Applying Differential Diagnosis to Depressive and Bipolar Disorders: case study Alex

 
What is it truly like to have a mental illness? By considering clients’ lived experiences, a social worker becomes more empathetic and therefore better equipped to treat them. In this Discussion, you analyze a case study focused on a depressive disorder or bipolar disorder using the steps of differential diagnosis.
To prepare: View the TED Talk “Depression, the Secret We Share” (TED Conferences, LLC, 2013) and compare the description of Andrew Solomon’s symptoms to the criteria for depressive disorders in the DSM-5. Next review the steps in diagnosis detailed in the Morrison (2014) reading, and then read the case provided by your instructor for this week’s Discussion, considering the client against the various DSM-5 criteria for depressive disorders and bipolar disorders.
By Day 3
Post a 300- to 500-word response in which you address the following:

Provide the full DSM-5 diagnosis for the client. For any diagnosis that you choose, be sure to concisely explain how the client fits that diagnostic criteria. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, medical needs, and the Z codes (other conditions that may be a focus of clinical attention). Keep in mind a diagnosis covers the most recent 12 months.
Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis.
Recommend a specific evidence-based measurement instrument to validate the diagnosis and assess outcomes of treatment.
Describe your treatment recommendations, including the type of treatment modality and whether or not you would refer the client to a medical provider for psychotropic medications.

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Morrison, J. (2014). Diagnosis made easier (2nd ed.). New York, NY: Guilford Press.
Chapter 11, “Diagnosing Depression and Mania” (pp. 129–166)
American Psychiatric Association. (2013e). Depressive disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm04
American Psychiatric Association. (2013c). Bipolar and related disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm03
Jain, R., Maletic, V., & McIntyre, R. S. (2017). Diagnosing and treating patients with mixed features. Journal of Clinical Psychiatry, 78(8), 1091–1102. doi:10.4088/JCP.su17009ah1c
Diagnosing and Treating Patients with Mixed Features by Jain, R.; Maletic, V.; McIntyre, R., in Journal of Clinical Psychiatry, Vol. 78/Issue 8. Copyright 2017 by Physicians Postgraduate Press. Reprinted by permission of Physicians Postgraduate Press via the Copyright Clearance Center.
Walton, Q. L., & Payne, J. S. (2016). Missing the mark: Cultural expressions of depressive symptoms among African-American women and men. Social Work in Mental Health, 14(6), 637–657. doi:10.1080/15332985.2015.1133470
Required Media
TED Conferences, LLC (Producer). (2013). Depression, the secret we share [Video file]. Retrieved from https://www.ted.com/talks/andrew_solomon_depression_the_secret_we_share
TEDx Talks. (2013a, May 23). Depression is a disease of civilization: Stephen Ilardi at TedxEmory [Video file]. Retrieved from https://youtu.be/drv3BP0Fdi8
Optional Resources
American Psychiatric Association. (2013b). Assessment measures. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.AssessmentMeasures
Santiago-Rivera, A. L., Benson-Flórez, G., Santos, M. M., & Lopez, M. (2015). Latinos and depression: Measurement issues and assessment. In K. F. Geisinger (Ed.), Psychological testing of Hispanics: Clinical, cultural, and intellectual issues (2nd ed., pp. 255–271). Washington, DC: American Psychological Association. doi:10.1037/14668-014
Thase, M. E., Weisler, R. H., Trivedi, M. H., & Manning, J. S. (2017). Utilizing the DSM-5 Anxious Distress specifier to develop treatment strategies for patients with major depressive disorder. Journal of Clinical Psychiatry, 78(9), 1351–1362. doi:10.4088/JCP.ot17015ah1
Utilizing the DSM-5 Anxious Distress Specifier to Develop Treatment Strategies for Patients with Major Depressive Disorder by Thase, M.; Weisler, R.; Trivedi, M.; Manning, J., in Journal of Clinical Psychiatry, Vol. 78/Issue 9. Copyright 2017 by Physicians Postgraduate Press. Reprinted by permission of Physicians Postgraduate Press via the Copyright Clearance Center.
Document: Suggested Further Reading for SOCW 6090 (PDF)

Note: This is the same document introduced in Week 1.
Case Study Alex (APA format and citations)
 
