Assessment and Diagnosis in Mental Health - Case Study Example

Assessment and Diagnosis in Mental Health: Case Vignettes Submitted by [Client’s Name] Submitted to [Professor’s Name] In partial fulfillment of the course syllabus in [Subject] [Date] Case Vignette I A person’s mental and psychological health can be easily established by following the outline proposed by DSM-IV TR. By following the outlined classifications, the identification of the mental and psychological disorders together with the underlying causes. Below is the multi-axial assessment on the case of Jane Bainbridge. Axis I – Depression (Major depressive attitude), Substance (cocaine) abuse and dependence, corpolalia (excessive swearing), hostility, and conduct disorder Axis II –Paranoid Personality Disorder, Borderline Personality Disorder, Axis III - None Axis IV – Suspension from Work, in-between unhealthy relationships, unsafe and unhealthy neighborhood, history of sexual abuse Axis V – None Outline of Decision-Making Process Jane Bainbridge has exhibited characteristics in three of five axes in DSM-IV TR. The multiaxial DSM-IV TR assessment for Jane Bainbridge is generated upon careful classification of the case vignette presented where her psychosocial characteristics and personal history are detailed. The following are the justifications for each of the five DSM-IV TR axes: Axis I – Depression and Major Depressive Attitude – Major Depressive Attitude is used in categorizing one or more depressive attitudes without history of manic and hypomaniac episodes. Bainbridge was admitted for depression and she has exhibited depressive disorders in various occasions. She exhibit episodic symptoms of major depressive attitude like sad and irritable mood, sleep disturbance, weight loss, loss of interest and pleasure, decreased energy, restlessness, free-floating anxiety, low self esteem and a sense of futility, guilty ruminations, a number of somatic complaints, and frequent suicide attempts. She was also clinically diagnosed for depression. Because of the absence of historical manic and hypomanic depressive attitudes, her condition qualifies for major depressive attitude. DSM-IV TR categorized all types of substance abuse under one umbrella. Substance abuse is characterized by less severe and prolonged use of drugs with the awareness of the negative consequences of such actions. Bainbridge dealt with her depression and major depressive behavior by taking cocaine and showing signs of substance abuse. Substance dependence on the other hand is classified by DSM-IV TR as the act of taking large amount of the substance with historical failure of quitting. Bainbridge has exhibited indiscriminate use of alcohol, benzodiazepines and cocaine. This substance abuse leads to substance dependence to deal with her depressive attitudes. Ms. Bainbridge has a serious conduct disorder as reported by many of her various psychiatrists. She was reported to have deliberately ignored all treatment programs proposed to her and has exhibited extensive disregard to the rules by showing promiscuity and emotional instability which often escalates to acting out towards her psychologists. All other codes that are not attributed to mental disorder but are considered for treatment are included in Axis I. Some of the disturbing characteristics exhibited by Bainbridge not attributed to mental disorder but are seriously considered for treatment includes copulalia or excessive swearing and hostility. Axis II – This axis includes all psychological disorders in adults and mental retardation. Bainbridge has exhibited at least two psychological disorders that are qualified in the axis II of DSM-IV TR which are paranoid personality disorder and borderline personality disorder. Paranoid personality disorder is in the Cluster-A disorder which includes Schizoid Personality and Schizotypal Personality disorders. Borderline Personality Disorder on the other hand belongs to Cluster-B disorder which includes Antisocial and Narcissistic personality disorders. In the case of Ms. Bainbridge, her paranoia and tendencies to exhibit borderline personality issues qualifies her for Axis II categories. She admits of her nagging paranoia and her inability to trust people as was seen in her inability to form platonic and other forms of social bonds. She is clinically diagnosed of borderline personality disorder. Axis III – While Ms Bainbridge has lived an interesting life, she does not have had any physical and mental conditions that could have aggravated any of the Axis I and Axis II conditions. Axis IV – Axis IV is a list of stressors that could have contributed to the first three axes. These stressors are categorized to psychosocial and environmental factors. There are various psychosocial and environmental factors that contributed to the alleviation of the conditions of Ms Bainbridge. There were at least four major psychosocial and environmental factors that were selected. These are suspension from work, in between relationships, unsafe and unhealthy neighborhood, and history of sexual abuse. Her suspension from work may have escalated her depression and her drug dependence. While there is no account on the degree of her dependence on and abuse of drugs, there is a strong indication that the removal of her license to practice nursing and the associated socioeconomic consequence has deeply aggravated her drug dependence. Working in between relationships with reported incidents of sexual molestation of her partner towards her daughter could have contributed to her paranoia, excessive swearing, and depression. It was reported that she was confused with whom to believe in the account that her daughter was raped by her partner. She also admitted of recalling her history of sexual abuse during her childhood which could have contributed to her paranoia. Also, the ease with which she can avail of the drugs (probably from her neighborhood) is also a contributing factor to her strong dependence on drugs. Conclusion The information provided on the possible case of Ms. Bainbridge can cause possible confusion on the type of diagnosis that will be given to her. However, with the aid of DSM-IV TR, all the mental and psychological illnesses are