This week, you have focused on key symptoms related to schizophrenia spectrum and other psychotic disorders. Now, in this Assignment, you practice diagnosing in this area.
This is your fifth practice in diagnosing mental disorders. When reviewing the case study, remember that social workers keep a wide focus on several potential syndromes, analyzing patterns of symptoms, risks, and environmental factors. Narrowing down from that wider focus happens naturally as you match the individual symptoms, behaviors, and risk factors against criteria and other information in the DSM-5-TR .
Here are a few tips or reminders:
· Catatonia is a specifier, although it does have a code. It even appears on a line of its own and may look like a code. However, it cannot be used as a diagnosis on its own.
· Remember to include all of the words that go with the diagnostic code.
Note: Remember that symptoms can occur in many disorders. As a result, all disorders in the DSM-5-TR covered up until this point may factor into your diagnosis (for example, as a possible additional disorder you diagnose).
Resources
Be sure to review the Learning Resources before completing this activity. Click the weekly resources link to access the resources.
WEEKLY RESOURCES
To Prepare
· Review the case study for this week.
· Start by familiarizing yourself with the disorders from the DSM-5-TR found in the Learning Resources this Week.
· Look within the noted sections for symptoms, behaviors, or other features the client presents within the case study.
· If some of the symptoms in the case study cause you to suspect an additional disorder, then research any of the previous disorders covered so far in the course.
· This mirrors real social work practice where you follow the symptoms.
· Review the correct format for how to write the diagnosis noted below. Be sure to use this format.
· Remember: When using Z codes, stay focused on the psychosocial and environmental impact on the client within the last 12 months.
ASSIGNMENT:
Submit your diagnosis for the client in the case. Follow the guidelines below.
· The diagnosis should appear on one line in the following order. Note: Do not include the plus sign in your diagnosis. Instead, write the indicated items next to each other.
Code + Name + Specifier (appears on its own first line) Z code (appears on its own line next with its name written next to the code)
Then, in 1–2 pages, respond to the following:
· Explain how you support the diagnosis by specifically identifying the criteria from the case study.
· Describe in detail how the client’s symptoms match up with the specific diagnostic criteria for the disorder (or all the disorders) that you finally selected for the client. You do not need to repeat the diagnostic code in the explanation.
· Identify the differential diagnosis you considered.
· Explain why you excluded this diagnosis/diagnoses.
· Explain the specific factors of culture that are or may be relevant to the case and the diagnosis, which may include the cultural concepts of distress.
· Explain why you chose the Z codes you have for this client.
· Remember: When using Z codes, stay focused on the psychosocial and environmental impact on the client within the last 12 months.
Week #7: Case Study
CASE of STUART
Intake Date: November xxx
IDENTIFYING/DEMOGRAPHIC DATA: Stuart is a 19-year-old, biracial male who was raised in Hugo, Oklahoma. Stuart’s mom is Caucasian, and his father is African American. Stuart has 3 siblings all younger than him. Stuart is in his first year at college and lives on campus.
CHIEF COMPLAINT/PRESENTING PROBLEM: Stuart presented in the emergency room (ER) having been brought in by his mother and a friend. Stuart indicated that he was having a strange experience – “I go into another world. I can hear people talking, but I can’t talk back. I can no longer trust my roommate – he is taking my food and hiding it”
HISTORY OF PRESENT ILLNESS: Stuart reports beginning to feel strange one month after he started school in August. He reports hearing voices outside his window in the dorm. It was an FBI agent calling his name. That is when he realized he cannot trust his roommate. He realized the roommate would put TV shows on that were referencing how Stuart was doing in his classes. His school papers were all over his room, and he could not organize them the way he wanted. At times, the FBI agents outside told him about his roommate.
In high school, Stuart socialized with his classmates and was engaged in leisure activities. He went to the senior prom and enjoyed the summer prior to college. Since coming to college, Stuart’s roommate reports that Stuart was socially withdrawn.
PAST PSYCHIATRIC HISTORY: Stuart’s mom does not report any psychiatric issues with Stuart in the past. His behavior was a typical teenage behavior, video games, dressing unusual, thinking in a way that differs from his parent’s beliefs.
SUBSTANCE USE HISTORY: Stuart denies consumption of alcohol or illicit drugs. He denies ever using chemicals that were not prescribed to him. Stuart reports now that he thinks about it, he is glad he never used drugs since drug dealers will kill their clients.
PAST MEDICAL HISTORY: Mother reports Stuart broke his arm at 7 years old. The arm healed successfully. Stuart had all his childhood shots, but she does recall her fear of his health early on when Stuart was 2 ½ weeks old he came down with a spring cold.
FAMILY MEDICAL AND PSYCHIATRIC HISTORY: There was no significant information about family history.
CURRENT FAMILY ISSUES AND DYNAMICS: Stuart was incoherent during most of the interview. He was able to indicate some history that was inconsistent with history taken from his mother. Mother indicated that Stuart was picked up several times within the past two months by campus police for “talking in public”.
MENTAL STATUS EXAM: Stuart presented as a casually dressed, unwashed young man. He has a fluctuating mood and an anxious expression on his face. Motor activity appeared agitated. Mood was anxious alternating with hostility and depression. Speech was pressured at times and inappropriately loud. His affect was inappropriate and at times blunted. Stuart’s thought processes were at times incoherent, and at times displayed a marked loosening of associations. He also reported bizarre delusions and auditory hallucinations. Stuart’s wishes for 5 years from now were unobtainable. Stuart is oriented to time, place, and person. Stuart can name 3 different objects correctly (bed, apple, shoe).
SUICIDAL/HOMICIDAL ASSESSMENT: Unable to ascertain.