6090 Week 6 – Discussion: Applying Differential Diagnosis to Depressive and Bipolar Disorders

Discussion: Applying Differential Diagnosis to Depressive and Bipolar Disorders

What is it truly like to have a mental illness? By considering clients’ lived experiences, a social worker becomes more empathetic and therefore better equipped to treat them. In this Discussion, you analyze a case study focused on a depressive disorder or bipolar disorder using the steps of differential diagnosis.

To prepare: View the TED Talk “Depression, the Secret We Share” (TED Conferences, LLC, 2013) and compare the description of Andrew Solomon’s symptoms to the criteria for depressive disorders in the DSM-5. Next review the steps in diagnosis detailed in the Morrison (2014) reading, and then read the case of Angel provided for this Discussion, considering the client against the various DSM-5 criteria for depressive disorders and bipolar disorders.

Provide a Discussion Post of 500+ words covering the following Content, Topics, and Headings: 

· Provide the full DSM-5 diagnosis for the client. For any diagnosis that you choose, be sure to concisely explain how the client fits that diagnostic criteria. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, medical needs, and the Z codes (other conditions that may be a focus of clinical attention). Keep in mind a diagnosis covers the most recent 12 months.

· Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis.

· Recommend a specific evidence-based measurement instrument to validate the diagnosis and assess outcomes of treatment.

· Describe your treatment recommendations, including the type of treatment modality and whether or not you would refer the client to a medical provider for psychotropic medications.

· Reference the above detailed learning resource

· Must contain at least 4 References and citations

· High Quality Master Degree Level

APAhigh qualityproper English

Week 6: Diagnosing Depressive and Bipolar Disorders

Diagnosing a depression is one of the most common—and yet most complex—differential diagnoses a social worker may make. The word itself covers a wide range of variations of the illness from normal sadness to serious clinical depressions that might not present the same way. Clinical depression disorders can look agitated or leaden even within the same specific form of the illness. They can be persistent depressions, mild and adjustment related, or caused by particular life events as in postpartum depressions.

Social workers need to know how to differentiate among types of depressions. They also need to know how to find the overlaps that depression has with other illnesses such as anxiety and trauma disorders.

This week you observe a case of unipolar depression and then apply your diagnostic decision-making process to

 

a case study. You also consider how to differentiate among disorders on these two spectrums and the importance of validating a diagnosis over time.

Learning Objectives

Students will:

· Analyze a case study focused on a depressive disorder or bipolar disorder utilizing steps of differential diagnosis

· Analyze lived experiences of depression

· Evaluate cases to determine accurate mood disorder diagnosis

Learning Resources

Required Readings

Morrison, J. (2014). Diagnosis made easier (2nd ed.). New York, NY: Guilford Press.

· Chapter 11, “Diagnosing Depression and Mania” (pp. 129–166)

American Psychiatric Association. (2013e). Depressive disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm04

American Psychiatric Association. (2013c). Bipolar and related disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm03

Jain, R., Maletic, V., & McIntyre, R. S. (2017). Diagnosing and treating patients with mixed features. Journal of Clinical Psychiatry, 78(8), 1091–1102. doi:10.4088/JCP.su17009ah1c

Diagnosing and Treating Patients with Mixed Features by Jain, R.; Maletic, V.; McIntyre, R., in Journal of Clinical Psychiatry, Vol. 78/Issue 8. Copyright 2017 by Physicians Postgraduate Press. Reprinted by permission of Physicians Postgraduate Press via the Copyright Clearance Center.

Walton, Q. L., & Payne, J. S. (2016). Missing the mark: Cultural expressions of depressive symptoms among African-American women and men. Social Work in Mental Health, 14(6), 637–657. doi:10.1080/15332985.2015.1133470

Required Media

TED Conferences, LLC (Producer). (2013). Depression, the secret we share [Video file]. Retrieved from https://www.ted.com/talks/andrew_solomon_depression_the_secret_we_share

TEDx Talks. (2013a, May 23). Depression is a disease of civilization: Stephen Ilardi at TedxEmory [Video file]. Retrieved from https://youtu.be/drv3BP0Fdi8

Optional Resources

American Psychiatric Association. (2013b). Assessment measures. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.AssessmentMeasures

Santiago-Rivera, A. L., Benson-Flórez, G., Santos, M. M., & Lopez, M. (2015). Latinos and depression: Measurement issues and assessment. In K. F. Geisinger (Ed.), Psychological testing of Hispanics: Clinical, cultural, and intellectual issues (2nd ed., pp. 255–271). Washington, DC: American Psychological Association. doi:10.1037/14668-014

Thase, M. E., Weisler, R. H., Trivedi, M. H., & Manning, J. S. (2017). Utilizing the DSM-5 Anxious Distress specifier to develop treatment strategies for patients with major depressive disorder. Journal of Clinical Psychiatry, 78(9), 1351–1362. doi:10.4088/JCP.ot17015ah1

Utilizing the DSM-5 Anxious Distress Specifier to Develop Treatment Strategies for Patients with Major Depressive Disorder by Thase, M.; Weisler, R.; Trivedi, M.; Manning, J., in Journal of Clinical Psychiatry, Vol. 78/Issue 9. Copyright 2017 by Physicians Postgraduate Press. Reprinted by permission of Physicians Postgraduate Press via the Copyright Clearance Center.

