CASE I
A 23-year-old war veteran was admitted to the hospital two years after he returned home from duty, at the request of his wife, after he began to experience depression, insomnia and flashbacks of his war-time experiences. He had been honorably discharged two years previously, having spent nearly a year in combat. He had only minimal difficulties in returning to civilian life, resuming his college studies and then marrying within 6 months after his return. His wife had noticed that he was always reluctant to talk about his military experience, but he wrote it off as a natural reaction to unpleasant memories.
The patient’s current symptoms began, however, about a year and a half after he returned home. He became preoccupied with watching TV news stories about the war. He then began to have difficulty sleeping, and at times would awaken at night in the midst of a nightmare in which he was reliving his past experiences. His wife became particularly concerned one day when he had a flashback experience while out in the back yard: as a plane flew overhead, flying somewhat lower than usual, the patient threw himself to the ground, seeking cover, thinking it was an attacking helicopter. The more he watched the news on TV, the more agitated and morose he became. Stories began to spill out about atrocities that he had seen and experienced, and he began to feel guilty that he had survived while many of his friends had not. At times he also seemed angry and bitter, feeling that the sacrifices he and others had made were all wasted.
The veteran’s wife expressed concern that his preoccupation with the war had become so intense that he seemed uninterested in anything else, and was emotionally distant from her. His symptoms had begun to significantly interfere with his ability to be productive at home and in his studies. His wife was dissatisfied with the state of their marriage and struggled with wanting to continue to stay married, he felt the same. When she suggested that they try to plan their future, including having a family, he responded as if his life consisted completely of the world of events experienced two years earlier, and as if he had no future.
1- Write out the complete diagnosis covering all aspects of the client’s presentation (meaning you included specifiers- if applicable), also include V-codes if any apply.
2- Detailed description of the criteria met for your diagnosis(es) and examples of how the client met each criterion (sign or symptoms). (BULLET POINTS IS PREFERRED)
3- Differential Diagnosis: What other diagnoses did you rule out? Why? (Give two diagnoses and two reasons for the rule out for each).
4- Write a treatment plan for the case which includes:
1. 3 Short-term goals and 3 long term goals/objectives
2. Specify therapeutic interventions related to short or long term goals. Give at least
two interventions for each the short and long term goals.
CASE II
Ms. A, a moderately obese 32-year-old white woman, presented to her doctor in January 1997 for a refill of her estrogen replacement medication, which she had been taking since her hysterectomy for endometriosis after the birth of her fourth child in 1995. She complained of increasing problems with depressed mood. Ms. A related feeling “depressed and moody” since her teenage years. Her mood aberrations were not related merely to estrogen replacement or adherence problems. Ms. A denied current use of alcohol or illicit drugs and smoked cigarettes about 1 pack per day for 20 years. She also drank 1 or 2 servings of caffeinated beverages per day. A physical examination and routine laboratory work were unrevealing.
The next time Ms. A was seen a month later, she complained of increasing hypersomnia and daytime lethargy, increased appetite, frequent crying, headaches, and memory problems since her last appointment. However, during a follow-up appointment two weeks later, she indicated that things had changed. She now only needed 3 to 4 hours of sleep per night. Ms. A described feelings of elation, inflated self esteem, and of having her mind filled with ideas and activities, racing from one thought to another and easily distracted. She had become markedly more talkative and social. Those around her noticed her behavior as distinctly different than usual. However, this sudden change sometimes lasted about 4-5 days, ended suddenly, and was followed by a steady decline in energy and motivation over the next several weeks. When she felt a decline in energy, she would also experience feeling very sad and in a depressed mood. She also felt a loss of energy, with lead her to feel worthless, and insomnia. Ms. A also did not feel like eating during her decline in energy and had a very hard time concentrating.
When asked if she’d had episodes like this in the past, Ms. A described experiencing similar brief periods every 2 to 3 weeks, where she experienced the ups and downs. The ups typically lasting from 4 to 5 days. She recognized these periods as being time limited and would try to make the best of them by shopping and doing housework, often late into the night.
1- Write out the complete diagnosis covering all aspects of the client’s presentation (meaning you included specifiers- if applicable), also include V-codes if any apply.
2- Detailed description of the criteria met for your diagnosis(es) and examples of how the client met each criterion (sign or symptoms). (BULLET POINTS IS PREFERRED)
3- Differential Diagnosis: What other diagnoses did you rule out? Why? (Give two diagnoses and two reasons for the rule out for each).
4- Write a treatment plan for the case which includes:
1. 3 Short-term goals and 3 long term goals/objectives
2. Specify therapeutic interventions related to short or long term goals. Give at least
two interventions for each the short and long term goals.
