Diagnostic Application

Diagnostic Application

Providing the correct mental health diagnosis can be the ultimate lifeline for a patient seeking medical care or therapy. It is often difficult to accurately pinpoint the exact mental health care therapy without an accurate diagnosis, especially where the patient shows slight or no symptoms. The process of providing care for mental disorders should go beyond delivering evidence of symptoms; it has to be proven that the patient suffers the disease and also give the severity of the disorder. Furthermore, without an accurate diagnosis, the client might not see any symptoms reduction.

The three different patient’s case scenarios provided will help detect presenting issues and the relevant history from the patient’s perception. The formation of the diagnosis will be based on patient information provided by assessing the different assessment tools to support the final diagnosis. Furthermore, accurate diagnosis of each patient will be determined through presenting DSM -5 and ICD -10 codes plus applicable Z codes, as well as assessing whether medical consultation is suitable.

Presenting Concerns:  Case of Kimi

The current issues for Kimi’s case were triggered by her separation from the husband who left her for a younger woman. Kimi is a professional woman at the top of her career and body eight. From her teenage years up to college, Kimi has struggled with self-confidence and body image. As a result, she usually conforms to binge eating as a self-copying tactic to deal with negative feelings. Kimi thought that she was on top of her purge behavior. The separation of her husband triggered a stress disorder resulting in her relapsing into the old stress relief mechanism.

Differential Diagnosis:  Case of Kimi.

Judging by Kimi’s primary symptoms and the severity of her persistent historical issues, it is an underlying indication that she has bulimia nervosa. Based on the DSM -V differential tree APA (2013), which suggests that the diagnostic criteria for bulimia nervosa are; recurring episodes of frequently eating large portions of food, lack of self-discipline during episodes of binge eating, and self-assessment which is excessively inclined by body weight.   All these underlying criteria are consistent with symptoms Kimi has visibly showcased.

Evaluation of Assessment Results:  Case of Kimi

For an accurate analysis of Kimi’s condition, the use of the Eating Disorder Symptom Severity Scale (EDS³⁾ would be useful in assessing the parameters related to her eating disorder, behavior, anxiety, eating disorder cognition as well as her treatment progress (Henderson et al., 2010). The EDS³ is a reliable assessment parameter for evaluating Kim’s primary intakes as well as assess her treatment progress during the treatment process. For further analysis, the use of the cross-cutting symptom measures, which can be used alongside EDS³ will aid in providing an all-inclusive mental status valuation, which is essential for Kimi’s diagnosis. Based on Henderson et al. (2010) cross-cutting symptom measure is useful mental disorder assessments that stretches accost 13 psychiatric parameters to measures psychosis, depression, sleep problems, anger, memory repetitive thoughts and behavior, mania, dissociations, anxiety, personality functions, somatic symptoms, substance abuse, and suicidal ideation. The 13 domains have a set of three questions, each which seek to find about the magnitude, or the frequency of the symptoms within the last two weeks (Henderson et al., 2010).

DSM and ICD Diagnosis:  Case of Kimi

Factors consistent with Kimi’s case showcase Bulimia Nervosa 307.51(F 50.2). In this case, it showcases that symptoms are dependable on the three particular features. Recurring incidents of binge eating, when she has stress and feels lonely at night, she results in eating large portions of ice cream and cookies, which happens a few times in a week Criterion A. Recurring compensatory behavior to avoid gaining weight. The patient Kimi clearly states that after episodes of binge eating, she results in vomiting criterion B. Lastly, Criterion D, practicing self-assessment, which is excessively swayed by body weight and shape. For Kimi’s case, she felt that she was past her binge eating disorder and was in the thick of things in regards to her weight, but the issue with her husband resulted in her relapsing. She knows the binge eating will result in her gaining weight (Nolen-Hoeksema, 2017). Furthermore, the diagnosis of bulimia Nervosa requires that binge eating and extreme exclusion should happen maybe once in a week for three months. In reference to this, Kimi posits that her eating disorders occur several times a week for the past six months (APA, 2013).