Document: Suggested Further Reading for SOCW 6090 (PDF)

 

Note: This is the same document introduced in Week 1.

Discussion: Applying Differential Diagnosis to Depressive and Bipolar Disorders

What is it truly like to have a mental illness? By considering clients’ lived experiences, a social worker becomes more empathetic and therefore better equipped to treat them. In this Discussion, you analyze a case study focused on a depressive disorder or bipolar disorder using the steps of differential diagnosis.

To prepare: View the TED Talk “Depression, the Secret We Share” (TED Conferences, LLC, 2013) and compare the description of Andrew Solomon’s symptoms to the criteria for depressive disorders in the DSM-5. Next review the steps in diagnosis detailed in the Morrison (2014) reading, and then read the case provided by your instructor for this week’s Discussion, considering the client against the various DSM-5 criteria for depressive disorders and bipolar disorders.

Provide a Discussion Post of 500+ words covering the following Content, Topics, and Headings:

· Provide the full DSM-5 diagnosis for the client. For any diagnosis that you choose, be sure to concisely explain how the client fits that diagnostic criteria. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, medical needs, and the Z codes (other conditions that may be a focus of clinical attention). Keep in mind a diagnosis covers the most recent 12 months.

· Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis.

· Recommend a specific evidence-based measurement instrument to validate the diagnosis and assess outcomes of treatment.

· Describe your treatment recommendations, including the type of treatment modality and whether or not you would refer the client to a medical provider for psychotropic medications.

· Reference the above detailed learning resource

· Must contain at least 4 References and citations

· High Quality Master Degree Level

· Proper English with no run-on sentences

1

CASE OF ANGEL

INTAKE DATE: May 2019

DEMOGRAPHIC DATA:

This is a voluntary intake for this 53-year-old Hispanic male. Angel had one psychiatric hospitalization in the past. Angel has been married for 19 years and has been separated from his wife for the past four months. His wife, daughter, and two sons live two blocks from him. Angel is employed as a car salesman manager and is very successful at his career.

CHIEF COMPLAINT:

“I miss my family and do not want to live without them. My wife said if I attend treatment we can get back together.”

HISTORY OF ILLNESS:

Angel reports first seeking psychiatric treatment when he was twenty-four-years-old. He sought treatment by the encouragement of his girlfriend at the time because she described him as strange. He was always excited and was “on top of the world.” He would buy her a lot of gifts, which she appreciated, but she later found out he charged everything and did not have the money to pay for the gifts. He was employed at a car dealership and was washing cars at the time. Sometimes he would become very irritable when he saw the credit card bills months later. His focus was on advancing his career and he believed he could be in charge of the entire car dealership in a short period of time. He always was a fast talker but during this period his girlfriend could not get a word in edgewise. She hated how he would be up most of the night. She needed to sleep to get to work but a few hours of sleep did not seem to affect Angel. This behavior seemed to settle down after a while, and Angel did not continue psychiatric help.

At thirty-four-years-old he attempted suicide after his wife of one year left him. He was hospitalized in a psychiatric unit for twelve days. Angel showed signs of feeling down, fearful, and suicidal. His wife indicated he would become very agitated and would sometimes punch the wall. She feared she would be the victim of some of his acting out. For a few weeks, he would not get out of bed or go to work because he said he could not concentrate on work he was feeling so bad.

PSYCHOSOCIAL HISTORY:

Angel grew up in an average household with both parents working in a factory. His dad was eventually promoted to foreman. Mom and Dad would have different shifts so it was rare that they would have dinner together. Angel has nice memories about Sundays since the family would go to church and have a nice dinner. Many of the relatives would gather each week at a different house. Angel has 6 siblings. Angel was initially considered an underachiever in the early years of school. He chose not to attend college because he wanted to get out in the work force for money.

SUBSTANCE USE HISTORY:

Angel indicates he is a social drinker. Through collaborative contact from his wife, she confirms he is a social drinker. One worry she has is recently when he had reported feeling down, she believed his alcohol intake increased slightly which was very different than his normal behavior.

MEDICAL HISTORY:

Angel has no significant medical history.

FAMILY ISSUES AND DYNAMICS:

Angel is currently married with three children, one daughter and two sons. This is his only marriage. Through collaborative discussion with his wife, she indicates Angel is a great dad and good provider. There was that one incident when he was hospitalized but overall, their relationship has been good.

More recently, Angel has been feeling depressed again. This feeling has been on and off but has been more consistent these past few months. He then would have angry outbursts and act out and punch the wall. His wife believed this was due to his lack of sleep. He says he is always tired but has difficulty sleeping, and she noticed he would play video games most of the night. He would then have a difficult time to go to work in the morning.

MENTAL STATUS EXAM:

Angel presents as a neatly dressed male who appears younger than his stated age. His nails are neatly groomed. Facial expressions are appropriate to thought content. Motor activity is appropriate. Thoughts are logical and organized. There is no evidence of hallucinations. Angel admitted to a history of suicidal ideation. During the interview, Angel talked slowly. Angel is oriented to time, place, and person. His intelligence appears above average.