Page 1 of 39
NR602 WEEK 6 I-HUMAN CASE: ALICE CHANEY
COMPREHENSIVE CASE STUDY: ADOLESCENT
DEPRESSION PRESENTING AS FATIGUE.
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NR602 WEEK 6 i-HUMAN CASE: ALICE CHANEY
Comprehensive Case Study: Adolescent Depression Presenting as
Fatigue
Patient: Alice Chaney
Age: 17 years old
Gender: Female
Height: 5'4" (163 cm)
Weight: 168 lbs (76.4 kg)
BMI: 29.0 (Overweight)
Reason for Encounter: Fatigue
Diagnosis: Major Depressive Disorder (MDD), Single Episode, Moderate, with
Anxious Distress
Setting: Outpatient clinic
Course: NR602 – Week 6
Case Summary
Alice Chaney is a 17-year-old female who presents with a chief complaint
of fatigue lasting approximately 2–3 months. On further questioning, she
reveals a constellation of symptoms consistent with Major Depressive
Disorder (MDD), Moderate, with Anxious Distress, including persistent sad
mood, anhedonia, sleep disturbances, appetite changes with weight gain,
difficulty concentrating, social withdrawal, low self-esteem, passive suicidal
ideation, and anxiety symptoms (feeling tense, restless, difficulty
concentrating due to worry, fear that something bad will happen). Her fatigue
is a manifestation of her underlying depression, compounded by anxious
distress. This case requires careful assessment for safety, mental health
referral, and evidence-based management of adolescent depression with
anxious distress.
SUBJECTIVE – History of Present Illness (HPI)
Chief Complaint (Patient's Own Words)
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"I'm just so tired all the time. I can't seem to get out of bed in the morning, and
I have no energy for anything. I also feel really on edge and worried all the
time."
History of Presenting Illness (HPI)
Alice Chaney is a 17-year-old female who presents with a 2–3 month history
of persistent fatigue. She reports that she has been
feeling "exhausted" despite getting adequate sleep (8–10 hours/night). The
fatigue is worse in the morning and improves slightly as the day progresses,
but she still feels "drained" by early afternoon.
Fatigue characteristics:
Onset: Gradual, worsening over 2–3 months
Duration: Daily, persistent
Worse time: Morning (difficulty waking up; feels "heavy")
Better time: Slight improvement in evening
Impact: Difficulty concentrating in school; falling asleep in class; unable to
participate in extracurricular activities
Depressive symptoms (on further questioning):
Mood: Reports feeling "sad," "empty," "worthless," and "hopeless" almost
every day
Anhedonia: Loss of interest in activities she used to enjoy (playing soccer,
hanging out with friends, painting)
Sleep: Insomnia (difficulty falling asleep) and hypersomnia (sleeping 10+
hours but still tired); early morning awakening (waking at 4–5 AM unable to
fall back asleep)
Appetite: Reports increased appetite and carbohydrate cravings; has
gained weight
Energy: Markedly decreased; feels "exhausted" doing minimal tasks
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Concentration: Difficulty focusing in school; grades have dropped from A/Bs
to C/Ds
Psychomotor: Reports feeling "slowed down" (psychomotor retardation)
Guilt/Worthlessness: Reports feeling like she is "letting everyone down";
feels guilty for not being able to do things
Social withdrawal: Has stopped seeing friends; avoids family gatherings
Irritability: Reports being "snappy" with parents and siblings
Anxiety symptoms (anxious distress specifier):
Feeling tense: Reports feeling "on edge" most of the time
Restlessness: Difficulty sitting still; fidgets frequently
Difficulty concentrating due to worry: Cannot focus because she is "too
worried" about school and social situations
Fear that something bad will happen: Reports constant worry that
"something terrible is going to happen" or that she is "going to fail at
everything"
Feeling like something bad might happen: Sense of impending doom
Suicidal ideation (CRITICAL SAFETY ASSESSMENT):
Passive suicidal ideation: Reports thoughts that "life is not worth living" and
"I wish I could just disappear"
No active plan: Denies having a specific plan, means, or intent to harm
herself
No past suicide attempts: Denies any prior self-harm or suicide attempts
No current self-harm: Denies cutting or other self-injurious behaviors
Protective factors: Reports close relationship with her older sister; wants to
"get better" but doesn't know how
Precipitating factors:
School stress: Final exams approaching; pressure to maintain grades
NR602 WEEK 6 I-HUMAN CASE: ALICE CHANEY
COMPREHENSIVE CASE STUDY: ADOLESCENT
DEPRESSION PRESENTING AS FATIGUE.
