Question

HINT: This Chapter is on Substance-Related and Addictive Disorders so the final daignosis should come from that chapter in the DSM-V

Instructions: Read the case study, The Coffee Shop Waitress, on pages 155-157 in the textbook. Then complete the following sections of the diagnostic report. This assignment should be no more than 5 pages long.

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 2 The Coffee Shop Waitress

Janelle is a 53-year-old widowed Caucasian female who began individual therapy three months ago in a women’s outpatient substance use treatment program as a self-referral. She wants to quit drinking once and for all and also get help for a deepening depression. She reports having been “depressed” since the death of her second husband four years ago (of a heart attack), but this has gotten worse in the past six months as she has tried to stop drinking. Janelle has abused alcohol on and off since she was 15. She takes no other drugs. Janelle’s father and one of her uncles were alcohol abusers, and her adult daughter (age 29) drinks heavily.

When Janelle began individual therapy, she reported having drunk approximately 10 beers a day during a previous nine-month time span, which ended six months ago (after which her depression began to worsen). During that time, she drank in larger and larger amounts to achieve the desired effect, despite the fact that she was aware of the possible negative effects on her health. Janelle states that her impulse to drink was strong whenever she tried to stop and that she experienced spells of shaking when she went without alcohol. Janelle reports having abused alcohol for many years before that, but not on a daily basis. She was more of a “binge drinker,” drinking mixed drinks in bars and at home to the point of passing out, alone or with friends, once every week or two. Janelle currently reports having abstained from alcohol for the past six months, except for two episodes of binge drinking since she began treatment one month ago. These episodes were related to being alone and feeling lonely.

Janelle admits to feeling “terrible” about herself, because she drank so much at times. “I must be a real weakling to have to rely on alcohol and not be able to quit. I’m certainly not very attractive in that condition.” In addition to the issues related to her drinking, Janelle reports intense feelings of loneliness that she attributes to a long-term sadness due to the loss of her second husband.

Janelle also has a serious physical condition. She was diagnosed with type II diabetes eight years ago and currently adheres to a special diet to control that illness. She reports several past hospitalizations due to dehydration, which frequently occurs in persons with type II diabetes. Janelle reports that she must be sure to drink enough liquids and watch out for symptoms such as dizziness and feeling weak. Janelle has also experienced episodes of nausea and vomiting since undergoing stomach surgery for an ulcer four months ago. Her doctor had told her to expect periods of nausea related to her stomach condition. Janelle reports that she used to “love food,” but since the stomach surgery she has experienced a decreased appetite and general lack of interest in food. She finds this very frustrating and admits that “now and then” she “forgets” about her diet and just eats what she wants, even though she may feel ill afterward. Physicians have warned her that drinking alcohol is hard on her stomach, and although this serves as a motivator for her to stop, she still can’t “just do it.” She sees her medical doctor regularly but cannot sustain the treatment plans he initiates with her.

Janelle is currently working as a waitress at a coffee shop. She seems to have a strong work ethic and has had a variety of jobs throughout her adolescent and adult life. They are all unskilled jobs, as Janelle has only a high school diploma and never “sets out to work in one place for too long, because my kids have always needed me.” Her three children are adults now, but she is highly involved in the lives of her two grandchildren, often caring for them. Janelle misses work occasionally due to oversleeping or being hung over, but she has never lost a job due to this behavior. She states that she is considered to be “likable” and a “good worker.” She adds that “working has been especially helpful since my husband died,” because it keeps her mind off her sadness. She admits that if she doesn’t have to go to work in the morning, she tends to lie in bed alone for many hours, feeling preoccupied with her sadness and crying about her lack of “purpose” in life.

Janelle currently lives alone in an apartment. She is in regular contact with her children. Although her family relationships provide her with support, they are also sources of stress in Janelle’s life. Her children make frequent and last-minute demands on her time for child care and financial assistance. Janelle currently has a romantic partner, who is separated but still involved with his wife. She views this relationship as shallow and temporary, and she wonders if she will ever again be close to a man. In addition to still grieving the loss of her second husband, she is also mourning the recent death of a good friend. Janelle currently has few friends, and although her church community is a possible source of support, she is not currently very involved with it. Janelle does not have regular transportation and must rely on friends and family in order to meet this need.

