RE: SOCW6090; Discussion – Response to 2 Students (wk5)

by

Humanities

Respond to at least two colleagues who identified a different diagnosis or intervention in the following ways:

  • Explain whether you agree with your colleague’s identified diagnosis and recommended treatment and why.
  • Explain any additional factors that your colleague should take into consideration for treatment planning.

Response to Latasha

In the case of Emily, my diagnostic tree would follow the pattern of considering if there is any significant medical condition. The case states that Emily has arthritis in her spine and her knees and must use a walker for safe mobility. This information allows me to consider anxiety disorder due to medical condition as a diagnosis. There is no reported substance use, but she is experiencing some compulsions or obsessions with scrubbing the house and tweezing her hair. This allows the consideration of obsessive-compulsive disorder as a diagnosis as well and even trichotillomania or excoriation.

I would venture to eliminate the differential diagnosis of normative hair removal/manipulation because she is not removing the hair for cosmetic reasons. I eliminated posttraumatic stress disorder (PTSD). Although, Emily’s parents died of illnesses when she was young, and she likely experienced other traumas she does not seem to be experiencing recurrent, distressing memories of any traumatic events. She is not reporting any flashbacks or distressing dreams either. So, this diagnosis does not fit. I believe the diagnosis for Emily is Trichotillomania F63.3.

I would use the DSM-5 Self Rated Level I Cross-Cutting Symptom Measure – Adult assessment to assist in ongoing validation of Emily’s diagnosis. The intervention I would use with Emily is Behavioral Therapy and medication. This intervention would be to help her identify and understand the triggers that cause her to pull her hair out. Once Emily can identify these triggers, she can then begin working on behavior modification. This therapy will call for Emily to log times when she is participating in hair pulling to eventually get to the point where she can control the motivation to pull (Lootens & Nelson-Gray, 2016).

Reference

Lootens, C. M., & Nelson-Gray, R. O. (2016). Treating Trichotillomania: Successful Application of Manualized Cognitive-Behavioral Therapy. Clinical Case Studies, 15(5), 376–391. https://doi.org/10.1177/153465011669438

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Response to Lusine

Emily’s diagnosis

F28- Other psychotic disorder, constant auditory hallucination

F41.8- Other specific anxiety disorder, less symptom attack

Z59.6- Limited income

Z62.29- Growing away from parental care

Z62.891- Relational issues with the siblings

Emily reported feeling anxious when she showed up in the clinic for treatment. She was bothered by continues crying, but she did not meet the Generalized Anxiety Disorder since her condition portrayed the inability to meet criteria C with sustainable signs for diagnosis (American Psychiatric Association, 2013). Due to this, Other anxiety Disorder has been used as a method of diagnosis as there is an option for disclosure the specific reason for the selection of this tool by using limited symptom attacks.

A DSM-5 diagnostic would be beneficial for Emily given that she was troubled with anxiety and she had the tendency of pulling her hair. Relating to DSM-5, the code of Specified Anxiety Disorder is 300.09 while the Unspecified Anxiety Disorder is 300.00. Also, it is worth mentioning that Emily is suffering from Trichotillomania (TTM), a disorder classified as obsessive-compulsive in DSM-4 and DSM-5. The disorder of hair-pulling is coded as 312.39 under DSM-5, and it involves the patient pulling hair in all the body parts without feeling any pain. It is possible to diagnose Emily with Obsessive Compulsive Disorder due to the symptoms.

Emily encounters constant challenge due to the anxiety and Trichotillomania. However, current and past experiences have caused her to have low self-esteem and depression. The past that might be affecting Emily is growing without parental care and unloving and ignorant aunt, lack of friends to socialize with, unsuccessful marriage, not having a boyfriend, and moving out of her sister’s apartment. All the mentioned factors would be of concern to the diagnosis since it would not be wise to provide a false sense of wellbeing to the patient (Morrison, 2014).

While diagnosing the patient, both DSM-4 and DSM-5 techniques would be appropriate to complement each other. I prefer using both the approaches to deal with the client as it enhances involvement so that she does not surround herself with negative energy. DSM-4 and DSM-5 can be used to assess the symptoms and target behaviors as the scales resonate around actions contrary to the normative social constructs. The scale such as DSM-5 is administered through patient behavior and scale juxtaposition. My diagnoses have revolved around Time, DSM-5 and the four scales (Dominguez, 2017).

References

American Psychiatric Association. (2013a). Anxiety disorders. In the Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm05

Chapter 12, “Diagnosing Anxiety, Fear, Obsessions and Worry” (pp. 167–184) 2), 112–114. doi:10.1176/appi.ps.201600440

Dominguez, M. L. (2017). LGBTQIA people of color: Utilizing the cultural psychology model as a guide for the mental health assessment and treatment of patients with diverse identities.

Journal of Gay & Lesbian Mental Health, 21(3), 203–220. doi:10.1080/19359705.2017.1320755

Morrison, J. (2014). Diagnosis made easier (2nd ed.). New York, NY: Guilford Press.

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My references (You have from intial discussion for this class)

López-Pina, J. (2015). The Yale–Brown Obsessive Compulsive Scale: A Reliability Generalization Meta-Analysis. Assessment, 12, 4-8

Morrison, J. (2014). Diagnosis made easier (2nd ed.). New York, NY: Guilford Press.

Piancentini, J., Bergman, L., Chang, S., Langley, A., Peris, T., Wood, J. J., & McCraken, J. (2012, February). A new OCD intervention combines individual Exposure-Based CBT and family intervention. Clinician’s Research Digest, p. 4.