Reference no: EM133581893

Case Study: JI, age 23, is a third generation farmer working the family farm her whole life, but full-time since high school graduation 4 years ago.

Her parents are still working. She employs about 30 migrant workers in the growing/harvesting season and has 2 full-time, year-round employees. JI grows cotton, corn and sweet potatoes on about 200. She has 1200 chickens contracted through a large chicken producing company housed on acreage within 2 miles of her primary residence. She has recently added a small herd of 75 beef cattle housed in a large barn and fenced property 5 miles from her primary residence. She operates all equipment (tractors, harvesters, etc.) and uses computer technology to manage the chicken houses, finances and procedures such as fertilizing, pesticides and feed orders.

Today is October 20 and it is JI's second visit to see you, her Midwife. She states that she feels much more comfortable with you and wants to talk about depression. Some days it is "all I can do to get out of bed." She admits to consuming 2-3 beers most nights, "to help me sleep." Her fiancé, JE, is concerned because she has stopped going out with him and their close friends to social activities. This change has happened over the past 6 months, and she says that she just "does not find it so fun anymore. It is such an effort to go out." She completes the Beck Depression Scale (BDS) and scores 8.

Questions:

1. What questions do you need to ask JI as part of the history of presenting illness?
2. Based on what you know from her previous visit and her complaint today, what physical examination components does JI need today?
3. What differential diagnoses should you consider? What is your final diagnosis based on the Beck Depression Scale (BDS)?