Please select whichever case analysis that you are comfortable with but make sure that you follow every detailed instruction that has been provided. There needs to be 5 complete pages not including the cover and reference pages.
American Psychiatric Association (Ed.). (2013). Anxiety disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA:
American Psychiatric Association (Ed.). (2013). Depressive disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, V
American Psychiatric Association (Ed.). (2013). Obsessive-compulsive and related disorders. In Diagnostic and statistical manual of mental disorders
NIH: National Institute of Mental Health. (2016, June). Brain stimulation therapies.
Harrigan, S. (Director), & Microtraining Associates (Producer). (2015). Bipolar disorders [Video file].
Harrigan, S. (Director), & Microtraining Associates (Producer). (2015). Depressive disorders [Video file].
Harrigan, S. (Director), & Microtraining Associates (Producer). (2015). Obsessive-Compulsive disorders [Video file].
Hinshaw, S. P., Pizzagalli, D. & Masterson, J. F. (Academic). (2006). Out of balance [Video file].
Microtraining Associates (Producer). (2015). Anxiety disorders [Video file].
Ricketts, T. (Practitioner). (2003). Scared to leave home [Video file].
RDF Media Group (Producer). (2007). The secret life of a manic depressive: Part 1 [Video file].
RDF Media Group (Producer). (2007). The secret life of a manic depressive: Part 2 [Video file].
Lebow, J. (2006). From research to practice, the verdict is clear. Psychotherapy Networker, 30(1).
Wenzel, A., Schmid, S. P., & Beck, A. T. (2006). AAMFT clinical update: Phobias. Family Therapy Magazine, 5(4), 36-44. [PDF document
Wilson, R. (2000). Everyday courage: Helping anxious clients open the door to uncertainty. Family Therapy Networker, 24(5).
Mary, S. W. (2003). Why is this man smiling? A self-described grouch is trying to turn happiness into a science. Psychotherapy Networker, 27(1).
Abramowitz, J. S., (2009). Couples Therapy for OCD. When OCD Becomes a Family Affair.
Pittenger, C. (2014). Therapy or Medication? What Research Tells Us About the Best Options For OCD Treatment.
Diagnose and Recommend Treatments for Depressive, Bipolar, Anxiety, Obsessive-Compulsive, and Related Disorder
Please read the three vignettes and choose one client from the three presented to write a case analysis with potential treatment options. After you read through and select your client, provide a diagnosis, an alternative/rule-out diagnosis, and a comprehensive treatment plan that explores psychopharmacological options, individual psychological treatment, family therapy, and biomedical treatments like electroconvulsive therapy (ECT).
Yvonne Perez is a 23-year-old woman who presented for an outpatient psychiatric evaluation two weeks after giving birth to her second child. She was referred by her breastfeeding nurse, who is concerned about the patient’s depressed mood, flat affect, and fatigue.
Ms. Perez said she has been worried and unenthusiastic since finding out she is pregnant. She and her husband planned to wait a few years before having another child, and her husband made it clear that he would have preferred that she terminate the pregnancy, an option she would not consider because of her religion. He was also upset that she was “too tired” to do paid work outside of the home during her pregnancy. She has become increasingly dysphoric, hopeless, and overwhelmed after the delivery. Breastfeeding is not going well, and she has begun to believe her baby is “rejecting me” by refusing her breast, spitting up her milk, and crying. Her baby has become very colicky, so she feels forced to hold him most of the day. She wonders whether she deserves this difficulty because she did not want the pregnancy.
Her husband is gone much of the time for work, and she finds it very difficult to take care of the new baby and her lively and demanding 16-month-old daughter. She sleeps little, feels constantly tired, cries often, and worries about how she is going to get through the day. Her mother-in-law has just arrived to help her care for the children.