, Page 2 of 39
NR602 WEEK 6 i-HUMAN CASE: ALICE CHANEY
Comprehensive Case Study: Adolescent Depression Presenting as
Fatigue
Patient: Alice Chaney
Age: 17 years old
Gender: Female
Height: 5'4" (163 cm)
Weight: 168 lbs (76.4 kg)
BMI: 29.0 (Overweight)
Reason for Encounter: Fatigue
Diagnosis: Major Depressive Disorder (MDD), Single Episode, Moderate, with
Anxious Distress
Setting: Outpatient clinic
Course: NR602 – Week 6
Case Summary
Alice Chaney is a 17-year-old female who presents with a chief complaint
of fatigue lasting approximately 2–3 months. On further questioning, she
reveals a constellation of symptoms consistent with Major Depressive
Disorder (MDD), Moderate, with Anxious Distress, including persistent sad
mood, anhedonia, sleep disturbances, appetite changes with weight gain,
difficulty concentrating, social withdrawal, low self-esteem, passive suicidal
ideation, and anxiety symptoms (feeling tense, restless, difficulty
concentrating due to worry, fear that something bad will happen). Her fatigue
is a manifestation of her underlying depression, compounded by anxious
distress. This case requires careful assessment for safety, mental health
referral, and evidence-based management of adolescent depression with
anxious distress.
SUBJECTIVE – History of Present Illness (HPI)
Chief Complaint (Patient's Own Words)
, Page 3 of 39
"I'm just so tired all the time. I can't seem to get out of bed in the morning, and
I have no energy for anything. I also feel really on edge and worried all the
time."
History of Presenting Illness (HPI)
Alice Chaney is a 17-year-old female who presents with a 2–3 month history
of persistent fatigue. She reports that she has been
feeling "exhausted" despite getting adequate sleep (8–10 hours/night). The
fatigue is worse in the morning and improves slightly as the day progresses,
but she still feels "drained" by early afternoon.
Fatigue characteristics:
Onset: Gradual, worsening over 2–3 months
Duration: Daily, persistent
Worse time: Morning (difficulty waking up; feels "heavy")
Better time: Slight improvement in evening
Impact: Difficulty concentrating in school; falling asleep in class; unable to
participate in extracurricular activities
Depressive symptoms (on further questioning):
Mood: Reports feeling "sad," "empty," "worthless," and "hopeless" almost
every day
Anhedonia: Loss of interest in activities she used to enjoy (playing soccer,
hanging out with friends, painting)
Sleep: Insomnia (difficulty falling asleep) and hypersomnia (sleeping 10+
hours but still tired); early morning awakening (waking at 4–5 AM unable to
fall back asleep)
Appetite: Reports increased appetite and carbohydrate cravings; has
gained weight
Energy: Markedly decreased; feels "exhausted" doing minimal tasks
, Page 4 of 39
Concentration: Difficulty focusing in school; grades have dropped from A/Bs
to C/Ds
Psychomotor: Reports feeling "slowed down" (psychomotor retardation)
Guilt/Worthlessness: Reports feeling like she is "letting everyone down";
feels guilty for not being able to do things
Social withdrawal: Has stopped seeing friends; avoids family gatherings
Irritability: Reports being "snappy" with parents and siblings
Anxiety symptoms (anxious distress specifier):
Feeling tense: Reports feeling "on edge" most of the time
Restlessness: Difficulty sitting still; fidgets frequently
Difficulty concentrating due to worry: Cannot focus because she is "too
worried" about school and social situations
Fear that something bad will happen: Reports constant worry that
"something terrible is going to happen" or that she is "going to fail at
everything"
Feeling like something bad might happen: Sense of impending doom
Suicidal ideation (CRITICAL SAFETY ASSESSMENT):
Passive suicidal ideation: Reports thoughts that "life is not worth living" and
"I wish I could just disappear"
No active plan: Denies having a specific plan, means, or intent to harm
herself
No past suicide attempts: Denies any prior self-harm or suicide attempts
No current self-harm: Denies cutting or other self-injurious behaviors
Protective factors: Reports close relationship with her older sister; wants to
"get better" but doesn't know how
Precipitating factors:
School stress: Final exams approaching; pressure to maintain grades
