Question

Differential Diagnosis

Read through the case presentation.

1. Specify three diagnoses that best fit the case presentation. Limit these to disorders covered in Chapters 5 through 15. You must refer to the disorders by the diagnoses referenced in the DSM-5. Additionally, the diagnoses must significantly differ between each other. For example, you will not receive full credit if you choose PTSD and Acute Stress Disorder.

For each diagnosis:

2. Identify THREE symptoms included in the case presentation that fit the diagnostic criteria for that diagnosis and WHY they fit (i.e., the symptom criteria you're referring to).

3. Identify AT LEAST ONE detail that does NOT fit with the disorder.

4. Specify THREE pieces of information you need to know to confirm the diagnosis based on diagnostic criteria or risk factors or epidemiological information that would make the disorder more or less likely.

Case study:

Mr. X is a 36-year-old male. During his intake interview, he appeared disheveled, poorly groomed, and was malodorous. He made poor eye contact with the clinician, appearing guarded and mistrustful during the interview. He stated that things had been “off” for the past six months. Mr. X stated that he “heard and saw strange things” for an extended period of time several months ago and that this had resulted in losing his job and being kicked out of his apartment for not paying his rent. Additionally, he reported that his most recent job had involved “working for the government as an undercover agent” and stated that he now believed the government was attempting to brainwash him in order to control his behavior so that he could not divulge “top secret” information. Mr. X appeared increasingly distressed and disoriented as the interview progressed. He displayed mild psychomotor agitation and low, rapid, impoverished speech. He reported feeling extremely “tired” because he didn't sleep well, except on nights when he managed to get a hold of a fifth of whiskey, and explained that he often stays up feeling “worried about his safety”. When asked how much he drinks on an average day, Mr. X laughed and said, “as much as I can get!” but quickly added, “I mean, I’m kidding, I only drink so I can sleep.” He denied both suicidal and homicidal ideation.

Answer 1

Hello, thank you for your question :)

1. Specify three diagnoses that best fit the case presentation. Limit these to disorders covered in Chapters 5 through 15. You must refer to the disorders by the diagnoses referenced in the DSM-5. Additionally, the diagnoses must significantly differ between each other. For example, you will not receive full credit if you choose PTSD and Acute Stress Disorder.

From what I can analyze from the case study mentioned the 3 possible diagnoses are

1) Major Depression

2) Schizophrenia

3) Alcohol use disorder

A little description of each of these disorders

Major Depression Disorder

It is characterized by the prevalence of 5 or more of the following disorders mentioned in the DSM5. They include

• Depressed or low mood throughout the day,
• lack of interest or pleasure in various activities,
• lack of sleep and appetite,
• feeling tired and fatigued all the time,
• psychomotor agitation or slow body movements or speech
• feeling worthless, hopeless or guilty,
• inability to concentrate and do daily activities,
• thoughts about death or a suicidal attempt
• The person shows a dramatic change in functioning as compared to before
• the symptoms should last for more than 2 weeks
• the symptoms should not be a manifestation of any other medical condition

In the above case, Mr. X shows the following symptoms of depression

• disheveled,
• poorly groomed
• malodorous
• psychomotor agitation and low, rapid, impoverished speech.
• feeling extremely “tired”
• insomnia
• symptoms were present for the past six months

3. Identify AT LEAST ONE detail that does NOT fit with the disorder.

• He had hallucinations and delusions

************************************

2. SCHIZOPHRENIA

It is characterized by the prevalence of 5 or more of the following disorders mentioned in the DSM5. They include

• 2 or more of the following symptoms must be present for at least 1 month (active phase) but residual symptoms can be present for 6months
• delusions- they are defined as a false belief that is firmly held in spite of contradictory evidence. the delusions can be of persecution, paranoia, grandiose, etc
• hallucinations - are defined as sensory stimuli (visual or auditory) that seem to be real to the patient but are not real or present
• disorganized speech or motor behavior, bizarre behavior (catatonia also)
• Negative symptoms - avolition, flat affect, alogia )

In the above case, Mr. X shows the following symptoms of Schizophrenia

• disheveled, poorly groomed, (associated symptoms of psychosis)
• poor eye contact (associated symptoms ie not main symptoms but are present as a result of them)
• appearing guarded and mistrustful (paranoia)
• heard and saw strange things (hallucinations)
• symptoms were present for the past six months
• The government was attempting to brainwash him in order to control his behavior so that he could not divulge “top secret” information. (delusions)
• mild psychomotor agitation and low, rapid, impoverished speech (disorganized speech)

3. Identify AT LEAST ONE detail that does NOT fit with the disorder.

• Depression, low mood
• he did not have many negative symptoms

3.Alcohol Use disorder

It is characterized by the prevalence of 5 or more of the following disorders mentioned in the DSM5. They include

• Alcohol is consumed for over 12months and has been causing impairment and distress in the client’s life
• the alcohol intake has increased
• cravings - a strong desire to consume alcohol
• tolerance - need to increase the consumption as that amount doesn’t get you drunk anymore
• withdrawal - without alcohol the patient experiences trembling, hallucinations, agitations and therefore ha to consume alcohol continuously to avoid those symptoms
• continued to use alcohol in spite of social, work and interpersonal problems
• the person is socially withdrawn as alcohol consumes their entire daily life and living

In the above case, Mr. X shows the following symptoms of alcohol use

• he consumes whiskey
• his tolerance level has increased
• he could be experiencing withdrawal symptoms or a substance-induced mental disorder which are causing the delusions and hallucinations

3. Identify AT LEAST ONE detail that does NOT fit with the disorder.

• Depression, low mood

******************************************

4. Specify THREE pieces of information you need to know to confirm the diagnosis based on diagnostic criteria or risk factors or epidemiological information that would make the disorder more or less likely.

• Family History which disorder is present in the family which makes it more likely that the patient will have it too
• Need to know if symptoms of depression have been present when his schizophrenia symptoms had been the worst ie to rule out Schizoaffective disorder there should be a period in time when both symptoms of depression and schizophrenia occurred simultaneously and how severe the depression is
• Need to find out the nature of the delusions or hallucination ie if the delusions and hallucinations are different, random, and bizarre then it could be schizophrenia. However, if the delusions and hallucinations are congruent it can be a delusional disorder. If the delusions are sad and depressed caused due to the low mood it can be depression with psychotic symptoms.
• How bad is his substance abuse ie whether he is using any drugs or alcohol that results in these symptoms. (substance-induced mental disorder) In such a case the history of the substance has to be taken to know which occurred first. Then the substance has to be eliminated to see if the symptoms still persist
• A medical check-up would be required to analyze whether there is any hormonal imbalance or neurological condition
• You can administer various psychological tests or screening tests for depression and alcohol use
• Family members and close associates need to be interviewed also

******************************************

I hope this was informative and helpful! :) Do rate my answer or give me feedback! :)