For this assignment, please choose one of the Case Studies you diagnosed in the Disorders Chapter. Develop a treatment plan for the first 5 meetings with your client. You may use one or more therapeutic models but ensure it is clear to the reader what model(s) you are using.
Assume all the details provided in the Case Study and delineate your treatment plan considering you are meeting with the client once a week. Describe what your goals would be for each week and how you might achieve them.
Case 1 DSM-5 Clinical Cases
by Michael Gitlin, M.D.
Nancy Ingram, a 33-year old stock analyst and married mother of two children, was brought to the emergency room (ER) after 10 days of what her husband described as “another cycle of dark days.” His wife was tearful, then explosive, and she had almost no sleep. Ms. Ingram’s husband said he had decided to bring her to the ER after he discovered that she had recently created a blog entitled Nancy Ingram’s Best Stock Picks. Such an activity not only was out of character but, given her job as a stock analyst for a large investment bank, was strictly against company policy.
Mr. Ingram said his wife was working on the stock picks around the clock, forgoing her own meals as well as her responsibilities at work and with her children. Ms. Ingram argued with her husband at this time and said, her blog “would make them rich.” The patient had first been diagnosed with depression in college, after the death of her father from suicide. On examination, the patient was pacing angrily in the exam room. Her eyes appeared glazed and unfocused. She responded to the examiner’s entrance by sitting down and explaining that this was all a miscommunication, that she was fine and needed to get home immediately to tend to her business.
She was speaking so rapidly, it was difficult for the examiner to interrupt. She denied hallucinations, but admitted with a smile, to a unique ability to predict the stock market. She refused to be cognitively tested and she said, “I will not be a trained seal, a guinea pig, or a barking dog, thank you very much, and may I leave now?”
Disorder: Bipolar disorder
Case 2 DSM-5 Clinical Cases
by Richard J. Loewenstein, M.D.
Irene Upton was a 29-year-old special education teacher who sought a psychiatric consultation because “I’m tired of always being sad and alone.”
…She had been hospitalized twice for suicidal ideation and severe self-cutting that required stiches.
She told the therapist that her sister reported “weird sexual touching” by their father when Ms. Upton was 13. There had never been a police investigation, but her father apologized to the patient and her sister as part of a church intervention…. Ms. Upton casually dismissed the possibility that she had ever been abused. She denied any negative feelings toward her father and said, “He took care of the problem. I have no reason to be mad at him.
”Ms. Upton reported little memory for her life between about ages 7 and 13 years. Her siblings would joke about her inability to recall family holidays, school events, and vacation trips. She explained this by saying, “Maybe nothing important happened and that’s why I don’t remember.”
Ms. Upton described being “socially withdrawn” until high school, at which point she became academically successful and a member of numerous teams and clubs. She did well in college. She excelled at her job and was regarded as a distinguished teacher of autistic children.
She denied use of alcohol or drugs, and described intense nausea and stomach pain at even the smell of alcohol.
She described herself as “numb” and said thoughts of suicide were “always around.” She denied flashbacks or intrusive memories, but reported recurrent nightmares of being chased by a “dangerous man” from whom she could not escape. She reported an intense startle reaction and avoidance of dating men. She did not have instances of time loss or unexplained possessions or inexplicable skills, habits and/or knowledge.
Disorder : Major depressive disorder, chronic, with suicidal ideation;
Case 3 DSM-5 Clinical Cases
by Jason P. Caplan, M.D.
Theodore A. Stern, M.D.
Paulina Davis a 32-year-old single African American woman with epilepsy first diagnosed during adolescence. She was admitted to a medical center after her family found her convulsing in her bedroom.
During her hospital admission, a routine electroencephalogram (EEG) was ordered. Shortly after the study began, Ms. Davis began convulsing. When the EEG was reviewed, no epileptiform activity was identified. Ms. Davis was subsequently placed on video-EEG (vEEG) monitoring. In the course of her monitoring, Ms. Davis had several episodes of convulsive motor activity; none were associated with epileptiform activity on the EEG. Psychiatric consultation was requested.
On interview, Ms. Davis noted that she had recently moved to the state to start graduate school; she was excited to start her studies and “finally get my career on track.” She denied any recent specific psychosocial stressors other than her move and stated, “My life is finally where I want it to be.” She was worried about missing the first day of classes (only a week away from the time of the interview). She was also worried about the costs of her hospitalization because her health insurance coverage did not begin until the school semester commenced.
When the findings of the EEG study were discussed with Ms. Davis, she quickly became quite irritable asking, “So, everyone thinks I’m just making this up?” The psychiatrist/clinician tried to ease Ms. Davis’ concerns by telling her that about 10% of people with epilepsy also experience nonepileptic seizures (NES).
NES can be caused by subconscious thoughts, emotions or 'stress', not abnormal electrical activity in the brain. Professionals do not believe that the seizures are purposely or fictitiously produced. The clinician told Ms. Davis she would not be exposed to unnecessary medication or studies, and that treatment, in the form of psychotherapy was available.
Disorder: Conversion disorder