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CON 321 Health Related Research

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CON 321 Health Related Research

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Course Code: CON321
University: University Of Southern Maine

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Country: United States

Question:

Case Study
At the time of intake, a history reveals that Roberta is a Caucasian female, 53 years of age, and single again. She divorced her second husband about 4 years prior to intake. Throughout her life, she had been hospitalized several times (more than once for depression) and has been prescribed a number of psychotropic medications during much of her adult life: Lithium, Depakote, Tegretol, and most recently Wellbutrin. Roberta has three children, all born to her early in her adult life with a live-in lover, with whom she broke off an engagement after 13 years of a live-in relationship. She has been married twice. Her relationship with her children is fair, with the exception of her youngest daughter, age 24, who exhibits anti-social behavior.
The assessment reveals that her story is one of episodic physical abuse in her family of origin. She has, as an adult, shown erratic behavior including excessive spending and holding grandiose ideas about her self-worth and intelligence. Many years ago, she wrote Oprah that she was the “perfect case” for one of Oprah’s TV shows with “Dr. Phil.” She has tended to write high-profile celebrities and then if anyone responds (even with a very general cover letter), she tells people that she is now “working” as an assistant or agent for the person. She had also spread the story that she was working undercover with the FBI.
She smokes cigarettes and has been diagnosed with congestive heart failure. She states that she wants to die, but gives no indication of active suicidal ideation, plan, or intent. She has also had numerous doctors of varying kinds. If one MD did not suit her in some way, she would go to another. Often, her primary rationale was to find an MD that saw her as gifted intellectually. Just prior to intake, she had stopped taking her medications, and become manic and forgetful. Her work performance has been very erratic over the years. Though gifted in sales, she has struggled to maintain jobs. Her current supervisor told her that she needed to straighten herself out or he would discharge her.
Instruction:
Follow the outline below as you write your assignment. You will have 3 major areas to your assignment: (1) key issues, (2) diagnostic impressions, and (3) general treatment recommendations. Follow the format below when completing your assignment.
1. Key Issues

List in order of priority of importance the key issues you believe are involved in the case study if you were the client’s counselor. Provide a rationale for the order in which you prioritized issues. What are the most important features to you and why?
Link your rationale for the order of priority in A to what you believe outcomes of treatment should be for this client. How does your order of priority contribute to a successful outcome for the client?
How might the client list a different order of priority of key issues differ from yours (the counselor)?
What additional information would be helpful for you to know if you had the chance to acquire it?

Diagnostic Impressions

Based on the information provided in the case study, use the current version of the DSM to accurately diagnose the type(s) of mental disorder(s) involved, including the appropriate use of specifiers. Refer to specific diagnostic criteria when presenting your impressions.
Be sure to consider the presence of any other co-occurring disorder(s), including other conditions that may be a focus of clinical attention.
Provide a rationale for your diagnostic impressions, giving consideration to differential diagnostic considerations.

3. Treatment Recommendations

List your recommendations (e.g., 1., 2., 3., etc.) so that you can clearly delineate what you believe will be of most help to your client. Also provide a sentence or two of rationale for each recommendation. Be sure to consider recommendations that will be motivating to your client and reflective of a collaborative approach.
Be sure to consider the biopsychosociospiritual aspects of the case. Make sure your recommendations are relevant to the case, able to be implemented by the client, and have some basis of support from professional literature.

Answer:
1. Key Issues

The main issue facing Roberta is depression which is as a result of key issues.

Some of key issues faced by Roberta in order of priority of importance includes; Depression, Physical abuse, Cigarette smoking, Erratic behavior and her social life.

