4.1-1 Based on the intake information alone, which psychiatric disorders seem most likely? What type (s) of information will you be interested in during the initial interview to help you narrow down the choice of diagnoses?
Several psychiatric disorders may lead to hyperactivity, such as attention deficit hyperactive disorder and bipolar disorder. The information to evaluate during the interview includes the regularities of the hyperactivity as well as whether the patient is aware of their actions.
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4.1-2 To what extent do you think Helen may be a danger to herself? What other information would be useful in determining her risk?
Helen may be of considerable danger to herself based on depressive feelings. Additional information that would be useful in determining Helen's risk of being a danger to herself includes her relationship with her sister and husband.
4.1-3 What would you like to know about Helen's social support system? Are there any steps you would take, (given the client's permission) to assure that her support system stays intact?
I would like to know her relationship with her close friends and family, as this will help me determine the most appropriate support system. If given the permission, I would contact those close to her depending on the information given, and emphasize their role as support systems.
4.1-4 What internal and external strengths do you see in Helen's case?
Internal strengths in Helen's case include her love for her daughter as well as her willingness to acquire psychological assistance. An external strength is her support system.
4.1-5 What is your primary diagnosis?
Based on the varying mood swings and extends of hyperactivity and depression, my primary diagnosis is bipolar I disorder. Additionally, the patient has revealed severe manic symptoms that forced her immediate hospitalization.
4.1-6 What specifiers would you include in your diagnosis?
The first specifier is the mixed features specifier that reveals the current and recent episodes of the patient. Helen is currently experiencing manic symptoms as well as depression, while her recent episodes include hypomania with symptoms of anxiety and depression. Additionally, the rapid cycling reveals that she has had more than four moods episodes during the year.
4.1-7 What psychological and cultural factors could impact your diagnosis?
Examples of psychological factors that could impact the diagnosis include the patient's emotion comprehension and ruminative tendencies, while a cultural factor includes the ethnic group from which the patient emerges. African Americans experience relatively intense manic episodes as compared to other ethnicities.
Case Study 4.2
4.2-1 At this point in the interview, what diagnosis you considering? What information do you feel you need to complete your initial assessment?
Based on the fact that the patient had been admitted to a hospital for four weeks and was prescribed lithium drugs, my initial diagnosis is bipolar II disorder due to the more prominent episodes of extreme depression and hypomanic episodes as well. Lithium is considered a mood stabilizer and hence my diagnosis. Information necessary to complete my initial assessment includes the duration of the depressive episodes as well as intensity of the manic symptoms and family history.
4.2-2 Discuss how much support Connie is likely to receive from her family of origin. Preliminarily, do you have any thoughts about how that support could be maximized?
According to information provided by the patient, Connie is likely to receive minimal support from her family of origin based on misconceptions regarding mental and psychiatric illnesses. My thoughts concerning how the support can be maximized are including the patient's siblings in the treatment as well as her mother who will play a significant role in her recovery.
4.2-3 From this preliminary interview, it would seem that Connie does not have much social support from Southfork. How would you go about exploring that issue? How important do you think securing local support could be?
Despite the patient's reservations about socializing in the new environment, I would recommend involvement in local community activities that concern her children as well as interactions that are facilitated by motherhood. Securing local support is crucial as it helps improve the psychological well-being of an individual diagnosed with bipolar II disorder and hence effective management of the issue.
4.2-4 What is your primary diagnosis?
My diagnosis is bipolar II disorder, as the patient's episodes are characterized mostly by longer episodes of depression and hypomanic episodes, whereby they last for a shorter duration. Additionally, other factors such as family history and the constant suicidal thoughts further support my diagnosis.
4.2-5 What specifiers would you include in your diagnosis?
The most significant specifier is melancholic features, which the patient depicts through her severe depressive symptoms, feelings of extreme guilt and the lack of pleasure in activities she once enjoyed. Similarly, the patient expressed rapid cycling which she switched completely to the depressive mode which facilitated her admission in hospital.
4.2-6 What psychological and cultural factors could impact your diagnosis?
The most dominant psychological factor that can impact the diagnosis is depression. This is revealed in the patient's suicidal thoughts, constant anxiety regarding her pregnancy and children as well as the feelings of despair. A cultural factor that can significantly impact the diagnosis is the cultural beliefs of Connie's family of origin.
Case Study 6.1
6.1-1 At this point, what kind(s) of disorders do you think Gloria might have?
At this point, I think the patient might have two kinds of disorders namely anxiety and depression. Depression causes symptoms such as shakiness, which Gloria experiences. Anxiety, on the other hand, is characterized by signs such as chest pain and shortness of breath, which led to Gloria being prescribed Xanax to relieve panic disorders temporarily.
6.1-2 What further information would you want to get from Gloria the next time you meet with her?
The next time I see Gloria I would like to get information regarding her lifestyle choices regarding physical activity and healthy eating and attitudes towards such aspects of treatment as relaxation techniques and meditation. Moreover, I would like to gain insight into her perception of joining support groups for individuals with anxiety and her ability to stop the panic attacks through engaging in recreational activities that will divert her mind from her worries. This information will help me better identify the most appropriate approach to cognitive behavioral therapy.
6.1-3 What are some of Gloria's strengths?
From the initial encounter, Gloria's self-confidence was evident in her conduct and speech. Similarly, from the first session another strength that was apparent was her organization and kindness as she proved to be open, engaging, and considerate of her husband's feelings and hence obsessed with perfection. She is also compassionate and self-aware, as depicted in her relationship with her husband's son and her view towards her husband carrying her to hospital respectively.
6.1-4 Would you want to see Gloria with her husband, for a session? Why or why not?
Yes, I would like to have a session with both Gloria and her husband present due to several factors. First, John, Gloria's husband, is a primary support system for the patient and thus a person of interest in the therapy process. Attending this session will allow him to understand Gloria's situation and in turn avoid any form of miscommunication or misunderstanding of Gloria's condition. Second, understanding John's perception of Gloria's episodes and general outlook towards his wife will help with identifying how to address Gloria's concerns regarding him.
6.1-5 What is your primary diagnosis for Gloria?
My primary diagnosis for Gloria is panic anxiety disorder based on her symptoms, which include increased heart rate, general weakness, and fatigue, especially during the morning hours.
6.1-6 List cultural and psychological factors that may impact Gloria's diagnosis.
Cultural factors that may impact the diagnosis include the prevalence of anxiety disorders among Caucasian females in society. While this may be considered a medical bias, I have experienced a significant number of Caucasian females with generalized anxiety disorder, social anxiety disorders, and panic disorders. Additionally, a psychological factor includes self-directedness, which will positively impact Gloria's treatment.
