To complete each assignment, you will need to read the case study. Assume that t

Question

To complete each assignment, you will need to read the case study. Assume that the client described in each case study meets criteria for a DSM-5 disorder. You will then consult the DSM-5 criteria and write 1-2 detailed paragraphs in which you assign a primary diagnosis for the client and justify that diagnosis. In this section you should reference EACH of the DSM-5 criteria for the diagnosis you are assigning and provide evidence from the case study for or against the presence of that criterion. If you have no information for a particular criterion you should specify this. For example, if the DSM-5 criteria specify that the symptoms cannot be accounted for by a medical condition and you have no evidence that the client has a medical condition that would explain their symptoms, you should state this. Next, write a paragraph in which you provide an example of at least one related diagnosis that you are ruling out based on the information you have. This is a process called “differential diagnosis.” As you know, the categories provided in the DSM-5 do not represent “true” categories in nature, and often clients will often have symptoms in multiple categories. As a clinician, you need to rule out other categories or explanations for the symptoms. For example, if someone is experiencing panic attacks in the wake of a traumatic event, you might consider the diagnoses of Posttraumatic Stress Disorder, Acute Stress Disorder, or Panic Disorder. The DSM-5 criteria will help you figure out which is the most appropriate diagnosis, and you should specify why you are ruling out another disorder, providing specific justification for ruling it out. The best disorders to rule out are those that share features or symptoms described in the case but are not the best diagnosis for the client. Finally, you will write one paragraph in which you may specify the use of a psychosocial treatment, a psychoactive medication, or both. You must briefly describe how this treatment works and you must justify your choice of treatment based on the research evidence for the efficacy of the treatment.

Case Study #2

Conrad is a 31-year old, married, European American former pharmaceutical sales manager who was admitted to a psychiatric inpatient unit after presenting at the emergency room reporting active suicidal ideation. He stated that he was concerned he might act on suicidal plans that had been plaguing his thoughts for several weeks. He reported that after losing his job two months ago he has been feeling hopeless and empty, and that he no longer experiences any pleasure in life. He stated that this is a major change from his “usual self.” In addition to his mood problems, he reports that he has been experiencing intense guilt about actions that caused him to get fired. Prior to his firing he had “borrowed” a significant sum of money from one of his company’s expense accounts and gambled with it, intending to replace the money with his winnings. He was caught when he lost all of the money, and, unable to replace it, was discovered by his company’s accountant. In addition to being fired, this incident, and other impulsive behavior, had done damage done to his marriage (he and his husband are now separated and his husband is considering filing for divorce). Upon presenting to the E.R. he appeared unkempt, and admitted that he had not bathed or changed his clothes for several days, and had mainly been staying in his bed. He has lost 15 pounds in the past month. Prior to losing his job, Conrad says that he was “on top of the world.” He said that in the weeks leading up to being caught taking the expense account money he had been very happy, and incredibly productive. He said that he had been breaking all previous sales records at work, and felt that he was poised to “take over the company” because at the time he felt that he was “far and away the best manager in the country.” Now he feels worthless and ashamed. Conrad denied substance use, any medical conditions, or any previous psychiatric diagnosis. He has not previously been prescribed any psychoactive medications.

Explanation / Answer

Diagnosis : Bipolar disodiso II current episode depressed

A. Criteria have been met for at least one hypomanic episode (Criteria A–F under “Hypomanic Episode” above) and at least one major depressive episode (Criteria A–C under “Major Depressive Episode” above).

More than 5 criteria for a major depressive episode

1. Depressed mood most of the day, nearly every day, for past two months as indicated by subjective report

2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day for past two months

3 . Significant weight loss. 15 pounds lost in the last month.

4. Fatigue or loss of energy nearly every day. Has been staying in the bed for most of the day.

5. Feelings of worthlessness or excessive or inappropriate guilt. After loosing job he has been feeling hopeless and empty and has been experiencing intense guilt.

6. Suicidal ideation present.

B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.  

C. The episode is not attributable to the physiological effects of a substance or another medical condition.

Hence criteria for the current major episode is met.

Before loosing job he has been experiencing a hypomanic episode as met by following conditions

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day. In the weeks leading up to being caught taking the expense account money he had been very happy, and productive.

B. During the period of mood disturbance and increased energy and activity, three (or more)

of the following symptoms have persisted (four if the mood is only irritable), represent a noticeable change from usual behavior, and have been present to a significant degree:

1. Inflated self-esteem or grandiosity. He felt that he was “far and away the best manager in the country.”

2. Increase in goal-directed activity. He had been breaking all previous sales records at work, and felt that he was poised to “take over the company”

3. Involvement in activities that have a high potential for painful consequences (foolish business investments). Prior to his firing he had “borrowed” a significant sum of money from one of his company’s expense accounts and gambled with it, intending to replace the money with his winnings.

C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic. His happiness and productivity before weeks leading to caught in gambling could be change in functioning rather than his sustained performance as indicated in case history.

D. The disturbance in mood and the change in functioning are observable by others. Not ruled out but from his reporting it might have happened. Neither it is confirmed .

E. The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization.

F. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication or other treatment). As reported in case history.

B. There has never been a manic episode. no sufficient symptoms to consider a manic episode other than grandiosity expressed in the statement “far and away the best manager in the country.” But he said that he was feeling “on top of the world.” suggesting euphoric or elated mood. But he was functioning well.

C. The occurrence of the hypomanic episode(s) and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder. Conrad denied substance use, any medical conditions, or any previous psychiatric diagnosis. He has not previously been prescribed any psychoactive medications.

D. The symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and hypomania causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Occupational dysfunctioning resulted.

Differential diagnosis

Bipolar I Disorder

Ruling out of manic episode already mentioned in the paragraph citing primary diagnosis (mentioned under B.)

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