Juan and Bianca are a middle-aged couple of Latino descent. The couple has two children, both away at college. Juan and Bianca were referred by their priest for counseling, due to Biancas history of depression and suicidal ideation. Bianca tells you, life has always been a struggle for me. I was raised by my grandmother who tried to protect me, but I was molested many times as a little girl. Ive often wanted to end my life, but my religious beliefs dont allow me to.  Bianca does report periods of joy and happiness in her life, especially regarding her children. She admits that during the last 5 years, she has had a few periods where she has actually felt euphoric, energized and elated with life. These times are brief and infrequent and, I return to that suffocating place of despair. She describes her husband as, a good man. I dont know why he has stayed with me all these years.  Juan is very supportive of his wife, but his worry about her has resulted in exhaustion, missing work and obsessively checking that all the kitchen knives are accounted for. He tells you that, sometimes Bianca cries out in her sleep and I dont know how to help her.  I worry that she will do something to end her life during one of these night terrors. Even though shes never tried, what if it happens and Im not able to stop her.

Directions: Consider Mood, Anxiety, OCD, and Trauma Related Disorders

1.  Taking into account the genetic, neurobiological, sociocultural, familial and environmental factors of assessment and diagnosis, what are your diagnostic thoughts for Bianca? What about Juan? Use the DSM-5 criteria to formulate your diagnostic impressions for Bianca and Juan, supporting what you see in the vignette that supports your diagnostic impressions.

2.  Using the psychotherapeutic and pharmacological interventions discussed in the text, describe an initial treatment plan for Bianca and Juan. Remember to treat the persons in the vignette, and not the diagnosis. Also remember to consider culture and legal/ethical issues.

3.  Given the diagnosis you have made, describe your medication treatment strategies. Discuss not only initial choices of medications but also your next-step strategy and why youve chosen it. (In doing so, be sure to provide a rationale for your choices.) What questions should be addressed about the class of medications that is chosen (e.g., mood stabilizers)?