The Different Types of Mental Health Diagnoses

Description of Problem 

Ms. Callaway is a 36-year-old woman, working as a teacher. Although she lives with her partners, along with their two children, Ms. Callaway is going through a divorce. She claims that her insurance has changed, and she needs a new provider. Despite having a four-year history of visiting a psychiatrist, Ms. Callaway’s symptoms have been stable for the last three months. Despite the psychiatrist visits and medical prescription, Ms. Callaway exhibits hyperactive and attention difficulties both at home and in the workplace. Ms. Callaway depicts symptoms of inattentions; she is very forgetful with multiple cases of forgetting items like her keys or phone. In addition, she also reports being disorganized. Ms. Callaway finds difficulties in finishing projects and tasks in school and at home. Ms. Callaway also experiences impaired concentration at work, describing herself to be inattentive. She finds difficulties listening when spoken too directly. The short attention span combined with the disorganization has resulted in most of Ms. Callaway's tasks being incomplete. Ms. Callaway currently displays a decreased level of concentration, isolative behavior, decreased level of interest in doing things she enjoyed previously. The depressive symptoms are affecting Ms. Callaway’s level of control. She denies having any suicidal thoughts or hallucinations. Ms. Callaway also lacks any form of an eating disorder. Ms. Callaway has a psychiatric history of depression, attention deficit hyperactivity disorder (ADHD), anxiety, and bipolar disorder. 

The Client’s Vulnerabilities 

Ms. Callaway has had a history of depression. Over the years, she has displayed various depressive disorder symptoms including poor energy, decreased concentration, isolative behavior, and decreased interest in performing activities that she previously enjoyed. Ms. Callaway was brought up in a family with mental health problems. Ms. Callaway’s father was diagnosed with depression. Children brought up by parents with depression are more predisposed to behavior problems and psychopathology, particularly higher rates of depression as well as greater functional impairment (“ Parental Depression: How it Affects a Child ”, 2020). The different parent-child interactions, as a result of depression, causes children to develop mental and behavioral problems. Therefore, Ms. Callaway’s father’s depressive condition must have affected the patient as a child. Besides, with two of Ms. Callaway’s sisters suffering from ADHD, the patient is more prone to suffer from the problem. The patient has also displayed generalized symptoms of anxiety. Ms. Callaway has always been worrying about events and activities. In addition to excessive worrying, Ms. Callaway showcases other symptoms, including difficulty in sleeping, difficulty in relaxing, restlessness, and difficulty in concentrating. While previous episodes of generalized anxiety disorder have been treated, Ms. Callaway’s history of anxiety disorder combined with being brought up by a parent with depression predisposes her to the recurrent of the generalized anxiety disorder. Ms. Callaway has also been previously diagnosed with other mental health disorders, including ADHD and bipolar. Ms. Callaway has other chronic medical problems in the form of seizure and neuropathy. Neuropathic pain is evident through sensory and affective disturbance. Depression and impaired cognition are some of the affective disorders associated with neuropathic pain. Depression, in many instances, is the magnification of pain in various conditions, including musculoskeletal pain, post-stroke pain, and Parkinson’s disease, among others (Torta et al., 2017). Therefore, by suffering from seizures and neuropathy, Ms. Callaway is exposed to neuropathic pain, and hence more predisposed to depression and ADHD, among other affective disorders that coexist with affective disturbances. 

The Client’s Triggers 

Ms. Callaway’s chronic medical problems are one of the primary triggers of mental health issues. There has been an association between psychological symptoms and seizure, with the primary link being the possibility of shared etiology, stigma, and psychosocial factors related to seizures. Also, psychiatric comorbidity is prevalent among patients with epilepsy (Mufaddel, 2014). Ms. Callaway's epileptic condition can be a trigger for various psychiatric conditions, including depressive disorder, anxiety disorder, and attention deficit hyperactivity disorder (ADHD). Due to her epileptic condition, Ms. Callaway may suffer from depression and anxiety as pre-ictal, inter-ictal, and ictal symptoms (Mufaddel, 2014). Furthermore, antiepileptic drugs have been known to cause psychiatric symptoms, particularly depression and anxiety, as side effects. Neuropathic pain can also trigger depression and anxiety in Ms. Callaway. Depression is an indicator of pain in conditions associated with neuropathy, such as chronic musculoskeletal pain, multiple sclerosis, and post-stroke pain, among others (Mufaddel, 2014). Furthermore, the patient might is also manifesting depressive disorder and anxiety symptoms due to the relationship conflict with her partner. Ms. Callaway is currently going through a divorce, despite the fact that she still lives with her partner. Resultantly, the patient has developed stress and anxiety that has translated to depressive disorder. 