For Kimi’s case, the additional ICD codes that are relevant are V61.10 (Z63.0) Relationship issues with intimate partners or spouse, V61.03 (Z63.5) Distraction of the family through separation or divorce, V62.89 (Z60.0) psychological stress/ phase of life issue (APA, 2013). These codes are consistent with the patient’s concerns, and Bulimia Nervosa is manifested with problems that have been revealed due to the phase of life she is currently in, which is due to separation from her husband. Additionally, she is self-checking herself as a result of her husband cheating with a younger woman; this prevalent issue has a toll on her body image.

Medication Referral/Consultation:  Case of Kimi

Based on the current issues that she is facing, it is visibly apparent that she might be suffering from stress, depression, or anxiety issues, which is kind of persistent given her life circumstances.  Therefore, she does not need any medical treatment for now. To help address her eating disorder, a Cognitive- Behavioral Therapy (CBT) will help Kimi’s overcome her problem. CBT treatment mechanism will teach Kimi to control the thoughts that surround her binge eating disorders. Indulging in the CBT treatment process, Kimi will be able to control unwanted thoughts and subsequently develop productive internal attitudes and beliefs regarding body weight (Nolen-Hoeksema, 2017). Kimi feels that indulging in eating reliefs stress, but in the real sense, the practice is a self-harming ordeal.

Presenting Concerns:  Case of Julio

Julio is a 36-year-old gay man. For the longest time possible, Julio has an issue with inattention, which makes him forgets crucial details, and these issues have overwhelmed his work, his personal life, and his relationship with Justin. His failure to commit and plan a wedding is currently upsetting Justin, who feels that Julio’s parents are the impending obstacle in their relationship. Julio’s parents are supportive of their son’s status and would like their son to show his intention clearly.

Differential Diagnosis:  Case of Julio

The primary visible symptom that is evident in the Julio case is distractibility/ inattention. Based on the criteria of DSM-5, APA, (2013), which suggest that distractibility happens when the patients fail to sieve peripheral stimuli that affect his ability to concentrate. Using the differential diagnosis tress to eliminate issues such as depression, substance abuse, or hallucinations, which are not patent with Julio’s case. Basing the analysis of this, then, Julio might have ADHD (APA, 2013). Based on the DSM-V criteria, Julio visibly meets the requirements of ADHD. However, he lacks parameters that indicate symptoms of hyperactivity and impulsively, which is common in adults who have ADHD.

Evaluation of Assessment Results:  Case of Julio

For a better analysis of Julio’s case, it is vital to evaluate the past, self, interview report, and other validated instruments. Based on the common symptoms, in this case, the diagnosis would be made through two assessment measures; Brown Attention- Deficit Disorder Scales (BAADS) will better serve as an assessment for diagnosis. This assessment tool uses interview-style valuation to diagnose ADHD patients better. It evaluates measures through various criteria ranging from attitude and compassion, working recollection, organization, maintaining energy, and sustaining attention (Leithead & Freeborn 2013). ‘

Besides, the use of Conners Adult ADHD Rating Scales (CAARS) can be a useful assessment test as this tool measures the current symptoms and disregards childhood ADHD. CAARS is an assessment that utilizes the observer and self-report evaluation, which means that Julio will write down a report, and the clinician will verify the report(Leithead & Freeborn 2013).

DSM and ICD Diagnosis:  Case of Julio

Indicators that are related to Attention Deficit Disorder (ADD) with predominantly inattentive presentation 314.00 (F90.0) are visibly manifested in Julio’s case scenario. This parameter requires that patients present six of nine symptoms of the irregularity of growth levels, which negatively impact social, professional, and educational activities. Julio indicates that when given a task at work, he often makes inconsiderate errors or forgets the critical details (Criterion A1a). Julio posits that when people are talking to him, he often loses attention (Criterion A 1c). He goes on to say that he does not finish the tasks assigned (Criterion A1d). Has issues organized things (Criterion A1 e). He often loses things (Criterion A1g) Julio indicates that the problem has been persistent for an extended period (Criterion B). The common symptoms have spanned from work to house life (Criterion C). The negative implications of the symptoms have affected his social and professional activities (Criterion D). Besides, Julio’s symptoms are not anywhere related to indications of suffering from schizophrenia or other psychotic disorders: Criterion E (APA 2013).

The additional ICD codes relevant to Julio’s case is V61.10 (Z63.0); relationship issues with an intimate partner or spouse (APA, 2013). The underlying factor to this chosen code concerning Julio’s ADHD condition is rooted in Justin’s issues in seeking a commitment from Julio. This additional stress burden can negatively impact Julio’s ADHD. Julio could be suffering from self-question, evident in his reference to being a single gay man, yet he has been in a relationship for five years.

