Overview
Assignment Objective: To introduce students to the interview/assessment process for psychopathology and how we begin to think about and formulate a diagnosis for the clients we work with. This will include "putting together" symptoms based on client presentation, while also considering other, potential diagnoses (that may or may not have enough information at this time to warrant a diagnosis), and then to begin considering appropriate treatment options based your diagnosis.
Instructions: You will be provided with the description of a hypothetical clinical case.
From this case, you must do the following:
(1) DIAGNOSIS: Determine a diagnosis (or multiple diagnoses) you would give this client and justify your decision for the chosen disorder by linking together the symptoms presented for this client.
(2) RULE OUTS: Discuss any "Rule outs" of possible disorders that the client may be presenting with, but you may not have enough information about their symptoms/presentation to determine one way or the other if the client meets criteria for that particular disorder. That is, list a possible Diagnosis (or two) that you would want to "rule-out" for this client in follow-up sessions/interviews. Justify this decision by providing information on symptoms of the disorder the client may be experiencing and the questions you would want to ask (or info you want to learn) that would help in determining if the client actually meets criteria for the "Rule out" disorder.
(3) TREATMENT: List at least two possible treatments that could be utilized for this client based on the diagnosis you provided.
IMPORTANT: See the grading rubric provided for this assignment for breakdown of possible points for this assignment. You should be able to answer these questions succinctly and within one page.
More information on #2 (above) regarding what a "Rule Out" is:
In determining which diagnosis to provide, if you feel the client displays some (but maybe not enough) symptoms of a particular diagnosis, it is acceptable to use what is termed a “Rule Out” (i.e., R/O). In such cases, the symptom presentation suggests a particular diagnosis, but there is simply not enough evidence to warrant a diagnosis (thus, you think it is necessary to obtain more information to “rule out’ – or “rule in” that diagnosis). When you name a "Rule Out", you must also explain what symptoms led you to that impression and also what other questions (or information) you may want to know about to confidently determine whether the client may have that disorder.
Vignette for Case Conceptualization 2
Jamie is a 16-year old youth who was admitted to the hospital from a juvenile detention center following a serious suicide attempt. He had, in some way, wrapped his shoelaces and tape around his neck, causing respiratory impairment. When found, he was semiconscious. He had been admitted to the detention center earlier that day, and it had been noted by staff there that he was quite withdrawn.
On admission, Jamie was reluctant to speak. At one point he had an outburst saying that he would “kill himself, and nobody could stop him!” After calming down and further questioning, he did admit to feeling "depressed" for “about a month” as well as some difficulty sleeping, decreased appetite, decreased interest, feelings of guilt, and suicidal ideation.
According to his parents, Jamie had had no emotional difficulties until, at age 13, he became involved in drugs, primarily using alcohol, LSD, and marijuana. His grades dropped drastically, he ran away from home on several occasions after arguments with his parents, and he made a suicide gesture by overdosing on aspirin. A year later, following an argument with the principal, he was expelled from school. Unable to control his behavior, his parents had him evaluated in a mental health clinic, and a recommendation was made for placement in a group home. He apparently did well in the group home, and his relationship with his parents improved immensely with family counseling. At that time, he was observed as "being responsible" including maintaining a part-time job and attending school. Additionally, he was not involved in any illegal activities, including use of drugs.
However, six months before admission to the hospital, Jamie again began using drugs and, over a course of about 2 weeks, engaged in 10 breaking-and-entering crimes, all of which he did alone. He remembers being “depressed” at this time, but cannot recall whether the mood change was before or after he began using drugs again. He was then sent to the juvenile detention center, where he did very well (with no disciplinary action). He was doing so well that he had been discharged to his parents’ care three weeks previously. One day after returning home, he impulsively left with his buddies in a stolen car for a trip to Texas, and he was subsequently picked up and readmitted to the detention center. Jamie’s depression began shortly thereafter, and, according to him, his guilt about what he “had put his parents through” led to his suicide attempt.