Differential Diagnosis for Robert
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Differential Diagnosis for Robert
DSM-5 Diagnosis
As specified in DSM-5, there are two groups of substance-related disorders, which include substance use disorders and substance-induced disorders. Substance use disorders refer to a range of symptoms that result from the continuous use of substance regardless of the problems on is experiencing (Langås et al., 2013). On the other hand, substance-induced disorders include withdrawal, intoxication, and medical induced mental disorders that are specified alongside substance use disorders (Lucire, 2016). For the case of Robert, The DSM-5 diagnosis is F13.239, which is Sedative, hypnotic, or anxiolytic dependence with withdrawal, unspecified.
Matching Criteria for this Disorder with Roberts Symptoms
One of the symptoms specified in the criteria that matched Robert’s condition is the intake of more significant amounts of amphetamine and other psychotic stimulants for more extended periods. From Robert’s illness history, it highlights that he started drinking at the age of 21 and continued taking alcohol to his late twenties. During this period, he began the intake of cocaine and amphetamine. Also, after involvement in a car accident, Robert started consuming more oxytocin than the recommended dosage. Besides, his medical history reports a time when he overdosed on Klonopin.
The other symptom specified in the criteria that matched the client is the continued usage of the substance even when it causes problems in relationships. Robert used to have arguments with his wife while still under the influence of amphetamines. According to medical history, his wife was always worried about their financial situation to the extent that he ended the relationship with him. However, even after the separation, Robert did still not stop taking the drug.
The other symptom specified in the criteria that matched Robert’s condition is the continued of the substance to achieve tolerance. Robert was always taking amphetamine to produce a relaxing mood. While admitted at the hospital as a result of an overdose of Klonopin, he began the use of amphetamine to cool the anger he was experiencing for his wife, who forced him to be hospitalized.
The other symptom specified in the criteria that matched Robert’s condition is the continued use of the substance even after realizing that one has a psychological or physical symptom caused by the use of the substance. Robert was once hospitalized in a psychiatric facility for treatment of drug abuse and alcohol addiction. However, even after being released, he felt uncomfortable and began the usage of amphetamine and alcohol. This approach made him more sad, fearful, and suicidal.
Severity of the Symptoms
The DSM-5 provides a specification for clinicians to assess how severe the problem of substance use is (Lucire, 2016). This approach allows the clinicians to recommend the requisite treatment option to manage the condition. The highlighted four symptoms indicate moderate substance abuse disorder.
Close Differentials Ruled Out
F33.1 Major Depressive affective disorder recurrent episode moderate degree
Some of the symptoms attributable to major depressive disorder that matched Robert’s case include:
- Depressed mood (Langås et al., 2013).
- Loss of interest in once pleasurable activities (Langås et al., 2013).
- Recurrent suicidal ideation (Langås et al., 2013).
- Fatigue and loss of energy (Langås et al., 2013).
- Inability to concentrate (Langås et al., 2013).
While the symptoms specified above matched with those of Robert’s, this condition was ruled out because the later symptoms were attributable to the psychological effects of drugs (Escobar and Vega, 2017). For one to be adequately diagnosed with major depressive disorder, his or her symptoms must not be attributable to the psychological effect of drugs.
F10.24: Alcohol dependence with alcohol induced mood disorder
Some of the symptoms attributable to alcohol dependence that matched Robert’s case include:
- Intake of large amounts of alcohol (Escobar and Vega, 2017).
- Continued usage of alcohol even if it caused problems in his relationship (Escobar and Vega, 2017).
- Using the substance continuously, even if it worsens the psychological problem (Escobar and Vega, 2017).
- Development of withdrawal symptoms that could only be relieved by the substance (Escobar and Vega, 2017).
While the symptoms matched with most of Robert’s one, this condition was ruled out because the primary drug that the client was found in possession was amphetamine after being treated successfully on drug and substance addiction (Lucire, 2016). Alcohol usage only came later when he separated from his wife. Besides, during this period, he took amphetamine.
Recommended Assessment Approaches
Two assessment tools will be recommended to validate the treatment of the client, which include Beck Depression Inventory (BDI) and the Addiction Severity Index (ASI). The BDI contains 21 questions on mood and other depression symptoms that can be used to track the symptoms and progress of recovery (Kathryn McHugh, 2010). On the other hand, the ASI is an essential tool in evaluating the severity of substance abuse by the client (Escobar and Vega, 2017). While this instrument assesses the history and frequency of alcohol and drug use, it can also be effective in treatment planning (Carmin, 2012). The tools mentioned above have been selected because they are essential in assisting the counselor to understand the client’s similarities and differences in symptoms for the specific psychological conditions and therefore play a vital role in the validation of the treatment approach.
