provide a diagnosis of a client vignette

*Doc uploadedInstructionsFor this assignment, you will provide a diagnosis of a client vignette (see week 3 vignette), describe the current evidence regarding the causes and prevalence of the diagnosis, and briefly explain the current treatment recommendations, including individual therapy, family/couple therapy, and medications.Diagnosis and Supporting Evidence – Develop an accurate diagnosis using the DSM-5 criteria listed for the disorders studied. Support the diagnosis by writing a description of the symptoms and related information from the vignette that substantiates your conclusions. While developing your argument to support the provided diagnosis, specifically address each of the criteria and include an example of how the client fits the criteria. If there is a rule-out diagnosis, please highlight the ways in which the client does not fit a rule-out diagnosis based on the criteria.Description of the Disorder –Briefly describe the possible causes (genetics, biological basis), course, and effects of the disorder. Please address the impact of the diagnosis on a client’s family members or significant others. Many psychiatric conditions have a genetic basis and family history; therefore, dynamics are very important to consider.Cultural Considerations and Implications: Provide a paragraph description in which you briefly comment on each component of Garcia and Petrovitch’s (2015) Diversity/Resilience formulation (see Week 1 readings): Intrapersonal, Interpersonal, Community, and Spiritual.   How is each of these illustrated in the client vignette?Treatments – Based on the readings and other outside information, please outline the best current evidence regarding treatment of the condition you diagnosed. Be sure to address each of the following:Medications:  What are the best current medications used to treat this condition?  Be specific to identify the drug classes used. You do not need to identify specific medications, but you do need to identify which class of drugs that are commonly used.Assessment of Suicide Risk:  Describe how you will assess the risk of suicide using a standard assessment (e.g., Columbia Scale).  How will you work with the client to develop a safety plan?Psychotherapy: What psychotherapy approaches have the best evidence in treating this condition?  How do these approaches address the symptoms of the diagnosed condition and improve functioning?Family and/or Couple Interventions:  Identify which family and/or couple interventions that have the best evidence supporting their use in treating the diagnosed condition.  Describe two specific interventions you could implement with this case.In your description of the treatments, be sure to continue to integrate information about the case from the vignette (i.e., do not simply discuss what you would do with a person with the given disorder; write about how the model and interventions that you have selected fit with the specific client from the vignette). Do not replicate the vignette in your paper.  Simply provide a synopsis of the vignette as you would in a clinical note.Length: 5-7 pages, not including title and reference pagesReferences: Include a minimum of three scholarly resources (not including the DSM-5).References:  The assignment must have a minimum of three scholarly references (not including the DSM-5) supporting the points made in the assignment.Papers must be written in third-person voice. Do not use personal pronouns (I, me, we, you, etc.)Your paper should demonstrate thoughtful consideration of the ideas and concepts presented in the course by providing new thoughts and insights relating directly to this topic. Your response should reflect scholarly writing and current APA standards. Be sure to adhere to Northcentral University’s Academic Integrity Policy.Upload your document and click the Submit to Dropbox button.Case One:Diane Taylor, a 35-year-old laboratory technician, was referred to the outpatient psychiatry department of an academic medical center by the employee assistance program (EAP) of her employer, a major pharmaceutical company. Her supervisor had referred Ms. Taylor to the EAP after she had become tearful while being mildly criticized during an otherwise positive annual performance review. Somewhat embarrassed, she told the consulting psychiatrist that she had been “feeling low for years” and that hearing criticism of her work had been “just too much.”A native of western Canada, Ms. Taylor came to the United States to pursue graduate studies in chemistry. She left graduate school before completing her doctorate and began work as a laboratory technician. She felt frustrated with her job, which she saw as a “dead end,” yet feared that she lacked the talent to find more satisfying work. As a result, she struggled with guilty feelings that she “hadn’t done much” with her life.Despite her troubles at work, Ms. Taylor felt that she could concentrate without difficulty. She denied ever having active suicidal thoughts, yet sometimes wondered, “What is the point of life?” When asked, she reported that she occasionally had trouble falling asleep. However, she denied any change in her weight or appetite. Although she occasionally would go out with coworkers, she said that she felt shy and awkward in social situations unless she knew the people well. She did enjoy jogging and the outdoors. Although her romantic relationships