Case Analysis Evaluation
Symptoms: anger, stress, depression, anxiety, suspicious of authority figures, low self-esteem, low confidence, inflicting self-harm, broken relationships with family, sexually active, chronic feelings of emptiness, high consumption of alcohol, cannot maintain a job for more than one year, lacks many friends, feelings of loneliness and unhappiness. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
a. Identify appropriate history questions to be asked to discriminate critical characteristics or attributes about the presenting complaint. Character: Does the patient have a history of anxiety and or depression? Is there any medication prescribed based on a diagnosis of anxiety or depression? Does the patient have a history of a lack of trust in authority figures? Does the patient recognize historical instances of inflicting self-harm? Is the patient aware of her drug abuse problem? Is the patient sexually active? Does the patient take sexual protection measures against sexually transmitted diseases? Does the patient have an existing relationship with family and friends? From family history, what are the mental health issues in the family? What is the patient’s character in sustaining current employment? Does the patient live alone? How does the patient feel about themselves based on esteem and confidence, happiness and loneliness? The client is legally bound to receive the best evaluation and treatment of ailment. The client’s rights for assessment require prior information about the process, what is required, what are the expected outcomes and how the process will be carried out. The client is also entitled to an assessment location that is suitable and comfortable for them. Any information that that patient asks is provided to them upon request, including preventative measures and accuracy of the test. In general, the client can request for professional assessment from an individual they are comfortable with during the evaluation. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Onset: does the patient recall when her anxieties, depression and feeling of loneliness, as well as unhappiness, begun? Does she remember when her suicidal thoughts began and when consequential self-harm started? Does the patient remember her journey toward alcoholism and being sexually active? Does the patient often feel lonely or unhappy? What times trigger the need to purchase alcohol? Why is the patient suspicious of authority figures? Is it related to her past or present events? Does this occur only in the presence or also the absence of authority figures? Does the lack of need to sustain relationships make the patient feel lonely and unhappy? Does it make her feel unloved? What effect does the medication she takes to have on controlling anxiety or depression? | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Location: Does the feeling of anxiety, depression and lack of authority figure trust occur during work or outside work? Does the feeling of loneliness, unhappiness, feeling unloved, and anxiety occur when they are home alone? The need to consume alcohol, does it occur when feelings of overwhelmed loneliness and depression occur? | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Severity: Does the feeling of loneliness and unhappiness occur at certain periods or as a result of specific thoughts? Does it trigger anxiety? For how long does the patient experience anxiety? Does it make her consume more alcohol? What is the trigger for alcohol consumption? How bad are the symptoms from 1-10 (with one being barely noticeable) and ten being highly noticeable). Does the patient show signs of restlessness and unwillingness to cooperate? Is the patient less likely to engage in answering the questions? Is the patient honest in their answers? | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pattern: does the medication prescribed, fluoxetine 20 mg, reduce the occurrence of the symptoms of anxiety and depression since you started? Fluoxetine 20 mg is a drug that allows patients to feel better based on the symptoms of anxiety. For instance, it can make the patient feel less anxious and reduce thoughts of being unloved and unfriendly to others. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Associated factors: will the patient present comfort and ease during the evaluation and treatment phase? Is there a need for an additional supervisory nurse or psychiatric professional needed? Further information on previous medical history is required. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
b. Delineate four hypotheses (differential diagnosis) that could support the above symptoms in relation to pertinent answers given in history. Most include DSM 5 diagnostic code and provide a rationale for each choice based on the presenting case.
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c. What would mental status exam findings be associated with each listed hypothesis above? What subjective data might the patient report? Use all seven component of MSE- Appearance, Behavior, Speech, Affect, Thought process, Thought content, Cognitive examination (level of awareness, Attention and Concentration, Memory, Orientation, etc.).
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d. What is the etiology associated with each of the four differential diagnosis? Include psychological factors and past experiences that may be contributing to current symptoms.
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e. What diagnostic screening tool would you use for each of the four differential diagnosis?
f. Analysis
The client displays diverse responses to her aggression and behaviour—the diagnostic criteria of disorders, either social or psychological factors in clinical practice and research. Criteria on the evaluation of the presence of disorders have to factor in false-positive, which may imply recognition of errors in criteria of diagnosis. The validity in assessment challenges the ability to pick mental disorders without any disputes with the knowledge that there is always an underlying shared symptom across disorders. It is, therefore, critical to distinguish between disorder and non-disorder. Common tests used include statistical deviance, family history, genetics, factor analysis and guides on disorders and non-disorders.
First et al. (2015).
Factors on environmental contributors such as insomnia, positive or negative sentiments, and seasonal affective disorders should also be factored. Measures of the association on identity are significant, including physical exam, laboratory tests and psychological examination.
The understanding difference in factor contribution including neurodevelopmental, depressive, anxiety, obsessive-compulsive, trauma, stressor and feeding and eating disorders can provide a better understanding of the symptoms and diagnosis of the patient.
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g. What is the appropriate treatment plan for this patient? Treatment should include specific psychological therapeutic modalities and the focus, social interventions (support or self- help groups, mobilization of family resources, vocational rehabilitation, financial planning) and identification of strengths.
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h. References 1. NIMH » Any Anxiety Disorder. (2020). https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder.shtml 2. Keeley, J. W., Reed, G. M., Roberts, M. C., Evans, S. C., Robles, R., Matsumoto, C., … & Gureje, O. (2016). Disorders specifically associated with stress: A case-controlled field study for ICD-11 mental and behavioural disorders. International Journal of Clinical and Health Psychology, 16(2), 109-127.
3. First, M. B., Reed, G. M., Hyman, S. E., & Saxena, S. (2015). The development of the ICD‐11 clinical descriptions and diagnostic guidelines for mental and behavioural disorders. World Psychiatry, 14(1), 82-90.
4. Kämpfer, N., Staufenbiel, S., Wegener, I., Rambau, S., Urbach, A. S., Mücke, M., … & Conrad, R. (2016). Suicidality in patients with somatoform disorder–the speechless expression of anger?. Psychiatry research, 246, 485-491.
5. Otte, C., Gold, S. M., Penninx, B. W., Pariante, C. M., Etkin, A., Fava, M., … & Schatzberg, A. F. (2016). Major depressive disorder. Nature reviews Disease primers, 2(1), 1-20.
6. Hofmann, S. G., & Otto, M. W. (2017). Cognitive-behavioural therapy for a social anxiety disorder: Evidence-based and disorder-specific treatment techniques. Routledge.
7. Rahm, A. K., Boggs, J. M., Martin, C., Price, D. W., Beck, A., Backer, T. E., & Dearing, J. W. (2015). Facilitators and barriers to implementing Screening, Brief Intervention, and Referral to Treatment (SBIRT) in primary care in integrated health care settings. Substance abuse, 36(3), 281-288.
8. Lee, S. M., Yoon, J. R., Yi, Y. Y., Eom, S., Lee, J. S., Kim, H. D., … & Kang, H. C. (2015). Screening for depression and anxiety disorder in children with headache. Korean Journal of paediatrics, 58(2), 64.
9. Crane, R. (2017). Mindfulness-based cognitive therapy: Distinctive features. Routledge.
10. Harris, R. (2019). ACT made simple: An easy-to-read primer on acceptance and commitment therapy. New Harbinger Publications.
11. Heinemann, A. (2015). The importance of the detail complexity (symptoms) and dynamic complexity (emotional flexibility) for the description, diagnosis and therapy of mental disorders (shown by the example of phobic and schizoid personality disorders). Psychiatria, 12(4), 213-237. |