Five Clinical Vignettes for Diagnostic Purposes - Case Study Example

? 5 Clinical Vignettes for Diagnostic Purposes CASE STUDY: HELEN KAY In Axis I Diagnosis, it is evident that that patient is suffering from 293.83 substance induced mood classified disorder. This is collaborated by the fact that her moods shifted from elation to utter lethargy and despondency in a moment. These mood swings seemed to be related to her shopping trips to a nearby liquor store. From the given history, she had also begun to drink heavily by herself in her room and this behavior had gone on for several months. After she had gone to the liquor store, she became abusive and uncooperative. In Axis II for personality disorders and mental retardation, the patient exhibited borderline personality disorder classified under 301.83. The patient has an intense pervasive sense of guilt over the death of her husband. She thinks that she is to blame for the death of her husband and that she did not do enough. In fact, when she is rescued by police from the beach, she mumbles that “I did all I could.” The history of the patient shows that she disrupted the funeral of her husband by laying the blame of his death on herself and even when she stayed with her son, she was emotionally instable. There is no diagnosis for Axis III covering General Medical Conditions. For Axis IV, the patient has Psychosocial and Environment Problems. She has problems related to her social environment due to the long illness and eventual death of her of her husband. The long illness affected her badly because she used to be okay during the first time in the university. However, she changed when she returned after the long illness of her husband during which time she was compelled to stay for long at his bedside. She tried to take care of him but and his death had a devastating effect on her mental health. In the assessment of her functioning in Axis V, the patient scores a GAF of 60(current). Her overall level of functioning is okay considering the fact that she could reason fairly well with the manager at the time that she refused to take breakfast in the common room. However, her occasional incoherent speech and hallucinations makes her to need help. Axis VI has no diagnosis. The patient seems to suffer from depression as well. This illustrated from the point that she would walk to the beach alone and when she was rescued, she stated that “I did all I could”. It implies that she has guilt feelings concerning past events, most likely the long illness and eventual death of her husband.. Mrs. Kay should be treated for depression. A psychiatric evaluation should be done to assess the impact that the death of her husband had on her mental status. Insight oriented therapy and long term cognitive behavior treatment would be appropriate in managing her mental condition. Also, she should undergo an alcohol rehabilitation program in order to manage her alcohol dependence. It should be noted that her mood disorder is induced by the abuse of alcohol and as such, managing the alcohol abuse would go a long way in rehabilitating the patient. The management of her alcohol consumption will set the ground for the recovery from the other mental disorders that affect the patient. 2. CASE STUDY: LIZ JONES In Axis I, it can be concluded that the patient was suffering from generalized anxiety disorder code 300.02. The informant, her second husband, states that she was worried during her ninth month of pregnancy that she wouldn’t survive childbirth and her husband may be forced to rear the child alone. This anxiety is reflected on her severe loss of appetite and lethargy. She also would not concentrate on handling her business due to short attention spans. It is also possible that she was suffering from adjustment disorder. The patient had two grown children from her previous marriage hence it was difficult for her to adjust into the idea of giving birth again after a long period. This is possible given that this was her second husband and several years may have elapsed since her she gave birth. In Axis II, the patient has a borderline personality disorder code 301.83. She exhibits a pervasive instability in her emotions. As the informant states, during her pregnancy she was often reserved and sulky. However after giving birth, she became jovial and she returned to high spirits like her former self. However, after a few weeks she changed again and exhibited unexpected desire for sex and had little affection towards the baby. After a few weeks, her mood transformed and went out with her girlfriends and seemed to have boundless energy. In fact, she was ready to open a bakery and she wanted to start the business as soon as possible. The informant also says that the patient declared that she was becoming God. In Axis III, there is no diagnosis. The patient does not suffer from any medical condition and as per the available information, she is healthy. The Axis IV analyses imply that there are no significant psychosocial and environmental problems. However, there may be underlying issues that have an emotional impact on the patient. Her fear and anxiety over the issue of giving birth may be a pointer to fear of discrimination or being negatively judged for having a baby after such a long time. In Axis V analysis, the GAF score is 40 (current). The functioning level of the patient is points out to a degree of impairment. When talking to the interviewer, the patient had bursts of energy and declared that she felt full of energy and at the best level of her life. However, the fact that she remembered where she bought her silk dress and the prevailing circumstances then show that she had a certain degree of control on her faculties. There is no diagnosis for Axis VI. The patient has memories of her past husband and she has not fully moved on. She needs to be counseled. Also, she should be advised on the issue of giving the required attention to the child since she is the biological mother. She seems to be in denial that her past relationship with the first husband was over and hence she should be counseled about this issue as well. 3. CASE STUDY: MARK SMITH The patient has disorders that were diagnosed at childhood level as evaluated on Axis I code 312.8 conduct disorder. He is temperamental and this is exhibited from as