The Diagnostic and Statistical Manual of Mental Disorders

Kristy Shay is the patient, and she is 68 years old who presents to the clinic for psychotherapy. The patients stipulate that she is outraged since people appear from nowhere and are not assisting her in any way. Recently, the patients state that she lost her mother and has been more into drinking alcohol. The patient is irritable, sarcastic, and at times dismissive. She suggests that she is not happy being at the Harmon Rehabilitation center and strongly emphasizes that she does not drink alcohol. However, when the provider in charge provides evidence of her history with alcohol, she accepts that she must have done whatever is in the records. She admits that her mother's death in September 2019 was a blow in her life and has made her undergo depression. At times when the issue of her mother's death arises, she ends up shading tears. However, she is in denial of having any suicidal or homicidal thoughts. She is furious at anyone who tries to talks to her as she feels they are not of great assistance to her.      

Client's Vulnerability 

            The vulnerability of the patient is from losing her mother and being an alcohol addict. Kristy Shay grew up with her mother, and they have a close and tight relationship. The absence of her mother makes her feel lonely and incapable of accomplishing some tasks. She suggests that "the death of her mother makes her drink lots of alcohol." She is more oriented to person and year. Thus, the presence of her mother in her life made her feel complete. She is more oriented to the years as it is the same period that she lost her mother. The idea of losing her mother has made her an alcohol addict and, thus, more vulnerable. After her mother's death, people have been trying to console with her, and she feels that they are not offering her a reliable solution to her problems. The situation makes her vulnerable as she denies even drinking alcohol. Kristy Shay says that "that I cannot remember drinking alcohol." However, form the history report, she started drinking alcohol while she was in her 20s. she is single and does not have any children. That makes her vulnerable as she has no one left in her life.   

Client's Triggers 

            There are two primary triggers of Kristy Shay's condition. One is the thought of losing her mother in September 2019. When she remembers the death of her mother, she starts to scream and shed tears. It appears that the death of her mother has primarily impacted her life negatively. The thought that she is now alone and no close family members are a scary thought that she does not want to have. Another trigger is having people around her try to talk to her and give her the comfort she deserves. The patient feels they are no need for having such people around her as all she wants is to have her mother back. The fact that she is struggling with alcohol disorder is another trigger. Whenever Kristy Shay starts to drink, she remembers her mother' smother's death and the feeling she will not let e alone. She does not have friends from the workplace as she is unemployed and lacks someone close to share her problems with them. Her mother was like her support system as Kristy Shay was living alone and jobless. Her mother's absence makes her feel depressed as she is uncertain of who will assist her with her bills before she secures a job.  

Pt. Core Beliefs 

            Kristy Shay believes that she is not suffering from any condition and does not require help form anyone. She attests that being in the health care facility is making her uncomfortable and unhappy. Instead, Kristy Shay believes that she is in a Las Vegas hospital and not a rehabilitation facility. She even chases away those trying to talk to her as she thinks they are not giving her the needed solution. Kristy Shay is in denial of struggling with an alcohol disorder. She denies having an alcohol disorder in the past but later admits to drinking because of her mother's death. However, she believes that just like any other person, she id drinking to relieve herself from the stress and depression of losing her mother and not having close family members to lean on. He believes it makes her mad and irritable at times. She does not want to see anyone close to her or even try to talk to her. The patient believes that her life is okay and that being in the Harmon rehabilitation center is a mistake.   

Central Thoughts, Feelings, Memories, Sensations, and Situation 

            The central through that the patient is avoiding is that of losing her mother. Anything that reminds her of the death of her mother makes her go haywire. She feels that her mother was not supposed to die. All those who are consoling her don't know what they are doing. He denies having memories of drinking in the past but later on accept but cannot remember when she first started drinking and why she was drinking. She is irritated by her surrounding as she wants to be left alone. Her current situation is making her despise those who are pitying her life. She feels obligated and in charge of what should be taking place in her life. The rest of the people are juts interference and are just trying to control her life situation. She feels that other people are taking advantage of the current situation to gain control over her life.     

Differential Diagnosis 

Depressive and Bipolar Disorder 

Diagnosis 1: Moderate Depressive Disorder, single, severe within partial remission ICD-10 CM code F32.1 with situational anxiety and mixed features Z63.8, high expressed emotion level with family. 

Diagnosis 2: Moderate substance – Related and Addictive Disorder, with use disorder, moderate or severe, ICD-10 CM code F10.232 sever with perceptual disturbance Z56.9, other problems related to employment. 

According to the DSM-5, Kristy Shay meets the above two differential diagnosis because of the following characteristics. 

Alcohol is consumed in large amounts and for a much more extended period than it was intended. The fact that Kristy Shay has a history with alcohol disorder implies that she is consuming it in large quantities and cannot do without it.  

There is consistency in the desire to quit the behaviour (American Psychiatric Association, 2013). Kristy Shay has shown some willingness to quite the action since she is in denial. Being in denial means that she wishes she could do without the alcohol.  

Much of the time is spent on activities that are necessary for obtaining alcohol. After the death of her mother, Kristy shay is now consuming more alcohol and keeps on crying and cannot do anything else that is useful to her life.  

Diagnosis 

Major Depressive Disorder 

            From the assessment, the patient appears to be suffering from a major depressive disorder. That is evident from the irritable mood that Kristy Shay is having all the time. She does not have any interest in any daily activities and spends most of her time drinking. While Kristy Shay was in the hospital on 06/01/202, the patient was very lethargic, and most of the time, she is having an inappropriate guild. The guilt is towards her alcohol disorder condition, which she keeps on denying most of the time. She is equally having some recurrent thoughts of the death of her mother, which is worsening the conditions. The symptoms that Kristy Shay is having are not due to alcohol withdrawal; instead, they form a depression for losing a loved one and feeling lonely most of the time. For an adequate assessment of Kristy Shay's condition on the alcohol use disorder, two tools are necessary.  

