Formulate a Differential Diagnosis for Sara. What comorbid disorders might you see?

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You are encouraged to use the DSM-5 Level 2 Assessment Measure(s) to formulate your diagnosis:
http://www.psychiatry.org/practice/dsm/dsm5/online-assessment-measures#Level2

All discussions must take into account the legal and ethical considerations, as well as issues of culture and human diversity that may pertain to the vignettes below. Legal and Ethical information is in Chapter 16 of the course text. Cultural information is covered throughout the course text and DSM 5. You may use alternative cultural resources to enhance your work.

Your assignment should be 3-4 pages plus a title and reference page.

Sara is a 38 year old woman who was referred by her employer for mandatory counseling. She presents as markedly underweight, in baggy clothing. She tested positive for amphetamine on a recent random test at work and is on suspension. It is obvious that Sara does not want to be there, but knows she must cooperate to get her job back. Sara is currently taking anti-psychotic medication and mood stabilizers. When you ask her why, she tells you that “my shrink thinks I’m nuts. OK, I admit that sometimes I think the devil is telling me to kill myself, but I never do it. I just cut myself instead. Nothing serious, just a scratch here and there”. She admits that, “a couple of drinks or a line, calms the beast and the voices stop”. She also admits to loving excitement and risk taking. “I love it when my mind races and I just hop in the car and go. Messes with my job sometimes, but who cares”.

During your psychosocial assessment, you learn that Sara was born in Japan. Her father was a Native-American spirit-seeker. He came to Japan to study Eastern Religions where he met her mother, who she describes as, “a meek and quiet little Japanese woman”. When Sara was 8 years old, they left Japan and moved to the United States, living with her father’s family. She appears nervous talking about this time of her life, but does admit it was a dark and fearful time, except for her grandmother, who she loved deeply, but died when Sara was age 14.

At age 15, she began seeing spirits of her deceased grandmother. She wondered if this was a spiritual sign. It saddened her so much, that she began self-abuse, strict dieting and substance use at about that age. She believes that the devil tells that her grandmother’s death, “was all my fault. I deserve to suffer”. Her guilt and self-loathing have prevented her from committing to a relationship. She has been dating the same man for 15 years who she describes as, “too good for me. I don’t know why he hangs around”.

1. Formulate a Differential Diagnosis for Sara. What comorbid disorders might you see? Support your ideas by discussing what you see in the vignette utilizing your course readings thoroughly in your diagnostic formulation. What information would you look for to confirm your diagnostic impression and why?

2. Choose two (2) theoretical models to explain to explain Sara’s clinical presentation and suggested treatment modalities. Support your ideas by discussing the models directly and specifically to Sara.

(Remember to consider culture, law and ethics when diagnosing and treating)
Assignment Outcomes:
Analyze the physical, cognitive, social and personality aspects of abnormal psychology and implications across the life span
Examine the major diagnostic domains and specific criteria associated with DSM-5 disorders.
Evaluate legal and ethical issues in mental health treatment
Develop an awareness of diversity and cross-cultural perspectives in abnormal psychology.
Explore available treatment and interdisciplinary services for community members experiencing mental health disorders.
Identify the barriers associated with seeking and receiving therapeutic services.

Explore available treatment and interdisciplinary services for community members experiencing mental health disorders.

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You are encouraged to use the DSM-5 Level 2 Assessment Measure(s) to formulate your diagnosis:
http://www.psychiatry.org/practice/dsm/dsm5/online-assessment-measures#Level2

All discussions must take into account the legal and ethical considerations, as well as issues of culture and human diversity that may pertain to the vignettes below. Legal and Ethical information is in Chapter 16 of the course text. Cultural information is covered throughout the course text and DSM 5. You may use alternative cultural resources to enhance your work.

Your assignment should be 3-4 pages plus a title and reference page.

Steven is a 28 year old male. His father was African-American and his mother was Hispanic-American. Steven grew up in East Los Angeles where gang activity was prominent. The oldest of 3 boys, Steven spent most of his childhood looking out for his 2 younger brothers. Both parents were alcoholics and “disinterested in us kids”. At age 19, Steven moved by himself to a major East Coast city where he attended college and is doing well as an architect. He is currently married to a woman he met in college. The couple is expecting their first child.

Steven comes to therapy upon the suggestion of his primary care physician due to chronic worry, anticipation of failure and fear that he will not be able to financially care for his wife and new baby, in spite of his lucrative and successful career. He also has ruminative thoughts, that that he is a facade and that, “people will find out who I really am.”

