CaseStudy of Molly
CaseStudy of Molly
1.Question one
(A).List of Molly’s presenting problems and behaviors that mayconstitute symptoms
Intrusive thoughts about people who are planning to hurt her
Hearing people saying negative things about her
Looks disheveled
Showers infrequently
Wears the same clothes that she during the day
Stays at home most of the time
Leaving home makes he feels uncomfortable
Reversed sleep-wake cycle
Refusing to talk for an extended period
Staying in her world
Speaking slow and with a few words
Hard to make sense of what she says
Limited emotional expression when speaking
Report feeling down and lonely
She cuts herself and drinks alcohol when she is down
Struggle with activities of daily living
B).DSM-5 criteria for three disorders
Diagnosis | DSM-5 criteria | Client symptoms | Criteria met (Yes/no) |
Schizophrenia | At least 2 of the following Hallucinations Delusions Disorganized speech Negative symptoms (such as flattening, and avolition) Grossly disorganized Persistent signs of disturbance that last for at least six months (American Psychology Association, 2016 and American Psychiatric Association, 2016). | Intrusive thoughts Hearing negative thoughts of people saying negative things about her Looks disheveled Showers infrequently Wears the same clothes that she wore during the day Reversed sleep-wake cycle Refusing to talk for an extended period Staying in her world Hard to make sense of what she says She cuts herself and drinks alcohol when she is down Struggle with activities of daily living | Yes Molly had more than 2 of the minimum symptoms required to classify a condition as schizophrenia under the DSM-5 criteria. |
Post traumatic stress disorder (PTSD) | A). Exposure to actual threatened or actual death, sexual violence, or serious injury. b). Present at least one of the following Intrusive memories of a traumatic incident. Recurrent and distressing dreams. Dissociative reactions. Prolonged and intensive psychological distress Psychological reactions to external or internal cues of the traumatic event. c). Persistent tendency to avoid stimuli that is associated with the trauma D).Negative altercations that are related to cognition of the traumatic event.E). Negative arousal that is associated with the even. F). Duration of disturbances lasts for at least one month. (Brand, 2016) | Intrusive thoughts Hearing negative thoughts of people saying negative things about her Looks disheveled Showers infrequently Wears the same clothes that she during the day Reversed sleep-wake cycle Refusing to talk for an extended period Staying in her world Hard to make sense of what she says She cuts herself and drinks alcohol when she is down Struggle with activities of daily living | No Molly had only a few symptoms (including intrusive thoughts), but they were not enough to classify the condition as PTSD. |
Major Depressive Disorder (MDD) | a). Express at least five of the following in two consecutive weeks Depressed mood Markedly decrease in pleasure in all activities Significant loss in weight Loss or excess sleeping Psychomotor agitation nearly all days Fatigue in nearly all days Feeling of worthless Decline in ability to concentrate Recurring thoughts about death b). Symptoms cause impairment of in occupation and social functions. c). Episodes are not associated to substance d). Occurrence cannot be explained by psychotic disorders, such as schizophrenia E). Patient has never experienced hypomanic or manic episodes. (Schreiner, 2014) | Intrusive thoughts Hearing negative thoughts of people saying negative things about her Looks disheveled Showers infrequently Wears the same clothes that she during the day Reversed sleep-wake cycle Refusing to talk for an extended period Staying in her world Hard to make sense of what she says She cuts herself and drinks alcohol when she is down Struggle with activities of daily living | No Only a few of the symptoms (such as interrupted sleeping) match with symptoms presented in the DSM-5 criteria. |
C).Molly’s primary diagnosis
Molly’sprimary diagnosis is based on four major symptoms. First, herintrusive thoughts and hearing of sounds of people are primary signsof Schizophrenia. These symptoms can be associated withhallucinations and delusions. Secondly, Molly looks disheveled wearsthe same clothes as she wore during the day, and showersinfrequently. All these symptoms can be classified as grossdisorganization under the DSM-5 criteria. Third, Molly’s tendencyto use a few words when speaking and the difficulty of making senseof what she says can be described as avolition under the DSM-5criteria. Fourth, Molly’s inability to take care of herself, whichis confirmed by inability to bath regularly, indicates that she haslost an interest in activities of daily living. These symptomsconstitute the primary diagnosis for schizophrenia because they canhelp in the diagnosing for the main condition that is beinginvestigated during a significant episode of the healthcare.Diagnosis is classified as primary when it pertains to the maincondition that the healthcare is investigating or the most intensivehealth condition that requires the attention of the provider when anindividual is hospitalized (U.S.A. Coverage, 2016). Therefore, thecurrent is primary because nearly all symptoms that were discoveredin Molly suggest that her main condition is schizophrenia. Thisimplies that schizophrenia will be the most resource intensive healthcondition.
