DSM-5 Diagnostic Case Studies Case Studies

Tom is a 30-year-old male who was near the World Trade Center during the 9/11 attack. He witnessed horrific scenes, including people jumping from the World Trade Center. Since that day, he has had nightmares. Whenever a plane flies overhead, he has the feeling that he needs to run to a secure place. He has thought of moving out of New York City because he finds himself reliving the event every time he is down in the area of the 9/11 attack.

Post-traumatic stress disorder (PTSD) although a very complex disorder, is a well-known psychiatric consequence of trauma, which is likely what Tom is experiencing (Iribarren, Prolo, Neagos, & Chiappelli, 2005). The event that is responsible for the PTSD must be directly experienced as a threat to one's own integrity and associated with intense fear, helplessness, or horror; the patient also persistently re-experiences the traumatic incident in such a way as distressing dreams, thoughts, or perceptions of the events, and the diagnosis is made typically when the symptoms have lasted more than one month and included some sort of functional impairment (Longo, et al., 2010).

2.Jennifer is worried about her friend Mark, who is a 19-year-old male who recently started hiding in his apartment bedroom. He told Jennifer that the government could hear everything he says, and does so in every room but his bedroom. More recently, Jennifer has visited him and found out he is not going to work, as he is feeling very low and depressed. She also recognized that he is smoking more pot than usual.

Based on the information provided, it is unclear if the disorder is a substance-induced psychotic disorder or a disorder such as schizophrenia. In many cases, an alcoholic or drug user may experience mental illness prior to ever beginning substance abuse and this could then confound the possibility of easy detection of symptoms that are due to the substance itself; however, in most cases, if the symptoms preceded the substance use, abstinence from the substance will lead to a continuation of symptoms (Gillespie, 2016). In the case of substance-induced psychosis, though, the effects typically subside after the drug wears off and the first step for Mark will be to gain sobriety.

3.Angela is a 35-year-old human resources manager and mother who has found that methamphetamines allow her to work long hours and also gives her enough energy when she is home to manage her household and children. More recently, she has started to think that her boss has been planning to fire her, even though there is no visible sign that her work has been suffering due to her use. When she passes by his office and he is on the phone, she is sure he is talking about her and his plans to fire her.

When some substances are consumed for long periods of time, they can manifest themselves as psychotic symptoms that may present themselves as schizophrenia-like symptoms. The psychiatric diagnoses, methamphetamine abuse and methamphetamine dependence, in DSM-IV-TR were replaced by one diagnosis, amphetamine-type substance use disorder, in DSM-5 listed under the broader category of stimulant use disorders (American Psychiatric Association, 2013). In many case, hallucinations or extreme paranoia can shift in the patient's reality, such that they believe that something far from reality is taking place which could explain why Angela believes that she will be fired without actually knowing whether or not that is the case.

4.Justin is a 20-year-old college student who recently started lining his single dorm room with tin foil. He thinks that his neighbors have been listening in on his phone conversations and wants to prevent their listening with the use of this foil. He has stopped going to classes and interacting with his friends. His friends are very worried about him and decided to go to the dean to talk to her about his behavior.

Schizophrenia is the prototypical psychotic disorder, and not only is it the most common psychosis, but schizophrenia tends to involve abnormalities in all five of the emphasized symptom domains: hallucinations, delusions, disorganized thinking (speech), grossly disorganized or abnormal motor behavior (including catatonia), and negative symptoms (American Psychiatric Association, 2013). It seems like it is most likely the case that Justin is experiencing irrational delusions that would be consistent with a form of paranoid schizophrenia and this should be reported as soon as possible due to the fact that this condition is often associated with self-harm as well as harm to others.

Part 2: Treatment Scenarios

Provide a 50- to 75-word response to each of the following scenarios:

Imagine that you are working with a client that has been diagnosed with a psychotic disorder. Select a psychotic disorder from the DSM-5 and discuss the approach you would you use for treating this client.

Disorder Selected -- PTSD

The diagnostic criteria for PTSD...

For example, PTSD is often accompanied by drug and/or alcohol abuse and patients may not provide an accurate history regarding the extent of substance abuse. Although questioning the client directly will likely provide insights into the extent of the psychosis that is substance related, it will typically take a significant amount of time in counseling to understand these relationships and they might not fully be understood until the patient is sober. Using a path analysis researchers have found that the effects of reference trauma type on PTSD symptom levels was mediated by levels of both peritraumatic shame and fear, suggesting that shame, in addition to fear, may contribute to the development of PTSD symptoms in survivors of interpersonal traumas (La Bash & Papa, 2014).
Imagine that you are working with a client with co-occurring posttraumatic stress and substance use disorders. How would you approach treating this client? What special considerations should you make?

The first step will be to recommend sobriety and develop a plan to reach this objective with the client while undergoing treatment for the underlying psychological condition. Many of these individuals will find the ability to cope through the use of drugs and alcohol which raises the likelihood of alcohol use disorders (AUD) in this population. The co-occurrence of PTSD and alcohol use disorders (AUDs) is particularly common, with epidemiological studies indicating that up to 52% of men and 28% of women with PTSD also meet lifetime criteria for alcohol abuse or dependence and this population not only uses increased amounts of substance abuse treatment but they also generally have poorer outcomes in treatment (Hruska, Sledjeski, Fallon, Spponster, & Delahanty, 2011). In any PTSD treatment, several points related to alcohol should be stressed (U.S. Department of Veteran Affairs, 2015):

When planning your treatment, the possible effects of drinking on your PTSD symptoms. As noted above, alcohol can affect sleep, anger and irritability, anxiety, depression, and work or relationship problems.

Treatment should include education, therapy, and support groups that help you with your drinking problems in a way you can accept.

Treatment for PTSD and alcohol use problems should be planned in a way that gets at both problems together. You may have to go to separate meetings on each issue, or see providers who work mostly with PTSD or mostly with alcohol problems. In general, though, PTSD issues should be included in alcohol treatment, and alcohol use issues should be included in PTSD treatment.

Once you become sober (stop drinking entirely), you must learn to cope with your PTSD symptoms in order to prevent relapse (return to drinking). This is important because sometimes the PTSD symptoms seem to get worse or you notice them more right after you stop drinking. Remember that after you have stopped drinking, you have a better chance of making progress in your PTSD treatment. In the long run, you are more likely to have success with both problems.

Works Cited

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Arlington: American Psychiatric Association.

Gillespie, B. (2016). Substance or Medication Induced Psychotic Disorder DSM-5 (Alcohol-292.1, Drugs-292.9). Retrieved from Theravive: http://www.theravive.com/therapedia/Substance-or-Medication-Induced-Psychotic-Disorder-DSM--5-(Alcohol--292.1,-Drugs -- 292.9)

Hruska, B., Sledjeski, E., Fallon, W., Spponster, E., & Delahanty, D. (2011). Alcohol Use Disorder History Moderates the Relationship Between Avoidance Coping and Posttraumatic Stress Symptoms. Psychology of Addictive Behaviors, 405-411. doi:10.1037/a0022439

Iribarren, I., Prolo, P., Neagos, N., & Chiappelli, F. (2005). Post-traumatic stress disorder: Evidence-based research for the third millennium. Evidence-Based Complementary and Alternative Medicine.

La Bash, H., & Papa, A. (2014). Shame and PTSD Symptoms. Psychological Trauma: Theory, Research, Practice, and Policy, 159-166. doi:10.1037/a0032637

Longo, D., Faucia, A., Kasper, D., Hauser, S., Jameson, J., & Loscalzo,…