early as tenth grade. He used a pair of scissors to assault a fellow student who had teased him. He also broke the headlamp of the car belonging to a baseball coach who had ostensibly insulted him. In the Axis II, it can be diagnosed that the patient is suffering from antisocial disorder code 301.7. This disorder is manifest considering the fact that Smith moved from job to job due to lack of social acceptance from workmates. He was fired from his first two jobs due to fighting with his co-workers. After moving to the Army, he was discharged within six weeks due to assaulting his first sergeant with a bayonet. It should be noted that Smith was easily provoked by the merest of disagreements but he did not have a hint of bad will. In fact, he was apologetic of his actions. There is no diagnosis for Axis III on general medical conditions. The analysis of Axis IV shows that Smith has psychosocial and environmental problems. Smith grew up with an abusive father who battered his mother and this might have made Smith to have withheld anger against his father. The Global Assessment of Functioning as analyzed in Axis V show that Smith has score o GAF 60(current), a fair level of functioning. He was well aware of his actions and even showed regret for his unpredictable, explosive behavior. He was willing to put a handle on it and he was afraid of drinking. For axis VI, the patient recognized that his behavior had a problem and he was ready to correct it. The recommended treatment for the case of Smith is thorough counseling and closure on the issue concerning his abusive father. It is evident that the temperamental nature of Smith has its roots in the bottled anger that he has against his abusive father. Therefore, Smith has to come to terms with the issues of the past issues and move on. 4. CASE STUDY: MONIQUE MALLEY There is no diagnosis in Axis I code V71.09. The personality disorder in Axis II that is affecting the patient is paranoia code 301.0. Paranoid personality is characterized by suspicion and general distrust of other people. Ms Malley had given her fourteen year old child a diet consisting mainly of breast milk which was not appropriate at that age. When the baby was to be hospitalized, she objected and she threatened to sue the hospital arguing that they aimed to poison her baby. Also, she had anemia previously and she rejected medical opting to treat herself. She had distrust to the medical personnel since she claimed that she managed to get a perfectly healthy baby despite the predictions of her obstetrician to the contrary. She even refused vaccination for her baby Rasheed by claiming that vaccination is unnatural. She even had pamphlets to support her notion that it was unnatural to use medication and opted for natural treatment. She was paranoid that normal medication may harm her health and that of her baby. In the analysis of Axis III concerning general medical conditions as per code 316.0, Ms Malleys had suffered from anemia during her pregnancy this led to complications. She had also suffered from anemia ten years and refused to have medical treatment. These medical issues seemed to form the basis for the mental orientation of Ms Malleys that became distasteful of formal medication. This explains the reason why she refused to feed the baby on the non organic iron that was prescribed by the pediatrician and instead opted for natural breast feeding. The medical conditions made Ms Malleys to be obsessed with natural medication and have distrust towards professional medication. The psychosocial and environmental problems as analyzed in Axis IV have an impact on the patient. She is an African American and she is of the belief that the medication provided is more “western” and may not be suitable for the “African genes”. She has a conflict of cultures and a perpetual identity crisis. This makes her think that Africans require different medication as opposed to the readily available Westernized treatment. The Global Assessment of functioning score for the patient is 40(current) indicating that she has problems with her levels of functioning. She has been completely brainwashed to believe that hospital treatment was not effective. Her arguments were coherent and consistent although they were based on questionable data. She appeared to show no element of disorganized speech or tangential conversation. In fact, she was cognizant of the differences between her and the mother. The effect of the brainwashing is evident from her statement that she was ready to lose her child instead of feeding her on iron which she believed poisoning. In Axis VI, she seems to have a consistent line of argument and belief. Ms Malleys should be counseled and enlightened concerning the importance of proper medication to the health of both her and the baby. The situation is critical and it may be necessary for her to be put under mandatory psychiatric medication. 5. CASE STUDY: ELLEN FARBER Considering Axis I, the patient has eating disorders code 307.1. She has had the problem of binge eating and the situation escalated due to recent financial difficulties. The problem of binge eating has resulted in her adding over 20 pounds of weight in a few months’ time. Also, the patient has anxiety disorder due to uncertainties concerning her life long goals and friends. In Axis II, the patient suffers from denial relating to paranoia, code 301.0. She describes a debt of $ 100,000 as a “small amount of money”. From the information available, there is no diagnosis in Axis III. The social life of the patient has problems. The diagnosis in Axis IV is that she has problems related to her social environment. She had many quick and intense relationships with both men and women but her temperamental nature ensured that they ended quickly. The lack of a social network made her lonely and susceptible to suicidal thoughts. In Axis V, her GAF score is 30. She has suicidal thoughts since she thinks of driving off a cliff. In Axis VI, she still has unresolved childhood conflicts but she exhibits the will to overcome her indifferences. The recommended treatment plan for the patient is behavioral therapy. She should undergo behavior remedy to check on her eating habits. Also, it is appropriate for her to undergo counseling on financial management so as to salvage herself. Read More