1. For each case provide a complete and accurate diagnosis for each vignette. Give code, diagnosis and relevant descriptors and specifier(s). * Please note that you must come to a consensus within your group as you will be turning in one copy of this exam to the professor with all of the names from the group listed on the title page. (Think about this from the perspective of being a member of an interdisciplinary treatment team.)
2. Identify/list any patient strengths across the ecological spectrum (micro-macro) that you can utilize to help build a successful treatment plan. Here are a few examples.
3. ***Make sure to justify your diagnosis with the symptoms.
-high cognitive function (micro) -recognizes problem (micro)
-high initiative for seeking help (micro) -girlfriend is supportive(messo)
-healthy family bonds (messo) -mental health insurance (macro)
• Hint 1. may have a comorbid diagnoses.
Jessica is a 24-year-old engineering graduate student who was referred for an urgent mental health evaluation after she confided to her best friend that she was making plans for suicide. Jessica has a history of mood symptoms that were under good control with lithium and sertraline, but her depressive symptoms returned 3 months ago after leaving home and beginning graduate school in a new community. Her friend reported that Jessica has become preoccupied with ways in which she could kill herself without inconveniencing others. Her dominant suicidal thoughts involved shooting herself in the head while leaning out the window so not to cause a mess in the dorm. Although she does not have access to a gun, her browser history indicates that she has been looking at places where she could purchase one.
Jessica’s mental health challenges began when she was 15. She began to regularly drink alcohol and smoke marijuana, usually when out clubbing with friends. Both of these substances calmed her and she denied that either had become problematic. She has not used any alcohol or marijuana since beginning graduate school.
Around age 17, she began experiencing brief, intense, depressive episodes marked by tearfulness, feelings of guilt, anhedonia, hopelessness, low energy, and poor concentration. She would sleep more than 12 hours a day and neglect responsibilities at school and at home. These depressive episodes would generally shift after a few weeks into periods of increased energy, pressured speech, and unusual creativity. She stayed up most of the working on projects and building prototypes. These revved-up episodes lasted about six days and were marked by feelings that her friends were turning against her and that they had not really been friends at all. Worried especially about the paranoia, her family took her to a psychiatrist, who diagnosed her with Bipolar II disorder and prescribed lithium and sertraline. Although Jessica’s moods did not completely stabilize on this regimen, she did well enough at a local university to be accepted into a prestigious graduate program far away from home. At that point, the depression returned and she became intensely suicidal for the first time.
Upon evaluation, the LCSW observed Jessica was visibly depressed, tearful and had psychomotor slowing. Jessica acknowledged that it was very hard to get out of bed and she for the most part; she has not been attending classes. She described feeling hopeless, having poor concentration, and guilt about spending family money for school when she is not able to do well. She has been experiencing suicidal thoughts almost daily and is unable to find anything to distract her. She denied any recent drinking of alcohol or cannabis use as she does not feel like “partying.” She has profound feelings of emptiness, and indicated that she occasionally cuts her arm superficially to “see what it would feel like.” She further noted that she knew cutting her arms this way would not kill her. She reported depersonalization and occasional panic attacks. She denied having mood instability, derealization, problems with impulsivity, concerns about her identity, and fears of abandonment.
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