Medication Referral/Consultation:  Case of Julio

The common symptoms showed by Julio can be an indication that the option of medical treatment is suitable.  Preferably pairing ADHD treatment with medicines and psychotherapy can significantly increase Julio’s ability to concentrate, build on time management, and planning. Personalized therapy session help is generating a specific treatment method for various clients.  Medicines carry the risk of symptoms degenerating when the patient fails to take the medication.

Differential Diagnosis:  Case of Daneer

Daneer is a 50-year-old male who emigrated from Serbia to the USA at the age of four years along with his brother and parents. His parents were ardent Muslim faithful and advocated for strict disciplined methods. Since becoming an adult, Danner has stopped practicing Islamic practices, which have caused a lot of rift between the family. Daneer typically has a fluctuating gesture of emotions waving from care/the doting son to extreme lashing out whenever his family questions his behavior. Currently, Daneer is divorced as his wife left him due to his anger issues. His failed marriage made him attempt suicide and occasionally thinks about suicide if ladies reject him. He is always in conflict with his coworkers and cannot hold to any job as a result

.  .  Differential Diagnosis:  Case of Daneer.

Daneer experienced child abuse as he would be harshly punished for his wrongful actions. ASPD is common for children who suffer child abuse, and usually, children develop this condition as a survival technique. Additionally, the symptoms formed by Daneer, showcase signs of shared markers consistent with Cluster B personality. Based on the differential tree diagnosis (self-harm tree) and aggressive behavior, Daneer might be experiencing borderline personality disorder and antisocial personality disorder. The case of slashing a woman’s tire or having suicidal thoughts is consistent with overdramatic and impulsive behavior for patients who are not concerned with their welfare nor the well-being of others (Nolen-Hoeksema, 2017).

Evaluation of Assessment Results:  Case of Daneer

To better evaluate the case of Daneer, the use of combination PSDI-6 and DSM is suitable to determine which personality disorder a patient will be diagnosed with. Further assessment is necessary to diagnose Daneer with a personality disorder. Furthermore, there are no generally accepted assessment approaches for personality disorder diagnosis (Guy et al., 2008). The use of structured interviews would help in the case of Daneer as the therapist makes present observation and clarification based on interview progress. The use of Structured Clinical Interview for DSM IV Axis II (SCID-II) is applicable in Danner’s case as the therapist makes an instant evaluation of the patient’s response to the questions. (Guy et al., 2008).

DSM and ICD Diagnosis:  Case of Daneer

Based on prevailing symptoms and issues experienced by Daneer, a diagnosis of Antisocial Personality Disorders, 301.7 (F60.2) is relevant for this case.  Additional codes applicable to this case; V15.42 (Z62.811) Personal History of psychological childhood abuse visible how his parents disciplined the children. V15.59 (Z91.5) Personal history of self-harm evident in recurring suicidal attempts and V61.8 (Z62.891) Sibling relational problem, both he and his brothers had a tormented upbringing (APA, 2013).

Medication Referral/Consultation:  Case of Daneer

Currently, personality disorders cannot be treated with any medication; however, checking into a Psychiatrist can help Daneer deal with the symptoms of impulsive aggression common in Cluster B personality disorder. Psychotherapy treatment, such as CBT, can help regulate the patient’s emotions, symptoms, and develop adaptive, healthy skills(Nolen-Hoeksema, 2017).

References.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Leithead, L., & Freeborn, D. (2013). A Practical Guide for Diagnosing Adult Attention Deficit Hyperactivity Disorder. Journal for Nurse Practitioners, 9(10), 688–694. https://doi-org.library.capella.edu/10.1016/j.nurpra.2013.08.016

Henderson, K. A., Buchholz, A., Perkins, J., Norwood, S., Obeid, N., Spettigue, W., & Feder, S. (2010). Eating Disorders Symptoms Severity Scale. PsycTESTS. https://doi-org.library.capella.edu/http://supp.apa.org/psyctests/supporting/999910209/babadayw526j.html

Nolen-Hoeksema, S. Marroquin, B. (2017). Abnormal Psychology, Seventh Edition. McGraw-Hill Education: New York, NY.