Ms. Perez is an English-speaking Hispanic woman who has worked in a coffee shop until midway through her first pregnancy, almost two years ago. She was raised in a supportive home by her parents and a large extended family. She moved to a different region of the country when her husband was transferred for work, and she has no relatives nearby. Although no one in her family has seen a psychiatrist, several family members appeared to have been depressed. She has no prior psychiatric history or treatment. She denied illicit drug or alcohol use. She has smoked for several years but stopped when she was pregnant with her first child. Ms. Perez has a history of asthma. Aside from a multivitamin with iron, she takes no medications.
On mental status examination, Ms. Perez is a casually dressed, cooperative young woman. She makes some eye contact, but her eyes tend to drop to the floor when she speaks. Her speech is fluent but slow, with increased latency when answering questions. The tone of her speech is flat. She endorses low mood, and her affect is constricted. She denies thoughts of suicide and homicide. She also denies any hallucinations and delusions, although she has considered whether the current situation is punishment for not wanting the child. She is fully oriented and could register three objects but only recalls one after five minutes. Her intelligence is average. Her insight and judgment are fair to good.
Samuel King, a 52-year-old never-married janitor, presented for treatment of depression. He has been struggling with depressive symptoms for years and has tried fluoxetine, citalopram, and supportive psychotherapy, with minor improvement. He works full-time but engages in very few activities outside of work.
When asked how he feels, Mr. King says that his mood is low, he is unable to enjoy things, and he has insomnia, feelings of hopelessness, low energy, and difficulty concentrating and making decisions. He denies current suicidality but adds that several months several, he stared at subway tracks and considered jumping. He reports drinking alcohol occasionally but denies using illicit drugs.
When asked about anxiety, Mr. King says he is worried about contracting diseases such as HIV. Aware of an unusually strong disinfectant smell, the interviewer asks Mr. King if he has any particular cleaning behaviors related to the HIV concern. Mr. King pauses and clarifies that he avoided touching practically anything outside of his home. When further encouraged, Mr. King says that if he even comes close to things that he considered potentially contaminated, he has to wash his hands incessantly with household bleach. On average, he washes his hands up to 30 times a day, spending hours on this routine. Physical contact is particularly difficult. Shopping for groceries and taking public transportation is a big problem, and he has almost given up trying to socialize or engage in romantic relationships.
When asked if he has other worries, Mr. King said that he has intrusive images of hitting someone, fears that he would say things that might be offensive or inaccurate and concerns about disturbing his neighbors. To counteract the anxiety produced by these images and thoughts, he constantly replays prior conversations in his mind, keeps diaries to record what he says, and often apologizes for fear he might sound offensive. When he showers, he makes sure that the water in the tub only reaches a certain level for fear that if he is not attentive, he would flood his neighbors.
He uses gloves at work and performs well. He has no medical problems. He spends most of his free time at home. Although he enjoys the company of others, the fear of having to touch something if he is invited to a meal or to another person’s home is too much for him to handle.
The examination reveals a casually dressed man who smells strongly of bleach. He is worried and constricted but cooperative, coherent, and goal directed. He denies hallucinations and other strongly held ideas. He denies a current intention to hurt himself or others. He is cognitively intact. He recognizes that his fears and urges are “kinda crazy,” but he feels they are out of his control.
An African American man (who is later identified as Mark Hill), who appears to be in his 30s, was brought to an urban emergency room (ER) by police. The referral form indicates that he is schizophrenic and an “emotionally disturbed person.” One of the police officers said that the man offered to pay them for sex while in the back seat of their patrol car. He referred to himself as the “New Jesus” and declined to offer another name. He refused to sit and instead ran through the ER. He was put into restraints and received intramuscularly administered lorazepam 2 mg and haloperidol 5 mg. Intravenous diphenhydramine (Benadryl) 50 mg was readied in case of extrapyramidal side effects. The admitting team wrote that he has “unspecified schizophrenia spectrum and other psychotic disorder” and transferred him to the psychiatry team that worked in the ER.
