Instructions Read through the case below and diagnose the client Explain your rationale and choose 1 cultural factor that may influence the case diagnosis Case 1 Lupita Lupita is a 28 year old female who moved to the US from the Philippines when she was 5 years old She has a very demanding high stress job as a second year medical resident in a large hospital Lupita has always been a high achiever She is the first in her family to attend college and graduated with top honors in both college and medical school She has very high standards for herself and can be very self critical when she fails to meet them Lately she has struggled with significant feelings of worthlessness and shame due to her inability to perform as well as she always has in the past For the past few weeks Lupita has felt unusually fatigued and found it increasingly difficult to concentrate at work Her coworkers have noticed that she is often irritable and withdrawn which is quite different from her typically upbeat and friendly disposition She has called in sick on several occasions which is completely unlike her On those days she stays in bed all day watching TV or sleeping At home Lupita s partner Mary has noticed changes as well She s shown little interest in intimacy and has had difficulties falling asleep at night Her insomnia has been keeping them both awake as she tosses and turns for an hour or two after they go to bed Mary recently overheard her having frequent tearful phone conversations with her closest friend which made Mary very worried especially since she cannot understand Tagalog When Mary tries to get her to open up about what s bothering her she pushes her away with an abrupt everything s fine Although she hasn t ever considered suicide Lupita has found herself increasingly dissatisfied with her life She s been having frequent thoughts of wishing she was dead She gets frustrated with herself because she feels like she has every reason to be happy yet can t seem to shake the sense of doom and gloom that has been clouding each day as of late 1 What disorders are you considering for Lupita MDD Anhedonia Disruptive Mood Dysregulation Disorder Persistent Depressive Disorder 2 Which disorder is the most fitting diagnosis for Lupita MDD She has lost pleasure and interest in her everyday life and other people are noticing those changes in her as well She gets irritated and moody at times She has insomnia and loss of energy She is disappointed in herself and feels worthless She also has death thoughts without plans of commiting suicide She can not stop thinking about death 3 What is one cultural factor that may be influencing Lupita s presentation diagnosis Insomnia and loss of energy are samples of the cultural factors in Lupita s diagnosis She is having difficulty falling asleep and keeps on tossing and turning for the first hour of the bed time She is also keeping the partner awake This causes lack of energy the next day on top of the lack of desire to do her normal daily activities throughout the day