Week 6
CASE OF ALEX 
INTAKE DATE: May 2019  
DEMOGRAPHIC DATA: 
This is a voluntary intake for this 53-year-old Caucasian female. Alex had one psychiatric hospitalization in the past. Alex has been married for 19 years and has been separated from her husband, Richard, for the past four months.  Richard, her 18 year old daughter, and two sons, 14 and 13 years old, live two blocks from her.  Alex is employed as a car salesperson manager and is very successful at her career. 
CHIEF COMPLAINT: 
“I miss my family and do not want to live without them.  My family believes if I attend treatment we can get back together.” 
HISTORY OF ILLNESS: 
About two years ago Alex began having trouble sleeping.  She would find herself waking up worrying about her job performance even though she was getting accolades from her superiors.  She would calm down then worry about sending her daughter to college which would be followed by her two sons.  Alex would spend a lot of time wondering if she did a good job raising children since her work took a lot of time from the family.  Her worries jumped from one thing to another and she was unable to control that.   
Over the past six months, she realized her mood was becoming depressed, with the inability to sleep well.  This contributed to her always being fatigued and interfered with her concentration.  She became very irritable with her husband and children, enough so that Richard asked her to leave the house.  This increased Alex’s worry about being a good parent.   
Once she left the house she did not want to do anything and barely visited with the children, which concerned her tremendously.  She found herself not sleeping or eating healthy and put on 20 pounds.  She has convinced herself that she is a bad mother and questions even being a parent.  She came for treatment when she began having passive suicidal thoughts again. 
PAST PSYCHIATRIC HISTORY: 
Alex reports first seeking psychiatric treatment when she was twenty-four-years-old.  She sought treatment by the encouragement of her boyfriend at the time because she was not active and did not want to do anything other than work.  She describes she was not “addicted” to work but that is all the energy she had.  She barely had the energy to get to work, had trouble sleeping at night always worrying about her “job, employees, making others happy, what is happening in the world”.   Her boyfriend at the time would become frustrated because after dating for 2 years Alex just did not have any interest in fun activities and socializing.  She was employed at the car dealership and was on the upper mobility track but worried because she was not as focused as she needed to be to get promoted.  Alex was prescribed an antidepressant, her mood stabilized, and she did not continue psychiatric help. 
In 2000, soon after her marriage to Richard, Alex attempted suicide when she had the same feelings as she did 10 years ago and did not want to go through that again.  She was hospitalized in a psychiatric unit for twelve days.  Alex showed signs of feeling down, fearful, and suicidal. Once stabilized Alex realized she was pregnant with her first child.    
PSYCHOSOCIAL HISTORY: 
Alex grew up in a typical working class household with both parents working in a factory.  Her dad was eventually promoted to foreman.  Mom and Dad would have different shifts, so it was rare that they would have dinner together.  Alex has nice memories about Sundays since the family would go to church and have a nice dinner.  Many of the relatives would gather each week at a different house.  Alex has 6 siblings. Alex was initially considered an underachiever in the early years of school. She chose not to attend college because she wanted to get out in the workforce for money.        
SUBSTANCE USE HISTORY:   
Alex indicates she is a social drinker.  Through collaborative contact with her husband, he confirms she is a social drinker.  
MEDICAL HISTORY: 
Alex has no significant medical history. She has had the normal childhood illnesses. 
FAMILY ISSUES AND DYNAMICS: 
Alex is currently married with three children, one daughter, and two sons.  This is her only marriage.  Through collaborative discussion with her husband, he indicates Alex is a great mom and good provider.   
More recently, Alex would become very irritated and have angry outbursts.  Richard believed this was due to her lack of sleep.  By the end of January, she was asked to leave her home.    
MENTAL STATUS EXAM: 
Alex presents as a neatly dressed female who appears younger than her stated age.  Her nails are neatly manicured.  Facial expressions are appropriate to thought content.  Motor activity is appropriate.  Thoughts are logical and organized.  There is no evidence of hallucinations.  Alex admitted to a history of a suicide attempt years ago.  Her mood is flat.  During the interview, Alex became teary eyed often.  Alex is oriented to time, place, and person.  Her intelligence appears above average.   

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