Despite her current stresses she enjoys some activities, most notably fishing and cooking. She values her role as a grandmother. Janelle also maintains a sense of humor about her physical health, her often stressful relationships with her children, and her overall life situation.

Janelle grew up in a rural community in the mountains of Virginia. She was raised and continues to identify as Baptist. She considers herself a religious person, and she attended church regularly in the past. Janelle’s household featured emotional and physical family violence. Her father was alcohol-dependent and physically and emotionally abusive toward Janelle, her two brothers, and her mother. Janelle identifies using alcohol as one way she learned to cope with the trauma and stress of her family situation. Even adolescents easily obtained alcohol in her community,, and Janelle states that she began to enjoy the “buzz” from whisky and wine soon after she began drinking. She and her friends often drank in each other’s homes and in the nearby woods and were rarely caught or confronted about their activity.

Shortly after graduating from high school, Janelle married a man she believed would be a “good provider.” She states that her attraction to the man, whom she never knew “too well,” abated after a year or so, but she stayed in that emotionally abusive marriage for 20 years, because “I had kids then.” He berated her as a wife, parent, and person. Janelle worked a series of unskilled part-time jobs during those years and says she was never happy. She saw her life as “all stress and all work.” She was prone to spells of extreme hopelessness in which she stayed in bed, wished that she could die, and wondered why there was nothing “pleasurable” in her life. Janelle reports that in the past six months, and at several other times in her life, she experienced symptoms such as low mood, fatigue, feelings of worthlessness, excessive guilt, and trouble falling asleep.

Answer 1

Client strengths--The female(janelle) is a middle age coffee shop waitress who recently faced a lot of problems regarding her health due to excessive alcohol and beer drinking and later on developed depression ,anxiety and stress related to the diagnosis of diabetes.The patient has a history of marital abuse although there is no report of marital discord and divorce and has gone through two marriages and both the husbands are dead now. The patient has developed mental strength and determination to overcome the bad habit of drinking and craving developed in the brain of her after so many of years of intoxication and damage to organs due to excessive alcohol intake.

Client limitations--The reward centres of the brain get accustomed accordingly to the habit of drinking with false perceptions,hallucinations and hysteria after the entering of alcohol in the brain regions after passing through the blood-brain barrier and leading to the destruction of the cells and neurons of the brain.Further the thinking and analysing capability of the person also gets affected and their are defects in locomotory motion of the person.The action potential and voltage of the impulse generated due to suppression of brain regions leads to excessive secretion of serotonin,acetylcholine, and dopamine leads to a condition of depression,stress and anxiety along with development of bipolar syndrome, autism, social seclusion and isolation with lack of care in old age with no friend or relative or children to take care of her although she has three children and grandchildren but all were living separately and away from her.The speech gets altered with stammering and their are visual, olfactory defects in old age associated with the persistent habit of drinking along with neurodegeneration of muscles due to wasting away and degradation of collagen,accumulation of lactate.The neuromuscular junctions become hyperactive and more polarized leading to the mechanisms of pain,twitching and uncontrolled involuntary muscular movements due to work stress,load and hypertension.The brain develops cravings with repeated developments of thoughts and perceptions related to the enjoyment and hysteria caused after the intake of alcohol due to the activation of beta-adrenergic receptors in the brain with agonist and antagonistic action analysed with the action of mood elevator drugs, barbiturates and sedatives which causes the inhibition of persistent and excessive signaling in the brain with development of false perceptions and beliefs in the brain.

Differentials and Diagnosis--Type DSM-V depressive disorder, seizures and pain with withdrawal of alcohol,bipolar disorder,autism,feeling of loneliness and seclusion,nervousness, weakness of muscles and nerves with pain,and degeneration of organs due to toxicity and loss of vision in old age.