1. List the Symptoms. 2. Make a DSM IV or DSM V diagnosis and list the stressors
ID: 3498906 • Letter: 1
Question
1. List the Symptoms.
2. Make a DSM IV or DSM V diagnosis and list the stressors. Use specific psychodiagnostic terms.
Set up a DSM IV diagnosis like this:
Axis I: whichever anxiety disorder you choose
AxisII: no diagnosis
Axis III: physical problems contributing to the DX?
Axis IV: what are the psychosocial stressors?
Axis V: Global assessment of functioning
Identify 3 problems that will be treated in psychotherapy and choose an approach and technique for each
3. Determine a treatment plan. Identify at least 3 problems, choose goals for each problem and methods of treatment (i.e. theoretical approach and technique). USE PSYCHOTHERAPY NOT PSYCHOPHARMACOLOGY
Connie, a 33-year-old homemaker and mother of a 4-year-old son, Robert, is referred by her general practitioner to a psychiatric outpatient program because of her complaint that she has been depressed and unable to concentrate ever since she separated from her husband 3 months previously.
Connie left her husband, Donald, after a five-year marriage. Violent arguments between them, during which Connie was beaten by her husband, had occurred for the last four years of their marriage, beginning when she was pregnant with Robert. There were daily arguments during which Donald hit her hard enough to leave bruises on her face and arms. During their final argument, about Connie?s buying an expensive tricycle for Robert, her husband had held a loaded gun to Robert?s head and threatened to shoot him if she didn?t agree to return the tricycle to the store. Connie obtained a court order of protection that prevented Donald from having any contact with her or their son. She took Robert to her parent?s apartment, where they are still living.
Connie is an only child, and a high school and secretarial school graduate. She worked as an executive secretary for six years before her marriage and for the first two years after, until Robert?s birth. Before her marriage Connie had her own apartment. She was close to her parents, visiting them weekly and speaking to them a couple of times a week. Connie had many friends whom she also saw regularly. She still had several friends from her high school years. In high school she had been a popular cheerleader and a good student. In the office where she had worked as a secretary, she was in charge of organizing office holiday parties and money collections for employee gifts. She had no past history of depression; and there was no family history of violence, mental illness, or substance abuse. Her parents had been happily married for 25 years.
Connie met Donald at work, where he was an accountant. They married after a three-month courtship, during which time Connie observed Donald using cocaine twice at parties. When she expressed concern, he reassured her that he was only ?trying it to be sociable,? and denied any regular use.
Donald, a college graduate, is the oldest of three siblings. His father drank a pint of bourbon each night and often beat Donald?s mother. Donald?s two younger brothers both have histories of substance abuse.
During their first year of marriage, Donald became increasingly irritable and critical of Connie. He began to request that Connie stop calling and seeing her friends after work, and refused to allow them or his in-laws to visit their apartment. Connie convinced Donald to try marital therapy, but he refused to continue after the initial two sessions.
Despite her misgiving about Donald's behavior toward her, Connie decided to become pregnant. During the seventh month of the pregnancy, she developed thrombophlebitis and had to stay home in bed. Donald began complaining that their apartment was not clean enough and that Connie was not able to shop for groceries. He never helped Connie with the housework. He refused to allow his mother-in-law to come to the apartment to help. One morning when he couldn?t find a clean shirt, be became angry and yelled at Connie. When she suggested that he pick some up from the laundry, he began hitting her with his fists. She left him and went to live with her parents for a week. He expressed remorse for hitting her and agreed to resume marital therapy.
At her parents' and Donald's urging, Connie returned to her apartment. No further violence occurred until after Robert's birth. At that time, Donald began using cocaine every weekend and often became violent when he was high.
In the three months since she left Donald, Connie has become increasingly depressed. Her appetite has been poor, and she has lost ten pounds. She cries a lot and often wakes up at five in the morning, unable to get back to sleep. Ever since she left Donald, he has been calling her at her parents? home and begging her to return to him. One week before her psychiatric evaluation, Connie?s parents took her to their general practitioner. Her physical examination was normal, and he referred her for psychiatric treatment.
When seen by a psychiatrist in the outpatient clinic, Connie is pale and thin, dressed in worn-out jeans and dark blue sweater. Her haircut is unstylish, and she appears older than she is. She speaks slowly, describing her depressed mood and lack of energy. She says that her only pleasure is in being with her son. She is able to take care of him physically, but feels guilty because her preoccupation with her own bad feelings prevents her from being able to play with him. She now has no social contacts other than with her parents and her son. She feels worthless and blames herself for her marital problems, saying that if she had been a better wife, maybe Donald would have been able to give up the cocaine. When asked why she stayed with him so long, she explains that her family disapproved of divorce and kept telling her that she should try harder to make her marriage a success. She also thought about what her life would be like trying to take care of her son while working full time and didn?t think she could make it.
Explanation / Answer
Answer.
Axis I:Connie meets the DSM criteria for major depressive mood disorder as she shows the following symptoms:
A general feeling of low mood and extreme sadness which extends for more than a week.
Inability to engage in leisure activities such as plying with her child due to her preoccupation with her sadness.
Anconsistenfeleing of worthlessness and hopelessness bout surviving los sof he rmarital relationship and a tendency to feel guilty and blaming oneself for her divorce.
A general loss of appetite with severe weight loss.
inability to sleep
lost ten pounds. She cries a lot and often wakes up at five in the morning, unable to get back to sleep.
Axis II: no diagnosis. Connie does not show signs of a major personality disorder or mental retardation
Axis III. Her loss of appetite due to depression has resulted in los sof weight
Axis IV:the history of physical abuse doemstic violence in her marriage along with the consequent divorce, managing full time work and responsibility towards her son as a single parent are found to be the major stressors in her life which could have perpetuated the presenting symptoms of depression.
Axis V: Connie’s symptoms can be rated as 61 – 70 on the Golabal assessment scale. There are Some mild symptoms (e.g., depressed mood and mild insomnia) and difficulty in social and occupational, or functioning e.g, inability to engage in quality time with her child , but generally she is functioning well, has some meaningful interpersonal relationships with her parents and son.
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