Making a Differential DiagnosisPrior to beginning work on this assignment, please read Chapter 1: Differential Diagnosis Step by Step in DSM-5: Handbook of Differential Diagnosis and review the same c
Making a Differential Diagnosis
Prior to beginning work on this assignment, please read Chapter 1: Differential Diagnosis Step by Step in DSM-5: Handbook of Differential Diagnosis and review the same case study you used to write your Weeks One and Two discussion forums and Week Three Assignment.For this assignment, you will create a differential diagnosis for the patient in your chosen case. This assignment continues the work you started in the Weeks One and Two discussion forums and the Week Three assignment. Be sure to follow the instructions in Chapter 1: Differential Diagnosis Step by Step when creating your differential diagnosis. Your assignment must include the following:
- Recommend a diagnosis based on the patient’s symptoms, presenting problems, and history.
- Assess the validity of your diagnosis using a sociocultural perspective.
- Compare at least one evidence-based and one non-evidence-based treatment option for the diagnosis. Research a minimum of two peer-reviewed sources to support your choices.
- Propose and provide an explanation for a minimum of two historical perspectives and two theoretical orientations that are inappropriate alternates for the conceptualizations in this case.
The Making a Differential Diagnosis assignment
- Must be three to five double-spaced pages in length (not including title and references pages) and formatted according to APA style as outlined in the Ashford Writing Center (Links to an external site.)Links to an external site..
- Must include a separate title page with the following:
- Title of paper
- Student’s name
- Course name and number
- Instructor’s name
- Date submitted
- Must use at least two peer-reviewed sources in addition to the course text.
- Must document all sources in APA style as outlined in the Ashford Writing Center.
- Must include a separate references page that is formatted according to APA style as outlined in the Ashford Writing Center.
Week One Case of Fred(Alzheimers patient)
Initial Call: Case 19 “My Husband’s Brain has stopped working!”.
Alzheimer’s Disease
According to the Alzheimer’s Association (2017), Delusions (firmly held beliefs in things that are not real) may occur in middle- to late-stage Alzheimer’s. Confusion and memory loss such as the inability to remember certain people or objects can contribute to these untrue beliefs. A person with Alzheimer’s may believe a family member is stealing his or her possessions or that he or she is being followed by the police” (para. 2). In both Major or Mild Neurocognitive Disorder, paranoia and other delusions are common features, and often a persecutory theme exists with these delusions. As you can imagine, this can be very stressful for the family members who care for their loved one with the neurocognitive disorder.
When diagnosing neurocognitive disorders, an important differential diagnosis is pseudo dementia, which is primarily associated with cognitive deficits in older patients who have depression. In contrast to dementia patients, individuals suffering from pseudo dementia can often recall the onset of their cognitive impairments, exaggerate their symptoms, and are frequently positively responsive to treatment with antidepressants.
Initial Call
Troy: Hello my name is Troy from the Louisville Wellness Health Association and I am here to help. For whom do I have the pleasure of speaking with today?
Margaret: Hello my name is Margaret and I am calling on behalf of my husband, Fred.
Troy: Hello, Margaret! What would be a good call back number in the event that we are disconnected?
Margaret: Oh, yes! My number is 555-123-6789.
Troy: Thank you, Margaret, for providing your call back number. How may I assist you today?
Margaret: I do not feel comfortable with giving my last name over the phone if that is ok but would like to see if I can speak with someone about my husband’s brain. It has stopped working properly. Troy, I am not sure I called the right number, but a friend told me to give this place a try. So, can you help us?
Troy: Is it alright that I call you Margaret?
Margaret: Sure, that is fine!
Troy: Does your husband Fred give permission to discuss any of his personal information and does he give his verbal consent for you to speak with me on his behalf?
Margaret: My husband Fred is very forgetful and not in his right mind according to the doctors so I take care of everything.
Troy: Is Fred not cognitively capable of making his own decisions and if not do you have medical power of attorney.
Margaret: Fred has become less and less capable of taking care of himself. His Dr. Schoenfeld, broke the news to us that Fred was suffering from a neurocognitive disorder, which because of it Fred cannot make sound or safe decisions for himself so I do everything for him.
Troy: Margret, I recommend you speak with Dr. Schoenfeld regarding your POA for Fred so that you can speak on his behalf for dual representation medically and financially.
Margaret: Thank you Troy, I will speak with Dr. Schoenfeld about this as soon as I hang up the phone with you.
Troy: Without legal consent due to going into any ethical code violations, how can I help to the best of my ability today Margaret?
Margaret: Well Troy, as I said before I am so upset and filled with all these mixed emotions because my husband’s brain stopped working and I really don’t know what to do or who can help us.
Troy: Margret, I can only imagine you may be going through various feelings of mixed emotions right now. I know this may be hard on you. Do you have any informal or formal supports assisting you at this time?
Margaret: Yes, my family provide support when able and available. But we don’t know why this has happened what caused it or where it can from and that’s why we want answers?
Troy: Margaret, without being the medical professional handling your husbands care, consulting with teams of other professional expert and knowing or reviewing all of his medical history and full diagnosis I would not be able to answer questions regarding why yours husbands condition is the way it is or what caused it and why.
Margaret: But he was fine prior to 8 years ago.
Troy: What activities does your husband enjoy doing like driving, housework, or anything of interest?
Margaret: Because of lack of concentration and forgetfulness Fred does not drive or do much of anything anymore. In fact, he had made a comment that he wanted me to put him away because of being a bother. His words were “I want you to put me away, Maggie, you know what I mean. Let me go, if I ever don’t remember who you are.” Who would say such a thing to the person they say they love. (Margret begins to cry) Then he went on further to say “just inject me or give me whatever is necessary in order to get this life over with. Don’t worry about whether it’s the right thing, because it is. I’m afraid that you won’t do this, that you’ll let me go on when I’m not myself anymore. I don’t want you to have to see me and not know that I love you and need you with me. I don’t want you to doubt my love for you because of this damned disease. Please, Maggie, don’t let that happen. Please promise me.” (Margret crying uncontrollably)
Troy: Margaret I do understand how painful this is for you.