tended to “not last long,” she felt that her sex drive was normal. She noted that her symptoms waxed and waned but had remained consistent over the past 3 years. She had no symptoms suggestive of mania or hypomania.Ms. Taylor was an only child. Growing up, she had a close relationship with her father, a pharmacist who owned a drugstore. She described him as a “normal guy who liked to hunt and fish” and liked to take her hiking. Her mother, a nurse, stopped working shortly after giving birth and had seemed emotionally distant and depressed.Ms. Taylor became depressed for the first time in high school when her father was repeatedly hospitalized after developing leukemia. At that time she was treated with psychotherapy and responded well. She had no other psychiatric or medical history, and her medications were a multivitamin and oral contraceptives. Case 2:Andrew Quinn, a 60-year-old businessman, returned to see his longtime psychiatrist 2 weeks after the death of his 24-year-old son. The young man, who had struggled with major depression and substance abuse, had been found surrounded by several emptied pill bottles and an incoherent suicide note.Mr. Quinn had been very close to his troubled son, and he immediately felt crushed, like his life had lost its meaning. In the ensuing 2 weeks, he had constant images of his son and was “obsessed” with how he might have prevented the substance abuse and suicide. He worried that he had been a bad father and that he had spent too much time on his own career and too little time with his son. He felt constantly sad, withdrew from his usual social life, and was unable to concentrate on his work. Although he had never previously drunk more than a few glasses of wine per week, he increased his alcohol intake to half a bottle of wine each night. At that time, his psychiatrist told him that he was struggling with grief and that such a reaction was normal. They agreed to meet for support and to assess the ongoing clinical situation.Mr. Quinn returned to see his psychiatrist weekly. By the sixth week after the suicide, his symptoms had worsened. Instead of thinking about what he might have done differently, he became preoccupied that he should have been the one to die, not his young son. He continued to have trouble falling asleep, but he also tended to awake at 4:30 a.m. and just stare at the ceiling, feeling overwhelmed with fatigue, sadness, and feelings of worthlessness. These symptoms improved during the day, but he also felt a persistent and uncharacteristic loss of self-confidence, sexual interest, and enthusiasm. He asked his psychiatrist whether he still had normal grief or had a major depression.Mr. Quinn had a history of two prior major depressive episodes that improved with psychotherapy and antidepressant medication, but no significant depressive episodes since his 30s. He denied a history of alcohol or substance abuse. Both of his parents had been “depressive” but without treatment. No one in the family had previously committed suicide. Case Three: An African American man (who is later identified as Mark Hill), who appears to be in his 30s, was brought to an urban emergency room (ER) by police. The referral form indicates that he is schizophrenic and an “emotionally disturbed person.” One of the police officers said that the man offered to pay them for sex while in the back seat of their patrol car. He referred to himself as the “New Jesus” and declined to offer another name. He refused to sit and instead ran through the ER. He was put into restraints and received intramuscularly administered lorazepam 2 mg and haloperidol 5 mg. Intravenous diphenhydramine (Benadryl) 50 mg was readied in case of extrapyramidal side effects. The admitting team wrote that he has “unspecified schizophrenia spectrum and other psychotic disorder” and transferred him to the psychiatry team that worked in the ER. Despite being restrained, he remained giddily agitated, talking about receiving messages from God. When asked when he last slept, he said he no longer needed sleep, indicating that he has “been touched by Heaven.” His speech is rapid, disorganized, and difficult to understand. A complete blood count, blood chemistries, and a toxicology screen were drawn. After an additional 45 minutes of agitation, he received another dose of lorazepam. This calmed him, but he still did not sleep. His restraints were removed. A review of his electronic medical record indicates that he experienced a similar episode two years ago. At that time, a toxicology screen was negative. He was hospitalized for two weeks on the inpatient psychiatric service and given a discharge diagnosis of “schizoaffective disorder.” At that time, he was prescribed olanzapine and referred to an outpatient clinic for follow-up. That chart referred to two previous admissions to the county inpatient hospital, but records were not available after hours. An hour after receiving the initial haloperidol and lorazepam, the patient is interviewed while he sits in a chair in the ER. He is an overweight African American man who is disheveled and malodorous, though he does not smell of alcohol. He makes poor eye contact, instead looking at nearby people, a ticking clock, the examiner, a nearby nurse—at anything or anyone that moved. His speech is disorganized, rapid, and hard to follow. His leg bounces rapidly up and down, but he does not get out of his chair or threaten