Steven tells you that lately he has gotten dizzy when driving on the highway and recently experienced the inability to breathe when at the mall with his wife. He also tells you that sometimes when he closes his eyes, he sees his parents “beating each other up and can hear them screaming.” He also discloses that sometimes he wakes up at night with clenched fists and feels like that scared little boy all over again. Lately he has been unable to leave the house without making sure the door is locked several times and avoids odd numbered streets on the way to work.

1. Formulate a Differential Diagnosis for Steven. What comorbid disorders might you see? Support your ideas by discussing what you see in the vignette utilizing your course readings thoroughly in your diagnostic formulation. What information would you look for to confirm your diagnostic impression and why?

2. Choose two (2) theoretical models to explain Steven’s clinical presentation and suggested treatment modalities. Support your ideas by discussing the models directly and specifically to Steven.

(Remember to consider culture, law and ethics when diagnosing and treating)
Assignment Outcomes:
Analyze the physical, cognitive, social and personality aspects of abnormal psychology and implications across the life span
Examine the major diagnostic domains and specific criteria associated with DSM-5 disorders.
Evaluate legal and ethical issues in mental health treatment
Develop an awareness of diversity and cross-cultural perspectives in abnormal psychology.
Explore available treatment and interdisciplinary services for community members experiencing mental health disorders.
Identify the barriers associated with seeking and receiving therapeutic services.

Evaluate the advantages and disadvantages of barcoding.

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For your Patient Satisfaction Quality Improvement Project, write a 1,400- to 1,750-word report in which you will:
• Explain the types of information technology systems you used to gather data.
o Explain how the use of nursing informatics applies to your department or unit, and how it relates to your quality improvement initiative.
o Evaluate the influence of information technology on patient care.
 Does it improve patient care?
 How much nursing time does technology take away from patient care?
 Evaluate the advantages and disadvantages of barcoding.
• Analyze which systems contribute to the management and maintenance of change for the organization.
• Analyze the Health and Medicine Division recommendations for integrated information systems (e.g., EpicCare, Cerner, ABELMed, FutureNet, or other system).
• Determine other types of applications of technology, other than the electronic medical record system, to implement the quality improvement project.

How has this technology been received, accepted, or rejected? Why? Is it feared or favored? What is the attitude toward change? How are the developers trying to sell the technology to the general public?

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This portion of the Course Project provides an analysis of the chosen technology’s influence on society considering all of the following components:
• Social

o How has this technology been received, accepted, or rejected? Why? Is it feared or favored? What is the attitude toward change? How are the developers trying to sell the technology to the general public? Look at attitudes, feelings (emotions), behaviors, personality, and the ways humans change as a result of this technology. What is being thought, and why? Is the human mind impacted? How? Are interactions between people changing as a result? Who is included or excluded, and why? Use Maslow’s hierarchy of needs, Piaget, or some other theorist. What psychological needs are met by the technology (e.g., cell phones once granted status and now promote a sense of belonging or connectedness) or created by the technology? Consumerism?
o Look at groups and organizations that have arisen and prospered because of this technology. Are these groups supportive or antagonistic, and why? (An example is genetically modified foods [GMOs] and the backlash against the Monsanto corporation. Another is cochlear implants that allow the deaf to hear yet reduce the deaf population that calls itself a community.) How does the technology change society, or how does society change in response to the technology? What factors in society led to the development in the first place? What do class, gender roles, race, norms, and the like mean in this context? Who will benefit from the technology, and who might be harmed (this might also belong in the ethics and morals section)? For example, prosthetics enable people to participate more fully and actively in society (some people compete in triathlons and marathons), and war has brought about the need for advances in prosthetic technology as casualties with missing limbs return home to the United States. Look at the workplace, new companies, and/or jobs created, jobs lost (or save this for the economics section, perhaps). Look at roles—subgroups, people’s interpersonal and intrapersonal relationships. Consider crime, healthcare, and schools. Surveillance cameras, for example, have recently been installed in New York City, and the result has been a decrease in the amount of crime, purse-snatching, pickpocketing, and so forth. Yet some fear the big-brother effect of always being watched and tracked, as well as concerns over “who will guard the guards.”
• Cultural

o This is a really important section. Consider the elements that comprise the culture and subcultures. Compare the United States’ use of the technology with that of other nations around the world. What is it about Americans that brings about innovation, or has America declined in terms of technical innovation, scientific research, and development? Look at advertising for the technology, the use of celebrities or stars or heroes, the applications (e.g., sports and nanotechnology), and the values represented by the culture. What has priority, and why? An example: IBM was spelled out in xenon atoms. Why were these letters chosen instead of something else? What new words have been added to our vocabulary from this technology? Horseless carriage was used long before the term automobile. Wireless preceded Wi-Fi, and webcasting preceded podcasting. Broadcast was a term adapted from agriculture long before it was used for radio and television.