Depression is one of the main issues that the client is facing. Her past family history has caused all these problems. Firstly of all, I will assess her family history. This will help me establish the main causes of her depression. This will also help with some knowledge on the issues she is facing in her life and provide the right medication together with good guidance and counseling for her (De Hert et al., 2011).
The client might list a different order of priority of key issues. This is because she is confused as she is undergoing a lot of stress in her life.
If I had the chance to acquire more information from the client, I will ask her whether she has an appetite. This is because the loss of appetite can increase depression thus leading to suicide. This will give me a chance to advise her best food that she can eat to help reduce her depressive disorder. Also, I will need to know her sleeping habit as depression disorders sometimes disrupt sleeping habits which may result in being unable to sleep or staying asleep. The third important information that I will require is from the client is whether she has fatigue or loss of energy. This is because depression disorder mostly causes patients to feel fatigue.

2. Diagnostic Impressions
Mental disorders are generally categorized by issues associated with people’s mind and moods. They are not well understood in regards to their causes but the signs and symptoms of mental disorders are scientifically well known via DSM.
As per the current version of DSM, Roberta might be suffering from bipolar disorder which can be characterized by shifts in mood or changes in activity and energy level. There are two types of bipolar depression which includes mania and depressive episodes. The client might be suffering from the depressive episode which is characterized by changes in feeling like the feeling of guilt, irritability and sadness. Individuals with this type of bipolar depression also may lose interest in activities they previously enjoyed doing such as their jobs and also have thoughts of suicide (Cuijpers, Hofmann & Andersson, 2010).
This is supported by the case study that Roberta who is gifted in sales has struggled to maintain her working performance as she has been too erratic. Her employer has warned her several times otherwise she might be fired. This is as a result of effects of depressive episode bipolar which has made Roberta lose interests in her talented sales jobs. The other supportive point from the case study is that Roberta threatens people that she wants to die with no reasons why she wants to die. This is as a result of the effects of depressive episode bipolar which is characterized by thoughts of suicide.
Another disorder that Roberta might be suffering is the social anxiety disorder, which involves an irrational fear of being judged. The anxiety that results from the disorder can have negative effects on an individual’s life and make it hard for them to do their activities. This can be supported by the fact that the client has had an unsuccessful marriage where she has been married two times. The client also has no moods for her sales job.
3. Treatment Recommendations

Support- living with depression disorder can be challenging and with good support in place can play a critical role in the treatment of the disorder. The client can get support from her family, friends and even doctors.
Education- managing symptoms associated with depression is complicated thus the client needs education on how she can avoid problems and deal with the effects of bipolar disorder.
Medication- medication is the best treatment of healing bipolar disorder. Recommending mood stabilizers can play a crucial role in the treatment of bipolar disorder (Southwick, & Charney, 2012).
Substance abuse therapy- the client smokes a cigarette and has been diagnosed with congestive heart failure. As a result, providing the client with guidance and counseling to avoid smoking and giving her medication can play a significant role in the treatment of depression (Hollon et al., 2001).
Guidance and the counseling-The client is being stressed with different issues in her life such as being single and her daughter having anti-social behavior and thus requires counseling on how she can deal with the situation thereby playing part in her depression therapy.

References
Cuijpers, P., Li, J., Hofmann, S. G., & Andersson, G. (2010). Self-reported versus clinician-rated symptoms of depression as outcome measures in psychotherapy research on depression: a meta-analysis. Clinical psychology review, 30(6), 768-778.
De Hert, M., Correll, C. U., Bobes, J., Cetkovich?Bakmas, M. A. R. C. E. L. O., Cohen, D. A. N., Asai, I., … & Newcomer, J. W. (2011). Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World psychiatry, 10(1), 52-77.
Hollon, S. D., Muñoz, R. F., Barlow, D. H., Beardslee, W. R., Bell, C. C., Bernal, G., … & Linehan, M. M. (2002). Psychosocial intervention development for the prevention and treatment of depression: promoting innovation and increasing access. Biological psychiatry, 52(6), 610-630.
Southwick, S. M., & Charney, D. S. (2012). The science of resilience: implications for the prevention and treatment of depression. Science, 338(6103), 79.

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