Core Beliefs 

Ms. Callaway is worried that her insurance changed, and she has to find a new one, despite attending psychiatric sessions for the last four years and being stable for the last three months. The patient faces multiple stress triggers that make her future uncertain. Aside from the insurance problem, Ms. Callaway is also dealing with a divorce. There she is uncertain about her medical cover in the future as well as her marriage and family. These events have let to the development of stress and anxiety, which has resulted in excessive worrying, lack of sleep, restlessness, and impaired concentration. Therefore, the patient has developed depressive disorder and general anxiety symptoms due to the recent occurrences in her life. Aside from the current conditions, Ms. Callaway is medically predisposed to various mental disorders, including anxiety, depression, ADHD, and bipolar. Ms. Callaway's family is associated with depressive disorder and ADHD. Besides, the patient’s medical history shows that she has been previously diagnosed by various mental health problems. Therefore, the combination of the current events in her life, in addition to the high predisposition levels puts the patients at a high risk of suffering from depression and anxiety. Ms. Callaway believes that her anxiety is triggered by multiple elements, and her family’s history is one of the factors that contribute to her current state of mind. 

The Most Central Thought the Client is Avoiding 

The patient is avoiding the fact that she still needs psychiatric assistance and the possibility of the recurrence of her previously diagnosed conditions. During the psychiatric visit, the patient is worried about the change in her insurance despite consistently visiting a psychiatrist and being stable for the last three months. The subject feels that she is in a better position compared to the past when she was diagnosed with various mental health disorders. However, she believes her lack of concentration, inattentions, lack of sleep, and loss of interest and as a result of the development of anxiety about events and activities in her life. The patient is trying the fact that she is going through a divorce, given the fact that they still live together. She refuses to accept the fact that she is worried about the uncertainty in her marriage and her nuclear family. 

Differential Diagnosis 

Separation Anxiety Disorder 

According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition), there are eight diagnostic criteria for separation anxiety disorder. Separation anxiety disorder is a developmentally inappropriate and extreme anxiety about separation from people who matter to the patient (American Psychiatric Association, 2013). Ms. Callaway could be experiencing a separation anxiety disorder in the form of recurrent excessive distress as a result of anticipation of a separation from her partner due to divorce. The anxiety experienced by the patient could also be a result of the excessive fear of being alone or without her partner. 

Diagnosis 

Generalized Anxiety Disorder 

The patient seems to be having Generalized Anxiety Disorder (GAD) as depicted by the excessive anxiety and worry about events and activities in her life (American Psychiatric Association, 2013). The patient has at least four symptoms associated with GAD. Aside from excessive worrying, the patient also experiences sleep disturbance. The patient is also experiencing difficulties in concentrating, which has affected her functionality in other tasks. The attention deficit has led to moderate impairment of Ms. Callaway’s functioning. Ms. Callaway is disorganized and lacks adequate concentration levels to complete tasks at home or in school. The patient was diagnosed with GAD, also due to the development and persistence of fatigue and loss of energy. The anxiety and worry have caused clinically significant distress, particularly with the impairment of the social functioning of the patient, which has led to isolative behavior (American Psychiatric Association, 2013). Furthermore, anxiety is not attributed to the physiological effect of a substance, such as drug usages or medication. 

Major Depressive Disorder 

Major depressive disorder is mainly characterized by depressed mood and loss of interest or pleasure. A patient often develops depressed moods almost on a daily basis, as depicted by either the subjective report or an observation (American Psychiatric Association, 2013). Reduced interest in all or about all activities most of the days. Ms. Callaway has lost interest in doing the things she used to enjoy. A major depressive disorder patient also experiences insomnia or hypersomnia, almost on a daily basis (American Psychiatric Association, 2013). Ms. Callaway has difficulty falling asleep. Other symptoms include the diminished ability to think or concentrate, and fatigue or loss of energy almost on a daily basis. The patient has a short attention span and does not seem to listen when spoken to directly. Furthermore, Ms. Callaway experiences a persistent loss of energy. The combination of these symptoms has negatively affected Ms. Callaway’s functionality in various aspects of life. 

