Critical thinking skills in the psychopathology of mental health patients
Analyze and apply critical thinking skills in the psychopathology of mental health
patients and provide treatment and health promotion while applying evidence-based
research.
Scenario: Jax is a 66-year-old Caucasian female whose wife has encouraged her to seek treatment.
She has never been in therapy before, and has no history of depression or anxiety.
However, her alcohol use has recently been getting in the way of her marriage, and
interfering with her newly-retired life. She describes drinking increasing amounts over
the last year, currently consuming approximately a six-pack of beer per day. She notes
that this amount “doesn’t give me the same buzz as it used to.” She denies ever
experiencing “the shakes” or any other withdrawal symptoms if she skips a day of drinking.
Jax comments that her wife is her biggest motivation to decrease her alcohol use.
She tells Jax that she gets argumentative and irritable when she drinks, though she does
not always remember these incidents. She has also fallen while intoxicated twice, causing
bruises both times and hitting her head on one of the occasions.
Questions: Remember to answer these questions from your textbooks and NP guidelines.
At all times, explain your answers.
1. Describe the presenting problems/issues. Is there any information that
was not provided that you would need to formulate a diagnosis?
2. Generate a primary and differential diagnosis using the DSM5 and ICD
10 codes.
3. What physiological and psychological processes lead to substance
dependence?
Sample Solution
Case Analysis: Jax
1. Presenting Problems/Issues
Jax presents with increasing alcohol consumption over the past year, despite experiencing diminished effects. This escalating use is impacting her life, manifesting in marital discord, impaired judgment leading to falls, and potential cognitive decline associated with chronic alcohol use. Her wife’s concern and Jax’s motivation to reduce alcohol consumption are positive indicators for potential treatment engagement.
Missing Information:
To formulate a comprehensive diagnosis and treatment plan, additional information is necessary:
- Detailed alcohol use pattern: Frequency, quantity, and types of alcohol consumed.
- Medical history: Comorbid medical conditions, such as liver disease or hypertension, which can be exacerbated by alcohol use.
- Mental health history: History of depression, anxiety, or other mood disorders.
- Social support: Availability of support systems beyond her spouse.
- Cultural factors: Cultural beliefs and attitudes towards alcohol use.
2. Primary and Differential Diagnosis
Primary Diagnosis:
- Alcohol Use Disorder (AUD): Based on the increasing alcohol consumption, tolerance, and negative consequences, a diagnosis of AUD is likely. Severity would be determined by the DSM-5 criteria.
Differential Diagnoses:
- Depressive Disorder: Alcohol misuse can often mask underlying depressive symptoms.
- Anxiety Disorder: Excessive alcohol use can be a form of self-medication for anxiety.
- Delirium Tremens: While Jax denies withdrawal symptoms, it’s essential to rule out this possibility, especially given her age and increasing alcohol consumption.
DSM-5: Alcohol Use Disorder (mild, moderate, or severe) ICD-10: F10.10 Alcohol use disorder
3. Physiological and Psychological Processes Leading to Substance Dependence
Substance dependence involves complex interactions between biological, psychological, and environmental factors.
Physiological Processes:
- Tolerance: The body adapts to the substance, requiring increased amounts to achieve the same effect.
- Withdrawal: Physical and psychological symptoms experienced when alcohol use is reduced or stopped.
- Reinforcement: The pleasurable effects of alcohol reinforce continued use.
- Brain Changes: Chronic alcohol use can alter brain chemistry and structure, contributing to dependence.
Psychological Processes:
- Cravings: Intense desire or urge to consume alcohol.
- Loss of Control: Difficulty in limiting alcohol intake.
- Neglect of Responsibilities: Prioritizing alcohol use over other life areas.
- Tolerance of Negative Consequences: Continuing to use alcohol despite harmful effects.
Understanding these processes is essential for developing effective treatment plans.