Week4DISJan

Prior to beginning work on this interactive assignment, please view the required video read Chapters 15, 20, and the Classes (or Names) of Medications That Can Cause Mental Disorders appendix in DSM-5 Made Easy: The Clinician’s Guide to Diagnosis; read Chapter 1 of DSM-5: Handbook of Differential Diagnosis; and read

Section 4: Privacy and Confidentiality Links to an external site.

from the APA’s Ethical Principles of Psychologists and Code of Conduct: Including 2010 Amendments.

 

To view the written transcript, please click

here

Download here

. (The transcript is uploaded below GRAND ROUND)

Mental health professionals hold grand rounds events to maintain their current knowledge of health care practices and to consult with colleagues on particularly difficult cases. During these professional events, mental health professionals sometimes present a case and seek feedback from peers regarding conceptualization and treatment of a patient’s problems. This interactive assignment is an opportunity to simulate a grand rounds event.
For your initial post in this forum, you will provide written feedback regarding your colleague’s presentation and questions. Your post must include the following:

• Provide an evaluation of the degree to which the presenter followed the ethical standards outlined in Section 4 Links to an external site.of the APA’s Ethical Principles of Psychologists and Code of Conduct: Including 2010 Amendments.   (https://www.apa.org/ethics/code/index)
• Highlight the relevant information from the patient’s history you will use to inform your conceptualization of the patient’s problems and diagnosis.
• Provide an evaluation of the patient’s symptoms and presenting problems within the context of a theoretical orientation that seems to be most appropriate for the situation. Be sure to indicate which theory you are using for your evaluation and provide a justification for your choice. (e.g., cognitive, behavioral, humanistic, biological, sociocultural, evolutionary, psychoanalytic, integrative, etc.). NOTE: Be clear that you are writing about theoretical orientations and using the theoretical orientations to explain the client’s symptoms and presenting problems. Do not use the theoretical orientations to discuss any therapy or treatment approaches. Your application of the theoretical orientations should answer the question: How did this client develop the symptoms and current presenting problems? For example, “Based on the cognitive perspective, how did this client develop the symptoms and current presenting problem?” “Based on the humanisitic perspective, how did this client develop the symptoms and current presenting problem?” Etc.
• Provide a diagnosis for the patient based on the DSM-5. Be specific about the DSM-5 criteria required for the diagnosis and how the client meets those criteria.
• Describe at least one evidence-based and one non-evidence-based treatment option for this diagnosis.
• Pose appropriate questions that you would ask the client to help determine the most accurate diagnosis for this patient.

Grand Rounds

Hi, and thanks for attending this case presentation. My name is Dr. Stephen Brewer and I am a licensed

clinical psychologist in San Diego, California and Assistant Professor of Psychology and Applied

Behavioral Sciences at Ashford University. Today, I will be sharing with you the story of Bob.

Presenting problem

Bob Smith is a 36-year-old man who came to me approximately six months ago with concerns about his

career choice and life direction. He did not have any significant psychiatric symptoms, besides some

understandable existential anxiety regarding his future. Bob was cooperative, friendly, open, and

knowledgeable about psychology during our first few sessions together. I noticed that he seemed

guarded only when talking about his family and childhood experiences. To confirm his identity, I checked

his driver’s license to ensure his name was indeed Bob Smith and that he lived close by in a mobile home

in Spring Valley. Given his relatively mild symptoms, we decided to meet once a week for supportive

psychotherapy so he could work through his anxieties. I gave him a diagnosis of adjustment disorder

with anxiety.

History

Here’s some background on Bob to give you a sense of who he is.

Family

Bob grew up as an only child in Edmonton, Canada, in a low-income, conservative, and very religious

household.

He shared that his father was largely absent during his childhood, as he spent most of the week residing

north of Edmonton, where he worked as a mechanic in the oil fields near Fort McMurray. On weekends,

Bob’s father would return home and spend as much time as possible with his family. Bob described his

father as warm, caring, and a hard worker. His father reportedly died one year ago.

Bob’s mother was described as a strict, rule-based woman who had a short temper and was prone to

furious outbursts over trivial matters. She worked in Bob’s junior high as a janitor, which meant that Bob

often crossed paths with his mother at school, where she would often check up on him. During Bob’s

high school years, Bob’s mother got a new job as a high school librarian.

