provision of benefits and entitlements. Navy Gold Star Program is another resource from the Navy that can provide appropriate support to family members to a deceased family member.  Another resource that may be available for Jane is Air Force Families Forever, which is dedicated to families and friends of a deceased service member (Military on Source, 2020).

Community resources are also available for Jane and her family. St. Elizabeth Healthcare Grief Support Services is one of such resources. It has specific programs appropriate for Jane and James. It can help Jane and James to overcome the grief (St. Elizabeth, 2020). In addition, Widows and Widowers Group of the Cathedral of Christ the King (2020) can connect Jane with other bereaved widows and widowers. This Group can provide Jane with a source of fellowship, strength, and support (Cathedral of Christ the King, 2020). Lastly, but not the least, Louisville Widows and Widowers Meetup may connect Jane with other widows and widowers who are also grieving (Meetup, 2020).