Essay: Diagnosis List For Four Case Studies." (50 Characters)

Case 3A Ella

Complete a diagnosis list (with rationale for each diagnosis) for four Case Studies. Be sure to write the number that identifies the case study. Each case will have at least one primary diagnosis and at least one secondary diagnosis and/or Z-code.

Case 3A Ella

Diagnostic Impressions

303.90 (F10.20) Alcohol-Use Disorder, Severe

309.0   (F43.21) Adjustment Disorder, with Depressed Mood

V63.82 (Z63.4) Uncomplicated Bereavement

V60.3   (Z60.2) Problem Related to Living Alone

Client diagnosed as 303.90 (F10.20) Alcohol-Use Disorder, Severe as evidenced by " a problematic pattern of alcohol use leading to clinically significant impairment or distress."  The client reports consuming increased amounts of alcohol over the past three years, increased drinking to current level of 12-18 beers or two bottles of wine per day.  The client reports her first activity of the day is to drive to the store to get her drinks for the morning and afternoon then return for her evening drinks.  The client reports having tried to cut back over the past 18 months but was unsuccessful.  The client reports that with each attempt to stop "I fail and become so angry with myself I drink more." The client reports when she does not drink she feels shaky, achy and "like I have the flu." The client reports having an increase in drinking to get the same feelings from lesser amounts.  the client reports experiencing headaches and dehydration in the mornings, "the hangovers lasting longer sometimes unable to get out of bed until noon."  The client reports getting noticeably intoxicated 2-3 nights per week.  The client reports guilt over drinking.  The client meets diagnostic criteria 1, 2, 3, 6, 7, 8, 10a, 11a.  The client does not meet the criteria for the differential diagnosis of nonpathological use of alcohol, sedative, hypnotic, or anxiolytic use disorder or conduct disorder in childhood and adult antisocial personality disorder.  The client does however meet the diagnostic criteria for a dual diagnosis of Adjustment Disorder, with Depressed Mood.

The client is diagnosed with a dual diagnosis of 309.0   (F43.21) Adjustment Disorder, with Depressed Mood as evidenced by "the presence of emotional or behavioral symptoms in response to an identifiable stressor."  The client reports an inability to take care of her home or a majority of her physical needs since the passing of her husband.  The client's daughter reports her once "social butterfly mother" chooses to spend every waking moment alone.  The client reports that she was "a touched depressed for six months after my husband died, but I do not feel depressed anymore."  The client meets diagnostic criteria A, B2, C, D.  The client does not meet the criteria for the differential diagnosis of major depressive disorder, posttraumatic stress disorder and acute stress disorder, personality disorders, psychological factors affecting other medical conditions or normative stress reactions due to not meeting the diagnostic criteria.  

Other conditions that may be a focus of clinical attention are V63.82 (Z63.4) Uncomplicated Bereavement and V60.3   (Z60.2) Problem Related to Living Alone as evidenced by clients continued grieving and the clients anger about growing old and not being able to control her life completely.  

