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 #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

Case 2:

The current case shows the symptoms for the diagnosis of Bipolar I mood disorder as he meets the DSM V criteria for the same. The major diagnostic criteria of the presence of a persistent and high level of hypomanic tendencies is relevant in his case as he showed hypomanic symptoms such as heightened productivity at work and high level of energy along with ideas of grandiosity about his professional ability and career. Moroever, his behaviour of gambling his previous employee’s funds indicate such the hypomanic symptom of greater risk taking and lack of impulse control. Furthermore, his feelings of worthlessness, low self esteem, guilt over ‘being caught’, interpersonal discord in his marriage, inability to engage in grooming and self care, tremendous loss of weight without any underlying medical reasons along with persistent suicidal tendencies meet the criteria for a major depressive phase lasting more than a week. He reported that he has been feeling depressed since the last two months before coming to the emergency room.

Differential diagnosis is made for rapid cycling as in rapid cycling, a person experiences four or more episodes of mania or depression in one year. However, based on the report given by the patient, he did not experience a rapid change in mania and depression in the last one year and his symptoms give evidence of only one episode of hypomanic phase and one of major depressive phase.

Effective treatment plan for the patient would involve psychotropic drugs such a small Selective Serotonin Reuptake Inhibitor (SSRI) to control his suicidal and impulse behaviours and keep him relaxed. he would be gradually introduced to psychotherapy based on the cognitive behaviour therapy. While medication plays an important role in recovery, adding cognitive behavioral therapy (CBT) to the treatment plan is argued to help stabilize the patient’s mood and help him avoid negative thoughts and beliefs associated with his depression and hypomania. Instead of feeling constantly worthless, guilty ( negative cognitive biases in depression) and unrealistically optimistic and superior ( associated with biased thinking in hypomnaia), CBT techniques would help the patient confront his own maladaptive thoughts, change them and bring a positive change in his behaviour toward such others in his personal and professional life. CBT would teach him to respond to situations with calmer thoughts, which would help to keep his mood stable.

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