Case Study
Patient Demographic: Client Age: 32 Sex: Female Gender: Female Sexual Orientation: Heterosexual Ethnicity: Latina; Mexican American Relationship Status: Married Counseling Setting: Community Mental Health Type of Counseling: Individual and Psychoeducation Presenting Problem: Depression Diagnosis: Major Depressive Disorder (MDD) with Psychotic Features 296.24 (F32.3)
Mental Status Exam: Mental Status Exam: The client is well groomed and appropriately dressed. Her voice is soft and low, and she avoids eye contact, mainly when talking about her family. She states, “I’ve put them through so much. And I feel so ashamed when I’m unable to care for them.” She endorses feelings of hopelessness but denies suicidal and homicidal ideations. The client says that she hears voices and believes that they are the voices of her deceased ancestors trying to communicate with her. She explains that the “spirits” whisper her name in the middle of the night and come to her when she is alone. The client denies command hallucinations. Her appetite is poor, and she has difficulty sleeping “most nights.” She has experienced depressive symptoms most of her life, but, outside of the recent hospitalization, she has not sought treatment due to believing that mental illness is a sign of weakness. History of Conditio
Presenting Problem: You work in a community mental health setting. Your client is a 32-year-old Latina presenting with symptoms of depression and psychosis. She reports that she was hospitalized more than 6 months ago and did not attend follow-up appointments due to losing her health insurance coverage. The client currently reports anhedonia, sadness, feelings of worthlessness, and poor concentration. She explains that there are many days when she cannot get out of bed and is unable to fulfill her role as a wife and mother. The client also reports audio hallucinations and says this began when her grandmother died more than a year ago. She explains that her grandmother lived in her home and that her loss was “devastating” to the client. The client is fluent in Spanish and English.
Other Contexts:    n and Family History: You obtain a signed release of information before the client’s session today, which has enabled you to receive the client’s hospital records. The client was admitted due to hallucinations and suicidal ideation. The hospital psychiatrist provided a diagnosis of brief psychotic disorder and bipolar II disorder. The client was prescribed antipsychotic medication and an antidepressant. She reports that she discontinued the antipsychotic medication shortly after discharge because it caused excessive sleepiness. Regarding the antidepressant, the client states, “I just take it on the days when I’m really having a hard time.” The client has two teenage sons and lives near her extended family.  The client says she felt like her soul left her body upon her grandmother’s death. This experience left her with feelings of sadness, loss, worthlessness, and suicidality

Question: The client says she felt like her soul left her body upon her grandmother’s death. This experience left her with feelings of sadness, loss, worthlessness, and suicidality. This describes which of the following culturally bound conditions?
(A): Ataque de nervios
(B): Mal de ojo
(C): Susto
(D): Confianza

Correct Answer: Susto
Explanation: Susto, in particular interpersonalsusto, is characterized by feelings of abandonment, loss, sadness, suicidality, and poor self-worth. According to the DSM-5-TR, “Sustois an illness attributed to a frightening event that causes the soul to leave the body and results in unhappiness and sickness, as well as difficulties functioning in key social roles” (APA, 2022). The DSM-5-TR describes syndromic types to include interpersonalsusto, sustorelating to a traumatic event, andsustomarked by somatic symptomsAtaque de nervios(ie, “attack of nerves”) is an idiomatic expression used by Latinos to describe symptoms of intense anger, grief, worry, dissociation, or emotional distressAtaque de nervioscan escalate to the point of uncontrollable crying, seizures, shaking, and verbal or physical aggression. These attacks can occur as the result of a stressful event (eg, news of the death of a significant person, familial conflict) but can also happen in the absence of a stressful event or trigger for a minority of individualsConfianza is a Hispanic value that refers to the sense of comfort and ease when revealing oneself to another. For Hispanics, establishing trust within the confines of the therapeutic relationship can promote healing and restore ties within the context of personal relationships. Finally,mal de ojo,a Spanish term meaning “evil eye,” is associated with social conflict or jealousy and is believed to cause physical illness, misfortune, and death. Therefore, the correct answer is (C)
Competency: intake, assessment, and diagnosis