Jenny is a 29-year-old single female who lives with her mother. She is bisexual, but is not currently dating. Jenny was recently in a relationship with a man, and they lived together briefly. They parted amicably when they just did not seem to be enjoying being together. Jenny moved back in with her mother, Barbara, to allow her boyfriend to take in a roommate to cover her share of the rent. She works as a bank teller and makes a modest income. She felt moving back home would allow her to provide some financial help to her mother. Jenny’s mother raised her as a single parent. Jenny and Barbara have shared many ups and downs over the years. Things were never easy, but they always made it through. Barbara is becoming increasingly concerned that Jenny is giving up on life and needs to snap out of it.
• The Case of Marisol:
Marisol is a 40-year-old single female from a tight-knit Puerto Rican family. She is employed full time as a data analyst for a technology company. She has steadily progressed in her career by working for relatively small companies, where her role allowed her to work relatively independently. Unfortunately, working for small organizations was less stable financially, so she has been working for a larger company for the past four years. Interacting with a larger work group has challenged her comfort zone. She prefers to spend time with a network of close friends she has known most of her life, with whom she visits one-on-one. Her family lives in the area, and she sees them frequently. Her parents and older brother have always provided a support system and practical help. She enjoys quiet evenings alone or at the home of her brother and his family. Her friends and family privately wonder why she has never dated or wanted to travel.
• Identify presenting concerns from the client’s perspective as described in the video and accompanying narrative. Include relevant cultural and systemic considerations that frame the client's presentation.
• Describe what information has been provided in each case that helps to determine which disorders are appropriate for consideration (differential diagnoses) for a final diagnosis. Evaluate how at least one assessment tool, which are listed in the Week 5: List of Assessment Tools and Supporting ResourcesLinks to an external site. reading list, will aid in obtaining further information to back up your final diagnosis. The Differential Diagnosis Decision Tree, which you can find in the Week 5: Diagnostic Skill Application ILinks to an external site. reading list, may be helpful to guide this process.
• Present DSM and ICD-10 codes, including relevant Z codes.
• Provide a descriptive rationale for the DSM diagnosis that best fits the information provided including relevant ICD codes. This should be written in a narrative form using complete sentences. Support your rationale with scholarly sources. Optional readings may be particularly relevant.
• Determine if a medication consultation is appropriate and provide a rationale with support from scholarly sources.
Sample Solution
Presenting Concerns and Cultural/Systemic Considerations
Jenny:
Possible Concerns: Lack of motivation, feelings of hopelessness, or difficulty adjusting to the breakup.
Cultural Considerations: Stigma surrounding mental health in some cultures might prevent Jenny from seeking help.
Systemic Considerations: Financial strain and living situation with her mother could contribute to her current state.
Full Answer Section
Marisol:
Possible Concerns: Social anxiety or introversion mistaken for lack of interest in relationships or travel.
Cultural Considerations: Family values and collectivism within her Puerto Rican background might shape her social preferences.
Systemic Considerations: Transitioning to a larger work environment might have caused discomfort for someone who thrives in independent work settings.
Differential Diagnoses and Assessment Tools
Jenny:
Differential Diagnoses: Adjustment disorder, depression (further information needed).
Assessment Tool: Beck Depression Inventory (BDI-II) - This tool can help assess the severity of depressive symptoms Jenny might be experiencing.
Marisol:
Differential Diagnoses: Social anxiety disorder, avoidant personality disorder (further information needed).
Assessment Tool: Liebowitz Social Anxiety Scale (LSAS) - This tool can measure Marisol's fear and anxiety in social situations.
DSM and ICD-10 Codes (Z codes not applicable in this case)
Note: A definitive diagnosis cannot be made without a full clinical assessment.
Jenny (Possible):
DSM-5: 309.0 (Adjustment Disorder with Depressed Mood)
ICD-10: F43.11 (Adjustment disorder with depressed mood)
Marisol (Possible):
DSM-5: 300.23 (Social Anxiety Disorder)
ICD-10: F40.10 (Social Anxiety Disorder)
Rationale for DSM Diagnosis (Jenny)
Based on the limited information, Jenny's situation suggests an Adjustment Disorder with Depressed Mood. She recently experienced a breakup, a significant life change that could lead to feelings of sadness, hopelessness, and difficulty adjusting. The BDI-II could provide further evidence of the severity of her depressive symptoms.
Rationale:
The symptoms (lack of motivation, hopelessness) align with criteria for Adjustment Disorder (American Psychiatric Association, 2022: [invalid URL removed]).
The timing of these symptoms coincides with a major life stressor (breakup).
Medication Consultation
Determining the need for medication consultation requires a more comprehensive evaluation. However, if Jenny's BDI-II score suggests moderate to severe depression, a consultation with a psychiatrist might be appropriate to explore medication options alongside potential psychotherapy.
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