Respond to at least two colleagues who presented a different diagnosis in the following ways:
- Explain the differences and similarities in your choice of criteria used to determine diagnosis, including Z codes (other conditions that may be a focus of clinical attention).
- Explain whether or not you agree with your colleague’s treatment recommendations.
Colleague 1:Samele Mayfield
Initial Post-Mayfield
Ronald is a 39-year-old white male who was admitted to the psychiatric facility on in March, 2021. Ronald reports anxiety and depression since the fall. He was hospitalized in August 2020, due to colitis. Based on observations and client self-report, Ronald’s diagnosis is as follows:
F06.32 Depressive Disorder Due to Irritable Bowel Syndrome, with major depressive -like episode
F42.2 Obsessive-Compulsive Disorder, with good insight
Z63.7 Other stressful life events affecting family and household
Diagnostic Criteria
Depressive Disorder Due to Irritable Bowel Syndrome, with major depressive -like episode
All of the criteria were met for Depressive Disorder Due to Irritable Bowel Syndrome, with major depressive -like episode: (A-E). There has been shown to be a relationship between colitis/IBS and depression (Hood et al., 2018). Additionally, Ronald began taking Lotronex, a drug approved only for women who have Irritable Bowel Syndrome in August of 2020. He reports that his depression began at during this time, and that he has been moody and depressed since fall. Lotronex is not approved for men as it has not been deemed beneficial and Lotronex has been known to cause a rare but possible side effect of depression and psychosis (Alosetron Side Effects: Common, Severe, Long Term – drugs.com, n.d.). For this reason depression due to substance was considered and Lotronex usage should be discontinued.
Obsessive-Compulsive Disorder, with good insight
Ronald’s symptoms meet the criteria for obsessive-compulsive disorder, with good insight as he has (A) Obsessions-recurrent and persistent thoughts about money and losing his job. He also has compulsions, banging the refrigerator 4 times, looking for dust and vacuuming if he has any and making sure there are even number of cans in the cabinet. The compulsions are time consuming (B). and are not attributable to substance or another mental disorder (C,D).
Other stressful life events affecting family and household
Ronald has experienced other stressful life events such as his mother in law’s death, family illness and job functions changing.
Diagnostic tools
The tool I would use to validate the diagnosis and assess outcomes of treatment is the Beck Depression Inventory (BDI), which is a 21-item report measuring depressive symptoms. The BDI can be used intermittently throughout treatment (American Psychiatric Association, 1996).
Treatment Options
The first thing I would do is refer Ronald to a physician to have him taken off of Lotronex and changed to another medication that my better help with his colitis symptoms. For OCD. He is currently on Xanax and we would assess the helpfulness of that, while adding in Cognitive Behavior Therapy (CBT) to treat the OCD and Depression.
References
5: Gastrohepatic Disorders. (2016). Monthly Prescribing Reference, 32(7), 79–99.
Alosetron side effects: Common, severe, long term – drugs.com. (n.d.). Drugs.com. Retrieved July 7, 2021, from com/sfx/alosetron-side-effects.html”>https://www.drugs.com/sfx/alosetron-side-effects.html
American Psychiatric Association. (1996). Beck depression inventory (bdi). https://www.apa.org. https://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/beck-depression
Hood, M. M., Wilson, R., Gorenz, A., Jedel, S., Raeisi, S., Hobfoll, S., & Keshavarzian, A. (2018). Sleep quality in ulcerative colitis: Associations with inflammation, psychological distress, and quality of life. International Journal of Behavioral Medicine, 25(5), 517–525. https://doi.org/10.1007/s12529-018-9745-9
Colleague 2: Britney Leverett
Week 6- Britney Leverett
Ronald is a 39-year-old white Jewish male who is married with three children. The client’s problem is anxiety and depression. Last year was a difficult time due to his mother-in-law having COVID, which lead his children to become ill. As a result, Ronald has been moody and depressed; he presents several habits, including banging against the refrigerator door four times, looking for dust in the living, vacuuming the entire living room, and having to count cans in the kitchen cabinet.
F31.9 Bipolar I
F42 Obsessive-compulsive disorder
Z91.5 Personal history of self-harm
Z72.9 problem related to lifestyle
Criteria A for Bipolar I disorder must include a period of abnormally and persistently elevated, expansive, or irritable mood and goal-directed activity for at least one week or any duration if the person was hospitalized. For example, Ronald was hospitalized in August due to paranoia and thinking he was poisoned.
Criteria A for Obsessive-Compulsive Disorder – Repetitive behaviors: Individuals feel driven to perform in response to an obsession or rule that must be applied rigidly. Ronald displays this behavior by counting cans in the kitchen cabinet, making sure they were all even and that would make him feel better.
• Recommend a specific evidence-based measurement instrument to validate the diagnosis and assess outcomes of treatment.
The DSM-5 states that a common feature of bipolar I disorder is impulsivity, contributing to suicide attempts and substance use disorders (APA, 2013). To treat the client’s suicidal ideation and abnormal behaviors, the evidence-based measurement I would suggest is Cognitive Behavioral Therapy. The client will also need psychotropic medications to manage/balance mental health. CBT would primarily be used to help adjust the client’s “abnormal” behaviors.
• Describe your treatment recommendations, including the type of treatment modality and whether or not you would refer the client to a medical provider for psychotropic medications.
Generally, when treating bipolar disorders, the goal is to bring the patients to a stable condition, resulting in psychotropic medications. Depending on the severity of the symptoms and occurrence of the episodes would rely on the psychotropic medications. Also, group therapy and individual therapy sessions would be recommended to eliminate suicidal ideations and alleviate symptoms of depression.
Reference:
American Psychiatric Association. (2013). Introduction. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596 Introduction
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