Despite being restrained, he remained giddily agitated, talking about receiving messages from God. When asked when he last slept, he said he no longer needed sleep, indicating that he has “been touched by Heaven.” His speech is rapid, disorganized, and difficult to understand. A complete blood count, blood chemistries, and a toxicology screen were drawn. After an additional 45 minutes of agitation, he received another dose of lorazepam. This calmed him, but he still did not sleep. His restraints were removed.
A review of his electronic medical record indicates that he experienced a similar episode two years ago. At that time, a toxicology screen was negative. He was hospitalized for two weeks on the inpatient psychiatric service and given a discharge diagnosis of “schizoaffective disorder.” At that time, he was prescribed olanzapine and referred to an outpatient clinic for follow-up. That chart referred to two previous admissions to the county inpatient hospital, but records were not available after hours.
An hour after receiving the initial haloperidol and lorazepam, the patient is interviewed while he sits in a chair in the ER. He is an overweight African American man who is disheveled and malodorous, though he does not smell of alcohol. He makes poor eye contact, instead looking at nearby people, a ticking clock, the examiner, a nearby nurse—at anything or anyone that moved. His speech is disorganized, rapid, and hard to follow. His leg bounces rapidly up and down, but he does not get out of his chair or threaten the interviewer. He describes his mood as “not bad.” His affect is labile. He often laughs for no particular reason but gets angrily frustrated when he feels misunderstood. His thought process is disorganized. He has grandiose delusions, and his perceptions are significant for “God talking to me.” He denies other hallucinations as well as suicidality and homicidality. When asked the date, he responds with an extended discussion about the underlying meaning of the day’s date, which he misses by a single day. He remembers the names of the two police officers who brought him to the hospital. He refuses more cognitive testing. His insight and judgment appear poor.
The patient’s sister arrives an hour later, after having been called by a neighbor who saw her brother, Mark Hill, taken away in a police car. The sister says her brother seemed strange a week earlier, uncharacteristically arguing with relatives at a holiday gathering. She says he claimed not to need sleep at that time and has been talking about his “gifts.” She has tried to contact Mr. Hill since then, but he has not responded to phone, email, or text messages. She says he does not like to talk about his issues, but she has twice seen a bottle of olanzapine in his house. She knows their father has been called schizophrenic and bipolar, but she has not seen the father since she was a child. She says that Mr. Hill does not typically use drugs. She also says he is 34 years old and a middle school math teacher who just finished a semester of teaching.
Over the next 24 hours, Mr. Hill calms significantly. He continues to believe that he is being misunderstood and that he does not need to be hospitalized. He speaks rapidly and loudly. His thoughts jump from idea to idea. He speaks of having a direct connection to God and having “an important role on Earth,” but he denies having a connection to anyone called the “New Jesus.” He remains tense and jumpy but denies paranoia or fear.
Serial physical examinations reveal no abnormalities aside from blisters on his feet. The patient is not tremulous, and his deep tendon reflexes wearer symmetrical and graded 2 of 4. He shows no neurological asymmetry. His toxicology screen is negative and his blood alcohol level is zero. His initial lab results are pertinent for elevated blood urea nitrogen and a blood sugar level of 210 mg/dL. His mean corpuscular volume, aspartate aminotransferase/alanine aminotransferase ratio, and magnesium level are normal.
After you select your client, choose one of the two options available to complete this assignment:
Option 1: Write a paper that addresses the following:
Develop a diagnosis and a differential/alternative/rule-out diagnosis.
Substantiate each diagnosis and the rationale for ruling out the differential diagnosis, with evidence from the patient’s life.
Based on the primary diagnosis, describe the following four different treatments and whether it is a viable option for your client. Be specific: a) psychopharmacological treatments, b) psychological treatments, c) family therapy–based treatments, and d) biomedical treatments.
In a table format similar to the one shown below, compare and contrast the effectiveness and drawbacks of each treatment option.
Length: 5-7 pages, not including title and reference pages
References: Include a minimum of 3 scholarly resources
This paper should demonstrate thoughtful consideration of the ideas and concepts presented in the course by providing new thoughts and insights relating directly to this topic
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