At 18, Bob moved to San Diego to study psychology at San Diego State University. He lived in the dorms

for his first few years, where he easily made friends and joined a fraternity. Bob maintained contact with

his parents, but ceased all contact when his mother suggested she would move to San Diego to be closer

to him. He graduated with a 3.2 GPA and began working for the county as a psychiatric technician. He

worked as a psych tech for 14 years and described it as “fun at first, but it got boring and predictable

after a while.”

Treatment

Bob shared that he has a medical doctor that he visits once every few years for his routine physical. He

denied having any significant medical problems. Additionally, he denied using any illicit substances and

reported drinking only on occasion with friends from his fraternity.

Collateral

About a month ago, I was curious to learn more about Bob from his friends and mother. He was happy

to sign a release of information for me to speak with his friends, but he refused to sign one so I could

talk with his mother. Still, since his mother’s point of view seemed very important to me, I hired a

private detective to find Bob’s mother’s contact information so I could speak with her about Bob’s life

and treatment.

Bob’s fraternity friends shared some startling information that I wasn’t expecting to hear. They shared

they were relieved that Bob was seeing a psychologist and that they have been trying to convince Bob to

see a psychologist for years. They added that Bob’s personality changed significantly approximately

three years ago. Where Bob was originally a friendly, gregarious, outgoing individual, he suddenly

turned into a suspicious and reclusive man who disappeared for months at a time. They observed Bob

losing a significant amount of weight over the course of only a few months, and they suspected drug use

of some kind. According to them, Bob hasn’t been showing up to work regularly and doesn’t return their

calls.

Current symptoms

Here is my problem.

Bob’s current presentation in therapy seems to be incongruent with what I’ve only recently learned

from his friends. It’s almost as if I’m learning about two completely different people. Although Bob

seems to be friendly and open with me, his friends describe him as suspicious and closed off. This is

puzzling.

Question

Given this new information, how should I make sense of Bob?

Discussion 1

After reviewing the video information, there are several different ethical standards that was presented. For instance, the psychologist used 4.01 maintaining confidentiality, 4.04 minimizing intrusions on privacy, and 4.05 disclosures. According to the American Psychological Association (2010), in section 4.01 maintaining confidentiality, is when the psychologist has primarily focused on maintaining the patient’s information that includes but not limited to, their name, their mental health disorders, their other personal health information, any of their demographics, and their information within their private sessions. Another is 4.04 which is minimizing intrusion on privacy, which means the psychologist has to include the consultation, in an oral and or written report. This induces the confidential information that is obtained by professional work in order to understand the matters presented. Another one that is considered is 4.05 which is disclosure. This is the form when a psychologist has prior authorization to disclose information in order to professionally help and assist the patient.

Brewer and Simpelo (2014), explain that the patient had experienced a loss of a loved one, and dealt with another who, according to the patient was short-tempered, and verbally aggression towards insignificant situations. This is relevant to the patient having possible anxiety. For instance, having a mother that had a consistently short temper can cause the patient to feel like they are walking on eggshells, which is a sense of anxiety. Another relevant factor is the father’s passing, clearly stating that the patient had feelings about not seeing their loved one for some time, and wanting to see them now that they are gone can cause anxiety about possible abandonment. 

Based on cognitive and behavioral perspectives, the patient is avoiding the truth about their true intentions and feelings. This is only based on the interview with peers and family. The patient was experiencing something different compared to what was stated. The patient could possibly have a generalized anxiety disorder, and or a depressive disorder. Even though peers assume it could be related to substances, there is no concrete evidence that substances were involved in the change in cognition and behavior.   

Brewer and Simpelo (2014) provide information regarding the patient’s peers indicating that the patient was different before, such as being outgoing, friendly, and even gregarious. However, over a few years, the patient changed their personality, such weightless, also being suspicious. With that sudden and extreme change in behavior, it can lead to the belief of possible depressive disorder with second anxiety disorder. These changes affect the person’s cognitive and behavioral actions.

Thus, the possible diagnoses are based on Morrison’s (2014), F41.1 Generalized Anxiety Disorder. This is when a person meets the criteria of, having a worry about everything, as well as being at the age of 30 years of age. This is shown with the patient seeking help because they are having anxiety with life choices and are at and or above the age of 30 years old.