Recommended Evidence-Based Treatment Approach
The recommended evidence-based treatment approach is Cognitive-Behavioral Therapy (CBT). This treatment assists an individual to get rid of self-sabotaging thoughts that fuel drug and alcohol abuse. CBT is a combination of two approaches, which include cognitive and behavioral therapy (Lucire, 2016). During psychotherapy, the therapist builds a therapeutic alliance with the client to enable talks that will promote healing and adaptation of healthy behaviors (Carmin, 2012). Unlike the psychoanalysis therapy that focuses on the past, cognitive behavioral therapy adopts a problem-oriented approach that assists an individual to look at dysfunctional patterns in his or her life to change the thoughts, behaviors, emotional reactions damaging their life (Kathryn McHugh, 2010). A previous study reported that 60 percent of the patients under CBT recorded clean toxicology reports after 52 weeks of follow-up for various types of addiction (Carmin, 2012). As such, for the case of Robert, will be beneficial for him since he struggles with more than one form of addiction, which is amphetamine and alcohol.
Cultural Factors taken into consideration when making Assessments and Recommending Interventions
One of the cultural factors taken into account is paralanguage. Vocal sues such as hesitations, speaking pace, and volume of voice may accidentally create a barrier for effective diagnosis of the patient (Escobar and Vega, 2017). According to his mental examination, Robert is pictured as a person who talks fast during the interview. White people who grew up in urban centers tend to speak at a faster pace when compared to their rural counterparts. This unique feature can be a source of cultural bias on the therapist and thus affect a proper diagnosis for the client (Carmin, 2012). As such, during diagnosis and when recommending interventions, this cultural trait was factored to ensure that a fair and effective treatment approach is developed.
Client Strengths
One of the primary strengths of the client that could be used during treatment is his willingness to change. Research highlights that without a sincere desire to participate in therapy, the gains will be minimal (Carmin, 2012). According to his mental status examination, Robert demonstrates a willingness to check on his weight and also gain muscles, which signals an individual who is ready to return to his regular life routine. This energy will be used to forge the requisite therapeutic alliance to ensure better treatment for the client.
Specific Skills and knowledge
Some of the skills that I will need to gain include active communication and listening skills, critical thinking skills, empathy skills, and cultural-tolerant skills. These skills will be appropriate in enabling me to effectively treat the client (Escobar and Vega, 2017). The plan to acquire the knowledge includes reading detailed books on the topics mentioned above, consulting my colleagues and tutors, and also seeking advice from my professional mentors (Carmin, 2012). The skill acquisition exercise will be undertaken parallel with the treatment approach to not only practice the skills but also evaluate my progress.
References
Carmin, C. (2012). Cognitive Behavior Therapy with Older Adults. Cognitive and Behavioral Practice, 19(1), 87-88. doi: 10.1016/j.cbpra.2011.07.001
Escobar, J., & Vega, W. (2017). Cultural issues and psychiatric diagnosis: providing a general background for considering substance use diagnoses. Addiction, 101, 40-47. doi: 10.1111/j.1360-0443.2006.01598.x
Kathryn McHugh, R. (2010). Evidence-Based Practice of Cognitive-Behavioral Therapy. Cognitive Behaviour Therapy, 39(1), 78-78. doi: 10.1080/16506070903190260
Langas, A., Malt, U., & Opjordsmoen, S. (2010). Primary versus substance induced affective disorders in first time admitted substance users – preliminary data. Journal of Affective Disorders, 122, S49. doi: 10.1016/j.jad.2010.02.048
Langås, A., Malt, U., & Opjordsmoen, S. (2013). Independent versus substance-induced major depressive disorders in first-admission patients with substance use disorders: An exploratory study. Journal of Affective Disorders, 144(3), 279-283. doi: 10.1016/j.jad.2012.10.008
Lucire, Y. (2016). Pharmacological Iatrogenesis: Substance/Medication-Induced Disorders That Masquerade as Mental Illness. Epidemiology: Open Access, 06(01). doi: 10.4172/2161-1165.1000217