Question

For this Discussion, review the client in the case study within the Learning Resources. Consider symptoms or signs presented by the client for a diagnosis. Think about how you, as a future professional in the field, might justify your rationale for diagnosis. Consider what other information you may need for diagnosis on the basis of the DSM diagnostic criteria.

Trauma and Stressor Related Disorders

FEMALE SPEAKER: Well, I just keep thinking what if something happens? I mean I've always had trouble concentrating. But this time, it's different.

FEMALE SPEAKER: Different, how?

FEMALE SPEAKER: Well, you know how like you were talking on your cell phone or something and it cuts out. You lose the connection. It's kind of like that. My mind just goes blank.

And when I'm at the hospital and it happens, I flip out. I could give the patient the wrong medication or something. What if it's early dementia? I mean I've read about that happening. I read an article just the other day about people in their 30s and 40s getting that. That's horrible.

FEMALE SPEAKER: It sounds like you're constantly nervous that you'll go blank and that something bad will happen. You mentioned having other symptoms. Like what?

FEMALE SPEAKER: Well, at work, my temper. I flip out on patients sometimes and on other nurses. I just freak out. I even started snapping at my daughter. And that has never happened before.

FEMALE SPEAKER: Well, I understand. You're feeling anxious. And you're having some temper issues, which are sort of out of character for you. How are things going at home?

FEMALE SPEAKER: Well, I'm not sleeping very well at all. One of my favorite things used to be to curl up at night with a book. But I can't concentrate. I have this whole stack of books by my bedside table. I mean they're history books. And I love reading about history. But I haven't even touched them.

And my husband got so upset the other day because he brought me this kit for scrap-booking, which is something I used to really enjoy doing. But I just took them back to the store. I could not deal with that either.

FEMALE SPEAKER: Well, it seems like you're not finding relaxation in the things that used to enjoy doing. Now, when you returned your husband's gift, you said that you couldn't deal with that. What exactly couldn't you deal with?

FEMALE SPEAKER: The expense. You have no idea what these scrap-making materials cost. I could spend that much in groceries in a week. And I thought—So that I lie in bed at night at 3:00 AM worrying about, just money, money, money, money, money.

And my husband and I both work. We work really long hours. But it's just not enough. We really should have started saving for college. I mean my eldest is going to start college in a few years. And I don't know what we're going to do. We don't have the money.

FEMALE SPEAKER: Did you talk to your husband about your concerns?

FEMALE SPEAKER: Yeah. Yeah. We talk. Alex, my husband, he's 12 years older than me. I mean we get along fine.

But I worry about him. I mean at work for example, he's been up for this really big promotion. But now it looks like he's not going to get it. And his health, he's got a whole history of early heart attacks in his family. And I just worry about that. I mean he hasn't shown any symptoms or anything. But I really, really, worry that one day something might happen to him. I mean the whole thing just feels like a awful. With care reform now, what if they cut back on my hours at work? And what if I lose my job? Doctor, I cannot afford to lose this job.

FEMALE SPEAKER: Any idea how long you've been having these symptoms, the lack of concentration, trouble sleeping, problems relaxing?

FEMALE SPEAKER: A while. Off and on, I guess. I went to see a counselor when I was in nursing school. I was Ms. Overachiever. I was making straight A's, but I couldn't help but worry that it was never enough.

FEMALE SPEAKER: It sounds like you were feeling the pressure of trying to achieve your career goals. Did the counseling help you?

FEMALE SPEAKER: Yeah. Yeah. I guess it did. I mean I went for a couple of months. And the counselor had me do this body scan exercise. And he suggested I should start meditating. But who had time to meditate. I was too busy making straight A's

With these thoughts in mind:

1. A diagnosis of the client in the case study.

2. Then explain your rationale for assigning this diagnosis on the basis of the DSM diagnostic criteria.

3. Finally, explain what other information you might need about the client to make an accurate diagnosis based on those criteria.

Answer 1

Answer 1. Provisional Diagnosis of the client in case study on the basis of available information according to my opinion is Generalised anxiety disorder.

Answer 2. After stating each category of DSM5 diagnostic criteria for Generalised anxiety disorder I will be giving the explanation in view of this particular case in question- DSM 5 states

A. Excessive anxiety and worry occuring more days than not for at least 6 months,about a no. Of event and activities.

Explanation- In this case the client is worried about no. Of issues like husband's health issues, child's college fees and further education,husband's promotion in work,about financial matters etc. She has somewhere stated that she had visited the counselor for more that couple of months which shows the problem is persisting from many months ,but exact duration could have been asked.

B.The individual finds it difficult to control the worry.

Explanation- even after taking help from counselor,meditating,she states that she could not help worrying continuously.

C.The anxiety and worry are associated with three of the following six symptoms.1. restlessness or feeling keyed up or on the edge.

2. Being easily fatigued

3. Difficulty concentrating or mind going blank

4. Irritability

5. Musle tension

6. Sleep disturbances

Explanation- in this case the client is having restlessness, difficulty in concentrating, irritability,sleep disturbances.

D. The anxiety ,worry or physical symptoms cause clinically significant distress or impairment in social, occupational or other imp areas of functioning.

Explanation- the client in case had difficulty in her work ,she said she could not perform well in her clinics and feared she would go blank while prescribing meds to her patients. She had stop persuing her hobbies and had started being irritabel on her daughter and everyone around.

E. Disturbances is not attributable to psychological effect of substance or other medical condition.

F. Disturbance is not better explained by another mental disorder.

Answer 3. More information that I would like to know for making accurate diagnosis is the duration of illness, personal history including menstrual history,history of any medical illness in the past as in thyroid dysfunction or hypertension, etc. Also if client has any addiction potential or abusing any substances,which may cause anxiety.

History of any other medicines use in the past.

Would like to know about her appetite. Any negative thoughts,ideas of hopelessness or worthlessness. Any suicidal thoughts?

Any family history of mental illness.