Attention Deficit Hyperactivity Disorder (ADHD) 

While there are three different types of symptoms for ADHD: difficulty in paying attention, being overactive, or acting without thinking, Ms. Callaway’s diagnosis is predominantly based on difficulty in thinking. The symptoms get in the way of functioning due to impaired concentration and multiple distractions. 

Coping Strategies 

The patient has a good plan for self-care in the form of a crisis aversion plan. Therefore, by being future-oriented and prepared, Ms. Callaway has tried to address her anxiety and depression disorders. In addition, Ms. Callaway has developed a protective structure around her, in the form of family support and therapeutic alliances. Her family can always be there for her in the event she needs their help. In addition, the patient has been attending psychiatric sessions for the last four years. She is also under medication to help contain and de-escalate her anxiety and depressive disorders. 

Treatment Plan 

Ms. Callaway will be treated as an outpatient. She would have only been admitted if she showed suicidal characteristics, which were not evident in the report (Bandelow et al., 2017). The treatment will combine supportive psychotherapy and pharmacotherapy. Psychotherapy was primarily used in addressing problems as a result of life stressors. Through psychotherapy, the patient was educated about medication and the benefits of adherence. In addition, the session was used to sensitize the patient about the importance of an effective social support network. Furthermore, Ms. Callaway was exposed to relaxation techniques that would help her manage her anxiety. Other aspects in the form of the diet, exercise, and sleep routine were also discussed in the session. The patient was advised on how to maintain a healthy lifestyle by adopting better diet choices. The patient was advised about the importance of incorporating fish oil in her diet. Ms. Callaway was advised against eating food high in carbohydrates and fats. To address symptoms including fatigue, lack of sleep, and impaired concentration, the patient was advised to diet and exercise regularly. Smoking contributes to the development of ADHD. Therefore, the patient was sensitized about the dangers of smoking and the potential benefits of stopping. 

Pharmacotherapy was also employed in the treatment plan. To treat the major depressive disorder, Ms. Callaway was using Effexor XR 75mg. However, the patient received a stronger prescription in the form of Effexor XR 150 mg, which would be taken every morning for the next month. While there is no cure for ADHD, existing treatment can help reduce symptoms and improve functioning. The ADHD medication often targets to reduce hyperactivity and impulsivity and improve the patient’s ability to focus. A stimulant was used due to its effectiveness in increasing the brain chemical dopamine, which is vital in facilitating thinking and attentiveness. Since Ms. Callaway was already using Adderall 30 mg, she received a refill of the same to help manage ADHD. 

As a general treatment principle, patients must be informed about the potential side effects of medication, safety warnings, and contraindications (Bandelow et al., 2017). Therefore, Ms. Callaway was advised about the potential effects of using the current medication, which included risks to the fetus, such as atrial septal defects, gestational hypertension, and fetal pulmonary hypertension, among others. The patient was also advised about birth planning and the use of contraceptives when using psychotropic medications. In addition, the patient was also advised to make follow-ups with her primary care provider. 

References 

American Psychiatric Association. (2013).  Diagnostic and statistical manual of mental disorders (DSM-5®) . American Psychiatric Pub. 

Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders.  Dialogues in clinical neuroscience ,  19 (2), 93. 

Mufaddel, A. (2014). Epilepsy and its Management in Relation to Psychiatry.  Int J Neurorehabilitation ,  1 (121), 2376-0281. 

Parental Depression: How it Affects a Child . (2020). Retrieved 30 May 2020, from https://www.yalemedicine.org/conditions/how-parental-depression-affects-child/ 

Torta, R., Ieraci, V., & Zizzi, F. (2017). A review of the emotional aspects of neuropathic pain: from comorbidity to co-pathogenesis.  Pain and Therapy ,  6 (1), 11-17.