The physical, emotional, social, and behavioral effects of the primary/secondary disorder(s).

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Case Study
Mike is a 20 year-old male who reports to you that he feels depressed and is experiencing a significant amount of stress about school, noting that he’ll “probably flunk out.” He spends much of his day in his dorm room playing video games and has a hard time identifying what, if anything, is enjoyable in a typical day. He goes back and forth between not sleeping for days to sleeping for multiple days at a time. He rarely attends class and has avoided reaching out to his professors to try to salvage his grades this semester. Mike has always been a self-described shy person and has had a very small and cohesive group of friends from elementary through high school. Notably, his level of stress significantly amplified when he began college. You learn that when meeting new people, he has a hard time concentrating on the interaction because he is busy worrying about what they will think of him – he assumes they will find him “dumb,” “boring,” or a “loser.” When he loses his concentration, he stutters, is at a loss for words, and starts to sweat, which only serves to make him feel more uneasy. After the interaction, he replays the conversation over and over again, focusing on the “stupid” things he said. Similarly, he has a long-standing history of being uncomfortable with authority figures and has had a hard time raising his hand in class and approaching teachers. Since starting college, he has been isolating more, turning down invitations from his roommate to go eat or hang out, ignoring his cell phone when it rings, and habitually skipping class. His concerns about how others view him are what drive him to engage in these avoidance behaviors. These avoidance behaviors are contributing to his depressed mood and overall apathy.
Instructions
Above is a case study of a 20-year old male. Write a 4-5 page paper addressing the following:
1. Provide the primary diagnostic impression based upon the DSM-5-TR. Include the full name of each diagnosis. Be sure to consider secondary disorders in addition to the primary disorder. Provide the following for all diagnoses:
1.
a. List the symptoms based on the client’s report and link them directly to the DSM-5-TR criteria. Make sure you have linked every client symptom to every DSM-5-TR criteria you will use to support the diagnosis.
3.
b. Using empirical research, discuss the physical, emotional, social, and behavioral effects of the primary/secondary disorder(s).
2. List other DSM-5-TR conditions you considered and the process you went through to decide they were not the correct diagnosis. For example: “The client reported three symptoms of Major Depressive Disorder, but five symptoms are needed for this diagnosis, so the disorder was ruled out.
3. Using empirical research, discuss what the most appropriate treatment would be based on the primary/secondary disorders.

 

Sample Solution

Client: Mike, a 20-year-old male

Chief Complaint: Depression and stress about school

History of Present Illness:

Mike is a 20-year-old male who presents to the counseling center with complaints of depression and stress about school. He reports that he has been feeling down and unmotivated for the past few months. He has difficulty concentrating on his schoolwork and has been skipping classes. He also reports feeling anxious and stressed about his grades. He is worried that he will flunk out of school.

Mike has always been a shy person, but his social anxiety has worsened since he started college. He finds it difficult to meet new people and often feels like he is being judged. He avoids social situations whenever possible.

Mike’s sleep pattern has also been disrupted. He has been going days without sleeping, and then sleeping for long periods of time. He also reports feeling tired all the time.

Mike’s appetite has also been affected. He has been eating less than usual, and he has lost weight.

Mental Status Examination:

Mike is a well-developed, well-nourished male in no acute distress. He is cooperative and polite. His mood is depressed, and his affect is blunted. He denies suicidal ideation or intent. His thought process is linear and goal-directed. His attention is slightly impaired. His memory is intact. His judgment is impaired.

Diagnosis:

Based on the DSM-5-TR, Mike meets the diagnostic criteria for the following:

  • Major Depressive Disorder, Single Episode: Mike has experienced a depressed mood for most of the day, nearly every day, for at least two weeks. He also reports anhedonia, changes in weight or appetite, changes in sleep, psychomotor agitation or retardation, fatigue, feelings of worthlessness or guilt, diminished ability to think or concentrate, and recurrent thoughts of death or suicide.
  • Social Anxiety Disorder: Mike has a marked fear of social situations in which he is exposed to possible scrutiny by others. He fears that he will be negatively evaluated, and he avoids these situations whenever possible. His avoidance of social situations has caused significant distress or impairment in his social, occupational, or academic functioning.

Treatment Plan:

Mike will be treated with a combination of medication and therapy. The medication will be used to target his depressive symptoms. The therapy will be used to help him address his social anxiety and improve his coping skills.

Prognosis:

The prognosis for Mike is good. With treatment, he is expected to experience a significant improvement in his symptoms. He is likely to be able to return to school and resume his social life.

Discussion:

Mike’s case illustrates the complex interplay of social anxiety and depression. Social anxiety can lead to avoidance of social situations, which can then contribute to depression. Depression can also lead to social withdrawal, which can make social anxiety worse.

It is important to treat both social anxiety and depression in order to achieve a good outcome. Medication can be helpful for targeting the symptoms of depression. Therapy can be helpful for addressing the underlying causes of social anxiety and teaching coping skills.

With treatment, Mike is likely to experience a significant improvement in his symptoms and be able to return to school and resume his social life.

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