Margaret: No, you don’t understand! The thing is the doctors said Fred’s condition is at the point that it has declined so much that he will die within a week. I am now at a point that I am sad but at the same time I feel a bit of relief because of knowing this is what he wants. Is this wrong of me to feel this way?
Troy: Margret you are not wrong in your feeling for they will be going through an emotional roller-coaster ride at this time. You are experiencing someone you love so dearly suffering.
Margaret: When Fred is gone that is, the bedridden Fred whose true spirit has already left us. When he is gone, we will all finally be delivered from this long ordeal. And Mark and I will be able to remember our beloved Fred again as he once was strong of mind and body.
Troy: That is right Margaret, he will be at peace and free from pain and all the suffering he was going through. You will be able to start the healing process ad know he will still be with you in your heart and in spirit.
Margaret: It’s just difficult that’s all seeing someone you love going through this.
Troy: We are here to help you Margaret. Let;s make an appointment for one of our support staff to come out and conduct a home visit within the next as soon as availability for all persons. I will confirm your phone number you provided was 555-123-6789. A support staff person will contact you in 72 business hours to set up that appointment. Please call the phone number you original called if you have any questions or concern in the meantime for someone is available 24 hours a day.
Margaret: Thank you, you have been very helpful.
Troy: Are there any other questions I can help you with today Margaret?
Margaret: No, I was just frustrated. Talking to you helped a lot thank you. I will wait for someone to call to set up the home visit.
Troy: That will be fine. I want to thank you for calling ABC We are here to help, you have a great day.
Margaret: Thank you Troy, and you do the same.
References
Alzheimer’s Association. (2017). Suspicion, Delusions and Alzheimer’s. Retrieved from
http://www.alz/care/alzheimers-dementia.suspicion-delusions.aspLinks to an external site..
Gorstein, E., & Comer, J. (2015). Case studies in abnormal psychology (2nd ed.). New York, NY: Worth Publishers. ISBN:
9780716772736.
Week Two
Case Study 19 Fred
Transcript-
Dr.: Hello Fred and Margaret it is very nice to meet you both. (Shakes hands with both)
Margaret: Hello Doctor, it is nice to meet you too.
Fred: Yes, nice to meet you.
Dr.: I am very glad you guys came in for a visit, please have a seat and make yourself comfortable.
Margaret and Fred: Thank you.
Dr.: Can I get you guys something to drink?
Margaret: No thank you.
Fred: I am fine.
Dr.: I would like to go over a few questions about the biographical form you filled out Fred.
- Is this the first time you decided to seek help and why now do you want therapy?
Fred: Yes, this is my first time seeking help and I am a bit scared about it. At first, I thought it was normal for my behavior to change and part of getting older is memory loss.
- What are you hoping to get out of therapy?
Fred: I am looking to get help, so that I can live my regular life again, not have to worry if I forgot something important or my biggest fear forgetting the people I love. I don’t want to rely on other people to have to take care of me like I am incompetent and a burden on their life.
- How does this problem typically make you feel?
Fred: This problem makes me feel angry, depressed and embarrassed, because I use to be this strong man, a good husband, hard worker, a good father to our son, I would never forget anything, in fact I would get on my wife to remember to pay the bills on time and now I don’t feel like myself, I feel hopeless, like someone took my life away from me and I can’t get it back.
The rational of the questions
- In the very first session I would ask Fred to tell me what made him decide to come for therapy right now. After all, most people have had problems for a while. The answers that most individuals would respond are quite revealing and very varied. Some common ones involve: loss, someone else suggested it, threat and even fear.
- This type of question lets me know quite a lot about the client. For example, if they answer some variation of, I don’t know: This client is either very naïve, very passive, or very resistant. They are also likely to expect me to set the therapy agenda for them. This may also be similarly vague and unsure in other important areas if their life. If they are resistant at this early a stage, it is likely to be a long, hard therapy. If they answer, I want to be happy: This is another undifferentiated and vague answer. Or even. I want to work on my anxiety (or depression, or my phobia, or my OCD): Unlike the previous answers, this one is very specific. And even saying, I want to get along with people better: This type of goal can indicate anything from this person needs basic social skills training to they are wildly Narcissistic and alienate everyone they meet.
- We all have problems or challenges that we must face. Are you an optimist or a pessimist? How do you feel when a problem pops up unexpectedly? Although feelings aren’t right or wrong, good or bad, every problem has a way of making us feel one way or another. So, how does this problem typically make you feel? Do you feel sad, mad, hopeless, stuck or what? We can receive a lot of information about how certain clients may feel about their problem and we can pin point or even eliminate certain diagnosis.
Resources
De Vries, S. (Writer & Director), & van den Engel, F. (Producer). (2011). Beer is cheaper than therapy: Fort Hood’s PTSD problem (Links to an external site.) Links to an external site. [Video file]. Retrieved from https://fod.infobase.com/OnDemandEmbed.aspx?Token=49272&aid=18596&Plt=FOD&loid=0&w=640&h=480&ref (Links to an external site.)Links to an external site.
First, M. B. (Ed.). (2013) DSM-5: Handbook of Differential Diagnosis. Washington, DC: American Psychiatric Publishing doi:10.5555/appi.books.9781585629992.mf00pre
Gorenstein, E., & Comer, J. (2015). Case studies in abnormal psychology (2nd ed.). New York, NY: Worth Publishers. ISBN: 9780716772736
