Applied Differential Diagnosis Paper

Applied Differential Diagnosis Paper

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Assignment 1: SA—Applied Differential Diagnosis Paper

In this assignment, you will read a case study and use the DSM-5 to provide an accurate diagnostic profile, which includes your diagnostic rationale.  Give the diagnosis (diagnoses) appropriate for each case scenario.  You must use the case format for each case. You may use Provisionals, however, these cases have been picked in order to demonstrate typical clinical presentations of certain diagnostic categories.  So, trust yourselves and be assertive in making your clinical decisions.  Good luck!

Scenario:

CASE # 1 (150 points)

 

Samir is a 32-year-old, single, unemployed man who migrated from India to the United States when he was age 13. His brother brought him to the emergency room of a hospital after neighbors                       

complained that he was standing in the street harassing people about his religious beliefs. To the psychiatrist he keeps repeating, “I am Vishnu. I am Krishna.”   Samir has been living with his brother and sister-in-law for the past 7 months, attending an outpatient clinic. During the last 4 weeks, his behavior has become increasingly disruptive. He awakens his brother at all hours of the night to discuss religious matters. He often seems to be responding to voices that he only hears. He neither bathes nor changes his clothes.

 

The first time Samir was emotionally disturbed was five years ago. Medical records are not available, but from the brother’s account, the symptoms seem to be similar to the present symptoms. There have been two other times when he had symptoms, each requiring hospitalization for a few months. Samir admits that starting about 5 years ago and virtually continuous since then, he has been troubled by “voices” that he hears throughout the day. There are several voices, which comment on his behavior and discuss him in the third person. They usually are benign (“Look at him now. He is about to eat.”) or insulting in content (“What a fool he is. He doesn’t understand anything!”).

 

When Samir is not experiencing these symptoms, according to both his outpatient counselor and his brother, he is a quiet, somewhat withdrawn person, but popular in his neighborhood because he helps some of his elderly neighbors with shopping and yard work. At these times his mood is unremarkable. However, he claims that, because of the voices, he cannot concentrate sufficiently to hold a job. He sometimes reads books, but watches little TV, because he hears the voices coming out of the TV and is upset that the shows often refer to him.

 

For the past 6 weeks, with increasing insistence, the voices have been telling him that he is the new Messiah, Jesus, Moses, Vishnu, and Krishna, and should begin a new religious epoch in human history. He has begun to experience surges of increased energy, “so I could spread my gospel,” and needs very little sleep. According to his brother, he has become more preoccupied with the voices and disorganized in his daily activities.

 

When interviewed, Samir is very happy and his speech is rapid and hard to follow. He paces up and down the wards and, upon seeing a doctor, grabs his arm, puts his face within 2 inches of the doctor’s and talks with great rapidity and enthusiasm about his religious “insights.” In the middle of a speech on his new religion, he abruptly compliments the doctor on how well his shirt and tie match. When limits are placed on his behavior, he becomes loud and angry. In addition to his belief that he is the Messiah, he feels that the hospital is part of a conspiracy to suppress his religious message. Although he seems to enjoy his “voices,” he sometimes complains about them and makes references to “those damned voices.” He states that he feels his religious insights and energy have been placed into him by God.

 

 CASE # 2 (150 points)

 

Eight-year-old Tim was referred by a pediatrician who asked for an emergency evaluation because of a serious weight loss during the past year for which the pediatrician could find no medical cause.  Tim is extremely concerned about his weight and weighs himself daily. He complains that he is too fat, and if he does not lose weight, he cuts back on food.  He has lost 10 pounds in the past year and still feels that he is too fat, though it is clear that he is underweight.  In desperation, his parents have removed the scales from the house; as a result, Tim is keeping a record of the calories that he eats daily.  He spends a lot of time on this, checking and rechecking that he has done it just right.

 

In addition, Tim is described as being extremely concerned with cleanliness and neatness. Currently he has no friends because he refuses to visit them, feeling that their houses are “dirty”; he gets upset when another child touches him.  He is always checking whether he is doing things the way they “should” be done.  He becomes very agitated and anxious about this.  He has to get up at least two hours before leaving for school each day in order to give himself time to get ready. Recently, he woke up at 1:30 a.m. to prepare for school.

 

Assignments:

Submit Final Exam

Your Final Exam is referred to as a Learning Assessment System Assignment (LASA) and defined below:

LASA: Benchmark assignments are required components of this course and may not be deleted or modified in any way. All professors teaching this course must assign the benchmarks. All students taking this course must complete the assigned benchmarks. Data resulting from the benchmarks must be entered into the assessment system. The benchmarks and their assessments (i.e., grading rubrics) are below:

Final Exam – Final Exam (i.e., LASA) â€“  300 points

(150 points for each of the 2 cases)

Students will be given two cases and for each case are expected to:

• Identify symptoms (CMHC Specific Standards C.2, L.1, K.1.)
• Identify impairments (CMHC Specific Standards C.2, L.1., K.1)
• Formulate diagnostic hypotheses (CMHC Specific Standards C.2, L.1, K.1.)
• Apply the diagnostic criteria to several case studies CMHC Specific Standards C.2., K.1., K.2., L.1.)
• Provide differential diagnoses for each case (CMHC Specific Standards C.2., K.1., K.2., L.2)
• Provide a diagnosis(es) for each case (CMHC Specific Standards K.1., L.1., L.2.)
• Discuss medications that might be appropriate for each case as well as potential side effects of the medications (CMHC Specific Standard G.3.)
• Develop an appropriate treatment plan for each case that includes treatment objectives, long- and short-term goals, and treatment interventions as well as the appropriate treatment modalities and placement criteria within the continuum of care (CMHC Specific Standards C.7., G.1., K.2) Discuss additional adjunct services (i.e., skill development, focused counseling, personal growth, peer support groups, alternate care or living arrangements, professional services, other health related services, organizations for socialization and leisure activities, and governmental services) to which you would refer your client.
• Demonstrate quality in written exams, including rationale for diagnoses. 

You must use the case format for the exam!

GRADING RUBRIC FOR BENCHMARK ASSIGNMENT

Each case is worth 150 points:

1. Student correctly identified all relevant symptoms in the case (60  points)
2. Student correctly identified all relevant impairments in the case (50  points)
3. Student identified the correct diagnosis (diagnoses) for the case (60  points)
4. Student accurately applied the case material to the diagnostic criteria (60  points)
5. Student identified the essential features that differentiated the various differential diagnoses from the diagnosis being considered ( 60 points)
6. Student accurately identified whether psychotropic medication(s) were indicated given the diagnosis (diagnoses), and if so, the appropriate class of psychotropic medications given the client’s diagnosis and clinical presentation, and the potential side effects of the medication (5 points)
7. Student developed an appropriate treatment plan for the case (5)

 You Must use the DSM-5 as one of your Reference.

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