Instructions: Read the case study, In the Hospital, on pages 112-113 in the text
ID: 3488880 • Letter: I
Question
Instructions: Read the case study, In the Hospital, on pages 112-113 in the textbook. Then complete the following sections of the diagnostic report
Client strengths: All clients have strengths. What are these client’s strengths and how could they benefit his recovery and continued good mental health?
Client limitations: What potential limitations does this client possess in terms of his recovery and continued good mental health?
Differentials: List three differentials for each disorder you are considering, why you considered it, and why you rejected it. Your differentials should be rational, not random. For example, do not use Alcohol Use Disorder as a differential when the diagnosis is Major Depressive Disorder. The client should exhibit some symptoms of the disorder you use as a differential, but not enough to qualify for the diagnosis.
Diagnosis:List all DSM-V diagnoses and specifiers for the client in the case. Some will have only one disorder, others will have multiple diagnoses.
Rationale for diagnosis: Looking at the DSM-V criteria for each final diagnosis you select, provide your rationale for selecting that diagnosis.
Case 3 In the Hospital
Jay is an 18-year-old African-American male who has been treated since birth for hemoglobin SS, a form of sickle cell disease. Over the course of Jay’s life, he has been hospitalized multiple times with pain crises and acute chest syndrome, both common ailments of those with sickle cell disease. Jay presents upon this hospital admission this time with both of those conditions. The attending hematologist consulted the social work intern after Jay threatened to commit suicide if the doctor entered the room. Upon arrival, Jay allowed this social work intern into the room, where he continued to appear distressed, revealing that he felt as though he was “having trouble breathing.”
Jay lives with his mother and 10-year-old half brother in a poor, urban area. His biological father was murdered when he was four. His mother was recently diagnosed with breast cancer. She is currently single and employed as an administrative assistant at a federal government agency. Jay is enrolled in the 11th grade at a charter school for those who excel in the arts. He is actively involved in the dance team and expresses a desire to become either a professional dancer or a fashion designer after graduation. His recurrent hospitalizations have forced him to repeat one grade and are currently affecting his ability to finish coursework to graduate on time. His health insurance is covered through Medicaid, which provides him with a case manager who is actively involved in coordinating all of his services.
When asked by the social work intern if he was having thoughts of suicide, Jay denied actually wanting to act upon his thoughts, but knew that it would “get the doctor out of the room.” Jay reports that over the past eight months he has been having episodes where he feels like he is “out of control” and these affect his breathing, heart rate, and cause him to have diarrhea. He reports that he “does not like” the doctor on service who entered the room when he was actively having an episode and that he “said the first thing that [he] thought would make him leave.” He says that he feels like he is going to go crazy if he cannot get himself “under control.” He reports he has these episodes up to two times a week and is always on edge because of fear of having another one.
Jay reports that over the past eight months he has started consuming a larger amount of opioids to control his pain and anxiety. He says he wants a different doctor to see him, because the current physician will not increase the amount of medicine he needs to get his pain under control and stop the anxiety. In a family meeting, his mother stated that she has recently started keeping his pain medication in a lock box to keep Jay from consuming more than he should. Despite her best efforts, she reports that he sometimes finds a way to break into the lock box and obtain the pain medication.
During this admission, Jay told the social work intern that he is bisexual and has been in a relationship with a male student at his school for the past several months. He reports that he wants to reveal his sexuality to his mother, but fears she will have a negative reaction. He also reports that he has anxiety over his mother’s recent cancer diagnosis and has been cutting his arms with a kitchen knife when his emotions become “too strong.” The intern did not observe any visible signs of the reported cutting.
Jay reports a strong relationship with his maternal grandmother who provides some financial support to his family. He attends church weekly and often has the hospital chaplain come to pray with him during admissions. He reports having a strong social support network at school and says that he has a good relationship with his dance coach, who is trying to help him get into a training program after graduation. Several of his classmates have visited him during this admission, which he reports cheers him up.
He states that he is not currently sexually active with his boyfriend and is aware of safe sexual practices. He reports that recently, he has started smoking marijuana occasionally with his boyfriend and other friends at school, although he denies regular usage. He says he has a good relationship with his mother, but blames her for his sickle cell disease because it is a genetic disorder, and he inherited it from her side of the family. His mother reports that he often becomes very angry and yells at her when he does not get his way, saying that she is responsible for giving him anything that he wants because she gave him “this disease.” She dismisses Jay’s current symptoms of anxiety and says that he was a nervous child who has always been sick.
Jay admits being comfortable with the social work intern, but often says he does not want to become too close because “you will leave me just like everyone else ever has.” Jay believes that he is not responsible for most of his problems and associates much of his distress with his lifelong medical condition. He believes that his recent episodes of extreme anxiety are related to worrying too much about his mother’s cancer diagnosis and the possibility of revealing his sexuality to his mother.
Jay believes if he is able to come out to his mother, much of his anxiety will be relieved and some of his symptoms will subside. He knows that his fear of “going crazy” is sometimes irrational, but he feels like he loses all control when the symptoms begin, which causes him to spiral further out of control. He says he is open to receiving treatment, but prefers pharmacological agents to control the symptoms because these have helped calm him down in the past. His mother is also committed to being actively involved in improving Jay’s condition and hopes that treatment will improve his overall mental status.
Explanation / Answer
CLIENT STRENGTHS
CLIENT LIMITATIONS
DIFFERENTIALS
1. MILD OPIOID USE DISORDER
Jay has 2 symptoms out of the 11 given within the specifier, which include:
The diagnosis was not used as the criteria of time of 12 months aren’t fulfilled. Jay has been reported doing it since past 8 months
2. PSYCHOLOGICAL FACTORS AFFECTING OTHER MEDICAL CONDITIONS
The diagnostic criteria for in DSM 5 are:
A. Medical symptom or condition (other than a mental disorder) is present. ( Sickle cell disease)
B. Psychological or behavioral factors adversely affect the medical condition in one of the following ways:
C. ( in this case there were differentials and another diagnosis present)
The diagnosis was ruled out as there is presence of another mental disorder.
3.PANIC DISORDER
The criteria according to DSM-5 are:
A. Recurrent unexpected panic attacks (which has suddenly and has reported of so)
B. At least one of the attacks has been followed by 1 month (or more) of one or both of the following:
Panic attacks are defined by an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four or more of the following symptoms occur. The abrupt surge can occur from a calm state or an anxious state:
C. The Panic Attacks are not restricted to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism, cardiopulmonary disorders). ( in this case he has a medical condition sickle cell disease)
The diagnosis was ruled out as there is presence of a medical condition.
DIAGNOSIS
ANXIETY DISORDER DUE TO SICKLE CELL DISEASE
With specifier of general anxiety disorder and panic attack
(please mention all the criteria from your dsm 5 )
RATIONALE FOR DIAGNOSIS
The rationale being Jay has always associated his symptoms with his illness and panic attacks.
He also has generalized anxiety with relation to his mother’s illness, his fears and other things in general.