One evidence base treatment to help a person dealing with a generalized anxiety disorder could be cognitive behavioral therapy. This type of treatment can be effective to help those who are dealing with anxiety disorder. This in turn will help their symptoms of anxiety, as well as help the person be more involved in their daily activities. A non-evidence-based treatment for generalization anxiety disorder could be mediation, and or a better sleeping pattern.

Some questions that could be asked to the patient is but not limited to:

1. With your consent, loved ones and peers indicated that your personality changed, is that accurate to present?

2. Have you taken any substance, such as alcohol, cocaine, marijuana, LCD, and or other substance?

3. In recent years, has your mother reached out to you in any way that possibly made you feel anxious?

Examine your colleague’s feedback and formulate a response based on your colleague’s questions. Assess the validity of your colleague’s diagnosis from a sociocultural perspective using the theoretical orientation from which you wrote your initial post. The goal of your response is to present information and feedback from your theoretical orientation for your colleague’s consideration, rather than forcing your colleague to take on your orientation as their own. Describe how your conceptualization differs from your colleague’s, if there is a significant difference.

Discussion 2

It was mentioned that you found it necessary to speak to individuals familiar with your client Bob Smith. Consent was given and signed allowing friends of Smith to talk about his condition. This process is in accordance with ethical principle 4.01 
maintaining confidentiality. It was not mentioned that there was any discussion on behalf of Dr. Brewer on his concerns with Bob Smith. He was only concerned with how Smith’s peers viewed him.  Informed consent was also provided by Smith which is in accordance with ethical principle 3.10 
informed consent. However, Smith did not provide permission allowing his mother to be consulted on his behalf, and his mother was still sought out, it is imperative that when speaking to his mother confidentiality is not broken principles are not broken or compromised. 

The patient explains that he is the only child born to low income religious, conservative and strict parents. He also explained that his father was only present on the weekends as he stayed away from home for work during the week. His mother worked at his school when he was in grammar school, and high school. She even tried to follow him to college. 

The patient initial issue with himself is that he is anxious with his future. The patient displays symptoms such as, being an occasional drinker, his friends showed concern in his personality shift, he lost a lot of weight in a short period of time, he has been described as closed off, and suspicious. There are also concerns of him being addicted to drugs. 

Based on the behavioral perspective, the client developed these symptoms and problems from private stimuli (Guercio, J.M., 2022). Behavior approach tells us that the environment causes behavior (Cloninger, 2019). Changes in behavior happen throughout life, consequences determine behaviors (Cloninger, 2019). 

Based off the DSM-5 the patient could suffer from substance use disorder. This disorder causes impaired functioning, and can be caused from drugs e.g., caffeine, alcohol, and pain medicine. The patient meets the criteria of this diagnosis in that, the use can cause distress or impairment. He exhibits this with his sudden change in personality, and his sudden weight loss. He has become closed off, so he has a reduction in activities. Those who suffer from substance abuse also develop issues within their personal and interpersonal life, employment, health and safety, and physiological sequels. He meets these criteria in the neglect of a relationship with his mother, and after fourteen years at the same job he has lost his devotion. It is possible that the client has substance/medication-induced anxiety disorder, which the use of a substance or medication has caused panic attacks or other symptoms of anxiety. 

One evidence-based treatment option for this diagnosis is A non-evidence-based treatment option for this diagnosis could be addiction medicine, while a non-evidence-based treatment option for this diagnosis are twelve step programs according to the CDC. 

Questions that could help determine the most accurate diagnosis would be:

1. What substances do you like to consume for recreational purposes and non-recreational purposes?

2. How often do you consume alcohol or other substances?

3. How do you feel when you do not have access to alcohol or other substances that you consume?

Examine your colleague’s feedback and formulate a response based on your colleague’s questions. Assess the validity of your colleague’s diagnosis from a sociocultural perspective using the theoretical orientation from which you wrote your initial post. The goal of your response is to present information and feedback from your theoretical orientation for your colleague’s consideration, rather than forcing your colleague to take on your orientation as their own. Describe how your conceptualization differs from your colleague’s, if there is a significant difference.