Case 4D Jimmy

Case 4D Jimmy

Diagnostic Impressions

309.81 (F43.10) Posttraumatic Stress Disorder

296.21 (F32.0) Major Depressive Disorder, Mild

303.90 (F10.20) Alcohol-Use Disorder, Severe

V61.10 (Z63.0) Relationship Distress with Spouse or Intimate Partner

V62.29 (Z56.9) Other Problem Related to Employment

V62.89 (Z65.8) Religious or Spiritual Problem

V62.22 (Z65.5) Exposure to Disaster, War, or Other Hostilities

V62.22 (Z91.82) Personal History of Military Deployment

Client diagnosed as 309.81 (F43.10) Posttraumatic Stress Disorder as evidenced by " exposure to actual or threatened death, serious injury, or sexual violence."  The client reports during last tour in Afghanistan being critically wounded and losing five soldiers from his unit in the firefight.  The client reports although medically cleared still having an ache in his shoulder from multiple bullet wounds.  The client wife reports no longer feeling safe at home.  The clients wife reports him being very moody, gets easily angered (5 times per week) - going from zero to rage in seconds, intense nightmares (3-5 nights per week) and sleeping 3 -4 hours a night.  The client reports feeling tired and fatigued with daily problems concentrating.  The client's wife reports he "will do everything possible to avoid thinking about that terrible day."  The  client reports "the world is not a safe place" keeping a loaded pistol on him at all times and staying on guard. The client reports being easily startled as evidenced by pulling his weapon out when loud noises startle him or when he is extremely angry at adults. The client meets diagnostic criteria A 1, 2; B 2, 3; C 2; D 2, 5, 6; E 1, 3, 4.  The client does not meet the criteria for the differential diagnosis of adjustment disorder, other posttraumatic disorders and conditions, acute stress disorder, anxiety disorders and obsessive-compulsive disorder, personality disorder, dissociative disorder, conversion disorder ( functional neurological symptom disorder, psychotic disorder, or traumatic brain disorder due to not meeting the diagnostic criteria.  The client does however meet the differential diagnosis of major depressive disorder.  The client does however meet the diagnostic criteria for a dual diagnosis of Major Depressive Disorder, Mild and Alcohol-Use Disorder, Severe as evidenced by client reports.

Client diagnosed as 296.21 (F32.0) Major Depressive Disorder, Mild as evidenced by "depressed mood  present nearly every day."  The client reports he does not eat much because he is not hungry  and client's wife reports he has lost 20 pounds in the six months since being home.  The client reports he is not depressed just tired and needs to rest.  The client reports most days he feels sad and empty.  The client reports hardly leaving the house except for "VA follow up appointments and running out for more beer and bourbon."  The client reports no interest in doing anything outside of the home.  The client reports no desire to play with his sons.  The client reports he feels extremely guilty daily for loosing members of his outfit even though reports reflect no wrong doing on his part.  The client meets diagnostic criteria A 1, 2, 3, 6, 7; B Yes; C Yes.  The client does not meet the criteria for the differential diagnosis of manic episodes with irritable mood or mixed episodes, mood disorder due to another medical condition, substance/medication-induced depressive or bipolar disorder, attention-deficit/hyperactivity disorder, adjustment disorder with depressed mood or sadness.  

Client diagnosed as 303.90 (F10.20) Alcohol-Use Disorder, Severe as evidenced by " a problematic pattern of alcohol use leading to clinically significant impairment or distress."  The client wife reports client has started drinking "to dull the pain from his injured shoulder and help him relax as he is always anxious."  The client reports increasing amounts of alcohol use initially 2-4 beers  nightly currently a six pack of beer and a pint of bourbon nightly.  The client reports having to drink more than previously to "feel his anxiety and pain lesson."  The client reports having attempted to reduce alcohol consumption but "he feels tense all the time and the alcohol helps him relax."  The client reports guilt over drinking.   The client meets diagnostic criteria 1, 2, 5, 6, 7, 9, 10a.  The client does not meet the criteria for the differential diagnosis of nonpathological use of alcohol, sedative, hypnotic, or anxiolytic use disorder or conduct disorder in childhood and adult antisocial personality disorder.

Other conditions that may be a focus of clinical attention are V61.10 (Z63.0) Relationship Distress with Spouse or Intimate Partner, V62.29 (Z56.9) Other Problem Related to Employment, V62.89 (Z65.8) Religious or Spiritual Problem, V62.22 (Z65.5) Exposure to Disaster, War, or Other Hostilities and V62.22 (Z91.82) Personal History of Military Deployment as evidenced by client reports.

Case 3A Ella

The client has been diagnosed as 297.1 (F22) Delusional Disorder with subtype Erotomania; this is defined as having a number of delusional states which involve real life situations; this delusional states occur for more than one month within the affected. The client reports that she had left her previous loveless relationship with her previous husband in Florida to marry Mr. Bennett. Investigating the client’s family in Florida, it is revealed that Rosa had expressed a mutual relationship between her and Mr. Bennett. The client did not report any symptoms of anxiety or depression when brought to the inpatient unit. Therefore she did not have schizophrenic outbursts. Her cooperative behaviour shows that the client did not have any bizarre mood swings. The client expressed details about how she and Mr. Bennett have maintained a consistent distant relationship for the last three years. Physical examination revealed that the client had a delusion of being pregnant with Mr. Bennett’s child. This shows that the client reports are consistent with the diagnostic criteria A, B, C, D, E (Arlington, 2013). Other conditions requiring a focus are V62.29 (256.9) Other Problems related to Employment. This may be due to the client being fired by her boss, Mr. Bennett.