Theother two diagnoses were ruled out on different grounds. For example,PTSD was ruled out because intrusive thoughts and memories that Mollyexperienced were not related to the car accident. Although it isevident that Molly was distressed, her psychological reactions werenot directly attached to external or internal cues of traumatic eventthat she suffered. Moreover, there is no evidence that Mollydisassociated herself with stimuli that is associated with thetrauma. This implies that there was no sufficient evidence that couldlead to classification of PTSD as the primary condition. Similarly,MDD could not be classified as the primary diagnosis since Molly didnot express psychomotor agitation, loss of weight, decrease inpleasure, and depressed mood as per the requirements of the DSM-5criteria. This implies that she did not meet the DSM-5 Criteria forMDD.
Thereare three other medical conditions that may be considered. The firstcondition is substance abuse, which may present symptoms that aresimilar to those that are found in Schizophrenic patients (Smith &Segal, 2016). From the case study, Molly abused alcohol when she feltdown, which implies that some of the symptoms that were associatedwith Schizophrenia could be attributed to alcoholism. Secondly, thereis a possibility that Molly could be suffering from Schizo-affectivedisorder, which is indicated by a combination of symptoms of mooddisorder and schizophrenia (Romito & Weinstock, 2014). Some ofthe symptoms (such as confusion, withdrawal, and agitation) that arediscussed in the case study can be associated with the mood disorder,which indications that Molly could be diagnosed with a combination ofmental condition, if a detailed analysis of her condition isperformed.
d).other information needed to classify Molly’s condition asSchizophrenia
Apartfrom the symptoms that Molly presents, there are three pieces ofinformation that can be used to confirm is she is suffering fromSchizophrenia. First, information about the diagnosis of any familymembers with the same condition in the past can confirm the Molly’sdiagnosis. This is because Schizophrenia has a hereditary component(Smith & Segal, 2016). Secondly, the possibility of exposure toviral infection during infancy or low levels of oxygen during birthcan indicate the possibility that Molly is suffering fromSchizophrenia. For example, the case study indicates that Mollyexperienced prenatal hypoxia, which could be a risk factor forschizophrenia (Smith & Segal, 2016). Lastly, information aboutthe possibility of brain injuries when Molly got an accident canconfirm the present diagnosis since abnormal brain structure may be arisk factor for Schizophrenia (Buckley, 2005).
Question2: A discussion of Molly’s primary disorder from the perspective ofcognitive-behavior
Thecognitive behavior perspective assumes that different abnormalitiesthat people suffer from stem from their cognitions about otherpeople, their world, and themselves (McLeod, 2008 and Aslin, 2016).In the case of Molly, suffering from the road accident predisposedher to a negative perception that made her believe that her boss wasvideo-taping her. The failure to have her contract renewed predicatedthe development of the primary condition, since she had to returnhome. This is confirmed by the fact that Molly withdrew and isolatedherself to in the bedroom. Molly’s decision to consider drinking asa solution to her psychological problems perpetuated or maintainedthe primary disorder because alcoholism complicated her condition.Some of the protective measures taken include the encouragement thatMolly got from her family members to see the doctor and herassignment to a case manager.
References
AmericanPsychiatric Association (2016). Schizophrenia spectrum and otherpsychotic disorder. APA.Retrieved May 4, 2016, from https://twitter.com/APA_publishing
AmericanPsychology Association (2016). Diagnosis criteria for Schizophrenia.BehaviorNet, Inc.Retrieved May 4, 2016, from http://behavenet.com/node/21556
Aslin,M. (2016). Anintroduction to a cognitive-behavior perspective of consumerbehavior.Wisconsin: University of Wisconsin.
Brand,W. (2016). The DSM-5’s new PTSD diagnosis criteria. NavigableWaters.Retrieved May 4, 2016, fromhttp://navwaters.com/2013/06/14/the-dsm-5s-new-ptsd-diagnostic-criteria/
Buckley,F. (2005). Neuroimaging of schizophrenia: Structural abnormalitiesand pathophysiological implications. Neuropsychiatry,1 (3), 193-204.
McLeod,S. (2008). Cognitive behavioral therapy. SimplyPsychology.Retrieved May 4, 2016, fromhttp://www.simplypsychology.org/cognitive-therapy.html
Romito,K. & Weinstock, S. (2014, November 14). Schizophrenia healthcenter. WebMD. Retrieved May 4, 2016, fromhttp://www.webmd.com/schizophrenia/other-conditions-with-symptoms-similar-to-schizophrenia
Schreiner,M. (2014, April 29). Major depressive disorder DSM 5 criteria.EvolutionCounseling.Retrieved May 4, 2016, fromhttp://evolutioncounseling.com/major-depressive-disorder-dsm-5-criteria/
Smith,M. & Segal, J. (2016). Schizophrenia. HelpGuide Organization.Retrieved May 4, 2016, fromhttp://www.helpguide.org/articles/schizophrenia/schizophrenia-signs-types-and-causes.htm
U.S.A.Coverage (2016). What is the definition of primary diagnosis? U.S.ACoverage.Retrieved May 4, 2016, fromhttp://www.usacoverage.com/health-insurance/what-is-the-definition-of-primary-diagnosis.html