Social work clinicians keep a broad focus on several potential syndromes, analyzing patterns of symptoms, risks, and environmental factors. Narrowing down from that wider focus happens naturally as they match the individual symptoms, behaviors, and risk factors against criteria A–E and other baseline information in the DSM-5.
Over time, as you continue your social work education, this process will become more automatic and integrated. In this Discussion, you practice differential diagnosis by examining a case that falls on the neurodevelopmental spectrum.
Read the case provided by your tutor for this week’s Discussion and identify relevant symptoms and factors. You may want to make a simple list of the symptoms and facts of the case to help you focus on patterns.
Read the Morrison (2014) selection. Focus on Figure 1.1, “The Roadmap for Diagnosis,” to guide your decision making.
Identify four clinical diagnoses relevant to the client that you will consider as part of narrowing down your choices. Be prepared to explain in a concise statement why you ruled three of them out.
Confirm whether any codes have changed by checking this website: American Psychiatric Association. (2017, October 1). Changes to ICD-10-CM codes for DSM-5 diagnoses. Washington, DC: Author. Retrieved from https://www.psychiatry.org/psychiatrists/practice/dsm/updates-to-dsm-5/coding-updates
Post a 300- to 500-word response in which you address the following:
Provide a full DSM-5 diagnosis of the client. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, and the Z codes (other conditions that may be a focus of clinical attention). Keep in mind a diagnosis covers the most recent 12 months.
Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis.
Identify which four diagnoses you initially considered in the case of the client, using the DSM-5 diagnostic criteria to explain why you selected these four items. In one or two sentences each, explain why three of these diagnoses were excluded.
Explain any obvious eliminations that could be made from within the neurodevelopmental spectrum.
Describe in detail how the client’s symptoms match up with the specific diagnostic criteria for the primary disorder that you finally selected for him. Note two other relevant DSM-5 criteria for that illness from the sections on “diagnostic features” and “development and course” that fit this case.
Hyunh is a 39-year-oldfemale of Vietnamese ancestry who has been married for 21 years. She lives with herhusband and her15-year-old son. Hyunh owns a nail salon.
CHIEF COMPLAINT/PRESENTING PROBLEM:
Hyunhpresents for treatment complaining of an increased sense of hopelessness and a persistent feeling of being a failure. She relates that she has no motivation and nothing seems to bring her pleasure. Hyunhreports feeling very sad and has difficulties getting out of bed in the morning, having irregular sleep patterns, frequently awakening throughout the night and staring at the clock, unable to fall back to sleep. Hyunhreports intense periods of anxiety affecting her sleep and occurring upon awakening and she especially worries about her son, her business, and things going on in her neighborhood, and wondering if everything will work out in her family members’ lives. She states that heranxiety becomes so severe that it makes her teeth chatter uncontrollably.Hyunhreports that she experiences periods of tearfulness and crying during the day especially when things are particularly stressful at her business.She is always tired and fatigued and has difficulty making even simple business decisions.
HISTORY OF PRESENT ILLNESS:
Hyunhstates that she has always worried about being successful and that the recent business ownership has increased these feelings.She states that feelings of impending disaster plague her in the morning and that these anxious feelings have been going on since June 2018 when she took possession of the nail salon. Client states that she feels as if her “anxiety regulator” has broken.
Client stated her husband is supportive and helps her with the nail salon. She wants this to work out and it frightens her that it may not. Client states her husband has complained a bit because Hyunh’sschedule left little time for him and that Hyunh was very involved with her parents and other family members. Hyunh believes she would fall apart if her husband stopped supporting her. Hyunh states this anxiety of hers has led to an intense period of frequent andsevere “attacks” which included chest pains, shortness of breath and dizziness.When this happens,she just wants to throw up.Client states that since she bought the nail salon she has bizarre dreams, suffers from night sweats and chills, and wakesup with a feeling that she is going crazy. Since June,Hyunh has lost 35lbs. and has difficulty concentrating on running her business. Her attacks would come on suddenly; they did not last very long, but it seemed like hours.
She states that she cannot shake feelings of anxiety, especially when she is unable to reach her husband. She has spent the last several months worrying about the attacks happening when she cannot reach him. Hyunh states she also began worrying about dying. She reports a previous period of depression that began in2015 after she left her previous job. She identified feelings of hopelessness and sleep disturbances as well as persistent thoughts of suicide. Client states she began psychotherapy and was put on Prozac for about one year. She worked through the loss of her job and felt generally happy for two years,but after going into business for herself, things became harder.
Client reports years of worrying about her life, her son, and all of her family members. Even though it makes her irritable, she doesn’t even try to stop it anymore.Being an owner of a business has increased things for her to worry about. She expresses concern about her business although there is no indication that there is any trouble.
CURRENT FAMILY ISSUES AND DYNAMICS:
Hyunh was married in 2001. Hyunhhas worked all her adult life, mostly as a manicurist. She comes from a family of business owners. Client has one child.
MENTAL STATUS EXAM:
Hyunh presents as friendly and cooperative and is dressed in neatly in inappropriate attire. Hyunh’smood is depressed. She is oriented to time, place, and person. She demonstrates general knowledge consistent with education. Hyunh demonstrates proper judgment, insight, and normal memory, both recent and remote. Additionally, Hyunhpresents with normal perceptions and a normal stream of thought. Hyunh’sspeech is spontaneous. She initially presents with an appropriate effect although she demonstrates moderate lability to her mood. Her expression of mood ranged from intense laughter to periods of uncontrollable sobbing. The mood was congruent with expression. Hyunhappeared anxious when discussing monetary matters. She denies active suicidal/homicidal ideation but states that her family would be better off if she were dead so that they could collect on the insurance.