carefully categorized leading to effective long-term solutions to treat her demise. Case Vignette II The importance of a multi-axial assessment using the DSM-IV TR is that other, unrelated display mental and psychological oddity can be outlined and can be the basis for the right and appropriate diagnosis. Below is a case of possible psychological disorder but can be proven to be a non-delusional, factual and established concern. Axis I – None Axis II –Paranoid Personality Disorder, delusional disorder Outline of Decision-Making Process There are three possible diagnoses in Mr. Petersen’s case. These are paranoid personality disorder, delusional disorder, and psychological trauma. Paranoid personality disorder (PPD) is characterized by long-term suspicion and mistrust on other, particularly in situations where suspicion is not warranted. Among the major characteristics of people with PPD are alertness and habits of blame and distrust. They always believe that certain individual or the people around them constantly seek to demean, threaten, or harm them; they have difficulty relaxing, are highly stubborn and argumentative, read hidden meanings on innocent remarks and glances, and perceive attacks on their character that are not obvious to others (Dziegielewski, 2006). While there is no established cause for PPD, it is generally accepted that PPD is caused by a combination of biological and psychological factors. DSM-IV criteria for PPD includes at least any four of the following: suspects, without sufficient basis, that the others are exploiting, harming, or deceiving him; is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates; is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him; reads hidden demeaning or threatening meanings into benign remarks or events; persistence in bearing grudges; and has recurrent suspicions, without justifications, regarding the fidelity of spouse or sexual partner (Beck et al, 2003; 119). In the case of Mr. Petersen, he qualified in at least four of these misinterpretations except for the fact that he has a strong and logical basis of suspicion. Although delusional disorder is a broader psychological disorder where paranoia belongs (Munro, 1999), there are certain signs and symptoms that are exhibited by PPD patients that belong to the general context of delusional disorder. By definition, delusional disorder is characterized by non-bizarre delusions in the absence of psychotic or mood symptoms. General characteristics of schizophrenia are typically absent in related delusions. DSM-IV TR defines these delusions to have been more than a month in duration. Although transitory hallucinations were experienced by some of the patients coded as delusional, persistent hallucination typically does not occur. The existing subtypes of delusions include erotomanic, jealousy, persecutory, somatic, grandiose, and mixed and unspecified. According to DSM-IV TR, delusional disorder is: (a) a primary disorder and not secondary to another psychiatric condition; (b) is a stable disorder characterized by the presence of delusions to which the patient clients with extraordinary tenacity; (c) the illness is chronic and frequently lifelong; (d) the delusions are logically constructed and internally consistent; (e) and the disorder is monomania, with a predominant, persistent theme among others (Abdel-Hamid & Brune, 2008). People with delusional disorder are more in contact with reality than patients having other psychological disturbance. Their delusions are more likely based on half-baked truths (or half-baked lies) they have erected to protect themselves from unwanted psychological attacks. Mr. Petersen has exhibited a certain degree of realism and none of his usual characteristics are affected by his paranoia other than the nagging feeling that someone has to hurt him. Lastly, the mention of his experience in the Gulf War where he was rescued by a colleague from a vehicle about to explode indicates a possible psychological trauma. Psychological trauma occurs when the psyche is traumatized by an event whose psychological damage could lead to post-traumatic stress disorder (Brown, 2009). Usually, a person re-experiences the traumatic event mentally or physically after the trauma has occurred which can be often uncomfortable or annoyingly painful. People affected by post-traumatic stress disorder are typically diagnosed with mild psychosis and panic attacks. In some cases, patients resort to psychoactive substances like alcohol and drugs for escape. In the case of Mr. Petersen, the events in the Gulf War might have been a traumatic experience for him which could have altered his mental and psychological health. Because his mental and psychological faculties were impaired, the recent events could have triggered him to recall everything that took place before. Among the three possible diagnoses for Mr. Petersen, it is highly likely that what he is experiencing right now is a delusional disorder. The development of Mr. Petersen’s delusions was based on strong and reliable grounds. His involvement in the conflict at work placed him in a difficult position where he is a very likely target for harassment and threats. Besides, clinical results indicate that he is mentally and psychologically sound which eliminates the possibility of paranoia disorder. Conclusion While it is highly likely that Mr. Petersen has delusional disorder, it is also highly probable that his concern for his life is grounded on solid evidences. With the aid of DSM-IV TR, possible treatment and intervention programs can be easily drawn to resolve these mental and psychological concerns. References Abdel-Hamid M, Brüne M. (2008) Neuropsychological aspects of delusional disorder. Curr Psychiatry Rep. 10(3):229-34 Beck, A., Freedman, A. & Davis D. (2003). Cognitive Therapy of Personality Disorders. Second Edition. The Guilford Press Brown, A. (2009). Posttraumatic stress disorder in childhood. New York: American Academy of Experts in Traumatic Stress. Dziegielewski, S.F. (2006). Psychopharmacology for the non-medically trained. New York: Norton Publishers. Munro, A. (1999). Delusional Disorder: Paranoia and Related Illnesses. Cambridge University Press. . Read More