312.31 (F63.0) Gambling Disorder

V60.3 (Z60.2) Problem Related to Living Alone

V62.82 (Z63.4) Uncomplicated Bereavement

V62.89 (Z60.0) Phase of Life Problems

The client has been diagnosed with 312.31 (F63.0) Gambling Disorder. This underlies a total of ten criteria which determines the level of disorder progression. The client Edna reports that she feels excitement about her casino trips and that she loved to win money by setting a higher limit in comparison to her previous casino wins. She expresses huge excitement while discussing about her biweekly casino trips. However, her expression becomes dull while discussing about her children. She tends to lie before her children for her gambling, although she does not like lying to her children. She further reports that she worries about how to spend her time without a work life, she therefore does not prefer to take retirement in this worry. She reports that her children continue to stay separated, therefore she does not like loneliness. She prefers to work during her loneliness. The client meets diagnostic criteria 1, 2, 4, 5, 6, 7, 8, 9, 10. She does not meet the criteria for differential diagnosis related to other mental or personality disorders (Jongsma, Peterson & Bruce, 2014). She reported irritability due to cancellation of any casino trip. Other conditions that require attention are V62.89 (Z60.0) Phase of Life Problems; this may be due to her difficult life phases during her transition from a complete motherhood to an empty house when she feels loneliness. V62.82 (Z63.4) Uncomplicated Bereavement and V60.3 (Z60.2) Problem Related to Living Alone also require focus.

300.01 (F41.0) panic disorder

292.21 (F32.0) Major Depressive Disorder, mild

V61.20 (Z62.820) Parent-Child Relational Problem

V61.29 (Z62.898) Child Affected by Parent Relationship Distress

The client has been diagnosed with 300.01 (F41.0) Panic Disorder which means that the client has frequent panic attacks due to fear and discomfort reaching to higher levels. The client reports that she suffers from fast heartbeat, chest discomfort, dizziness and she has a fear of losing control. The client further reports that she suffers from a persistent fear that she might develop panic attacks when around her friends. She also reports of her distressed behaviour when her dog was bitten by her father. She reports that her panic attacks last for two minutes, however, it seems to her as if those symptoms have been continuing for long hours. She reports that she suffered extreme turmoil due to her parents’ arguments amongst them. The client expresses guilt because of her presence within the family. She reports that she feels extremely sad all throughout the day. The client meets the diagnostic criteria A 1, 4, 5, 6, 8, 12; B 1, 2; C and D. The client does not meet the criteria for differential diagnosis of personality changes, behavioral changes, and psychosocial trauma.

 The client is also diagnosed with 292.21 (F32.0) Major Depressive Disorder, mild; she suffers from depressing episodes during the entire day. She even suffers from difficulty to sleep. A feeling of worthlessness has been reported by the client. The client expresses guilt of her presence and that her presence is a cause of her parents’ divorce in life. She reports that a recurrent thought The client meets the diagnostic criteria A, Ba, Bb, Bc, Ca, Cb, Cf. The client does not meet the criteria of differential diagnosis for major depression disorder, stress conditions. Other conditions that need attention are V61.20 (Z62.820) Parent-Child Relational Problem and -V61.29 (Z62.898) Child Affected by Parental Relationship Distress. This is possibly due to her distressing mental conditions as a result of her parents’ divorce. She faces relational disturbances with her parents.

References:

Arlington, VA. (2013). American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th edition).

Jongsma, A. E., Peterson, L. M., & Bruce, T. J. (2014). The complete adult psychotherapy treatment planner. Hoboken, NJ: Wiley& Sons, Inc.