            One of the tools is the alcohol dependence data questionnaire (SADD). The SAAD is precisely to determine the severity level of alcohol dependence (Hagman, 2017). The tool will assist in the determination of how much Kristy Shay is dependent on alcohol. The strategy mainly focuses on some of the withdrawal symptoms (Hagman, 2017). Kristy Shay does not report any form of withdrawal symptoms as she does not have any suicidal thoughts. On the other hand, the AUDIT will be useful in screening the possibility of being at risk of alcohol use disorder. The tool will reflect the level of alcohol consumption of Kristy Shay.  

Coping Strategies 

            Kristy Shay stipulates that she has been drinking heavily as one of the ways of coping with the pain of losing her mother. Being alone has been of great help as she does not want people around her to give advice all the time. There are no physical conditions that attribute to the unspecified mood of the patient. Changes in her attitudes are the other coping strategy as it makes people stay away from her as all she needs is time to be alone and drink to relieve herself.    

Comprehensive Treatment Plan 

            One of the strategies for the treatment is to incorporate the patient in the process. Engaging the patient means the use of cognitive-behavioral therapy. The goal of the treatment is to have an engagement talk with the patient to alter the negative thought and emotional response. The intervention will be critical in explaining to Kristy Shay how alcohol consumption has pushed her to make negative life choices and affecting her relationship with other people who are trying to help her. There is a need to engage the patient to understand better their issue (Jain, Maletic, and McIntyre, 2017). The elaboration will be on the behaviour that she has a presence. A comparison will be necessary for diagnostic tools. The journaling method is the best treatment strategy to engage Kristy Shay. The intervention will be towards journaling what she feels when she wants to discuss her alcohol drinking behaviour and discussion the death of her mother. She should be writing down what she feels like when she wants to drink alcohol and bring it up to be engaged in a discussion. Depression is a challenge to most individuals, and they are not aware of how best to handle the situation ("TED Conferences, LLC (Producer)," 2013). Talking to others is the best way to get rid of the case. There is a need to make Kristy Shay understand that people are trying to have a conversation with her are on her side.  

            The focus of the intervention will be on three main elements. The elements are behaviour, thoughts, and feelings. The feelings will be in handling through the journaling method. Ideas will be taken through the talks for Kristy Shay to speak out, and the behaviour will be dealt through elaboration to make her understand how dinking is negatively affecting her life and that of others around her. However, there are challenges in using the intervention. One of the critical issues related to AUD is the issue of relapse. Most people can control the intake of alcohol and live a good life (Stock, 2017). The ability to have control of oneself is what is vital. Thus, the abstinence-based treatment intervention will be the most effective. There is a strong belief that Kristy Shay will primarily benefit from medical treatment intervention. The medical treatment strategies suggest that the withdrawal symptoms result from the body's chemical imbalance (Walsh, 2019). The method will be safe and effective for Kristy Shay as she does not have the withdrawal symptoms from alcohol disorder, which makes the intervention easy to implement. Some of the resources that will assist Kristy Shay include various support groups in the local community, even after being discharged from the rehabilitation center.  

           There is also a need to have a one-on-one counselling session to reduce any relapse that may occur in the future. Equally, there is a need to connect with the family, which is the primary concern for Kristy Shay. Bonding is one of the traditional ways to make people open up their struggles and situation (Walton and Payne, 2016). Sometime should be for bonding between her and other close relatives who may not necessarily be from the nuclear family. The strategy will be useful in reducing the time she spends taking alcohol. Also, they will act as motivation to quitting the behaviour. Finally, SSRIs will be very useful in reducing depression symptoms. The SSRI raises the brain's serotine level, and there is the ease of transiting messages (Fookes, 2018). The drugs will make Kristy Shay be calm when having talks with others and reduce the mods relapse.   

References 

American Psychiatric Association. (2013). Depressive disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi: 10.1176/appi.books. 9780890425596.dsm04 

Fookes, C. (2018). Selective Serotonin reuptake inhibitor. Retrieved from: https://www.drugs.com/drug-class/ssri-antidepressants.html. Accessed 3 October 2020. 

Hagman, B. T. (2017). Development and psychometric analysis of the Brief DSM-5 Alcohol Use Disorder Diagnostic Assessment: Towards effective diagnosis in college students. Psychology of Addictive Behaviors, 31 (7), 797–806. doi:10.1037/adb0000320 

Jain, R., Maletic, V., & McIntyre, R. S. (2017). Diagnosing and treating patients with mixed features. Journal of Clinical Psychiatry, 78(8), 1091–1102. doi:10.4088/JCP.su17009ah1c 

Stock, A.-K. (2017). Barking up the wrong tree: Why and how we may need to revise alcohol addiction therapy. Frontiers in Psychology, 8, 1–6. doi:10.3389/fpsyg.2017.00884. 

TED Conferences, LLC (Producer). (2013). Depression, the secret we share [Video file]. Retrieved from https://www.ted.com/talks/andrew_solomon_depression_the_secret_we_share 

Walsh, L. (2019). Medication and Counseling Treatment . Retrieved from https://www.samhsa.gov/medication-assisted-treatment/treatment#medications-used-in- mat. 

Walton, Q. L., & Payne, J. S. (2016). Missing the mark: Cultural expressions of depressive symptoms among African-American women and men. Social Work in Mental Health, 14(6), 637–657. doi:10.1080/15332985.2015.1133470.