the interviewer. He describes his mood as “not bad.” His affect is labile. He often laughs for no particular reason but gets angrily frustrated when he feels misunderstood. His thought process is disorganized. He has grandiose delusions, and his perceptions are significant for “God talking to me.” He denies other hallucinations as well as suicidality and homicidality. When asked the date, he responds with an extended discussion about the underlying meaning of the day’s date, which he misses by a single day. He remembers the names of the two police officers who brought him to the hospital. He refuses more cognitive testing. His insight and judgment appear poor.The patient’s sister arrives an hour later, after having been called by a neighbor who saw her brother, Mark Hill, taken away in a police car. The sister says her brother seemed strange a week earlier, uncharacteristically arguing with relatives at a holiday gathering. She says he claimed not to need sleep at that time and has been talking about his “gifts.” She has tried to contact Mr. Hill since then, but he has not responded to phone, email, or text messages. She says he does not like to talk about his issues, but she has twice seen a bottle of olanzapine in his house. She knows their father has been called schizophrenic and bipolar, but she has not seen the father since she was a child. She says that Mr. Hill does not typically use drugs. She also says he is 34 years old and a middle school math teacher who just finished a semester of teaching. Over the next 24 hours, Mr. Hill calms significantly. He continues to believe that he is being misunderstood and that he does not need to be hospitalized. He speaks rapidly and loudly. His thoughts jump from idea to idea. He speaks of having a direct connection to God and having “an important role on Earth,” but he denies having a connection to anyone called the “New Jesus.” He remains tense and jumpy but denies paranoia or fear. Serial physical examinations reveal no abnormalities aside from blisters on his feet. The patient is not tremulous, and his deep tendon reflexes are symmetrical and graded 2 of 4. He shows no neurological asymmetry. His toxicology screen is negative, and his blood alcohol level is zero. His initial lab results are pertinent for elevated blood urea nitrogen and a blood sugar level of 210 mg/dL. His mean corpuscular volume, aspartate aminotransferase/alanine aminotransferase ratio, and magnesium level are normal.Case 4: Yvonne Perez was a 23-year-old woman who presented for an outpatient psychiatric evaluation 2 weeks after giving birth to her second child. She was referred by her breast-feeding nurse, who was concerned about the patient’s depressed mood, flat affect, and fatigue.Ms. Perez said she had been worried and unenthusiastic since finding out she was pregnant. She and her husband had planned to wait a few years before having another child, and her husband had made it clear that he would have preferred that she terminate the pregnancy, an option she would not consider because of her religion. He had also been upset that she was “too tired” to do paid work outside of the home during her pregnancy. She had then become increasingly dysphoric, hopeless, and overwhelmed after the delivery. Breast-feeding was not going well, and she had begun to believe her baby was “rejecting me” by refusing her breast, spitting up her milk, and crying. Her baby had become very colicky, so she felt forced to hold him most of the day. She wondered whether she deserved this difficulty because she had not wanted the pregnancy.Her husband was gone much of the time for work, and she found it very difficult to take care of the new baby and her lively and demanding 16-month-old daughter. She slept little, felt constantly tired, cried often, and worried about how she was going to get through the day. Her mother-in-law had just arrived to help her care for the children.Ms. Perez was an English-speaking Hispanic woman who had worked in a coffee shop until midway through her first pregnancy, almost 2 years earlier. She had been raised in a supportive home by her parents and a large extended family. She had moved to a different region of the country when her husband had been transferred for work, and she had no relatives nearby. Although no one in her family had seen a psychiatrist, several family members appeared to have been depressed. She had no prior psychiatric history or treatment. She denied illicit drug or alcohol use. She had smoked for several years but stopped when she was pregnant with her first child. Ms. Perez had a history of asthma. Aside from a multivitamin with iron, she took no medications.On mental status examination, Ms. Perez was a casually dressed, cooperative young woman. She made some eye contact, but her eyes tended to drop to the floor when she spoke. Her speech was fluent but slow, with increased latency when answering questions. The tone of her speech was flat. She endorsed low mood, and her affect was constricted. She denied thoughts of suicide and homicide. She also denied any hallucinations and delusions, although she had considered whether the current situation was punishment for not wanting the child. She was fully oriented and could register three objects but only recalled one after 5 minutes. Her intelligence was average. Her insight and judgment were fair to good.

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