Carefully Read The Following Case And Then Use Your D

Carefully Read Over The Following Case And Then Using Your DSM 5 Com

Carefully read over the following case and then, using your DSM-5, complete the form that follows, all the way through the treatment plan. Take the time and explore differential diagnosis, cultural factors, life experience, and circumstances. There may not be enough information provided within the case to substantially fill in all of the area of the form, but try to be thorough.

Nancy Ingram, a 33-year-old stock analyst and married mother of two children, was brought to the emergency room (ER) after 10 days of what her husband described as “another cycle of dark days.” His wife was tearful, then explosive, and she had almost no sleep. Mr. Ingram said he had decided to bring her to the ER after he discovered that she had recently created a blog entitled Nancy Ingram’s Best Stock Picks. Such activity was out of character and, given her job as a stock analyst for a large investment bank, was strictly against company policy. Mr. Ingram said his wife was working on the stock picks around the clock, forgoing her own meals as well as her responsibilities at work and with her children. Ms. Ingram argued with her husband at this time and said her blog “would make them rich.” The patient had first been diagnosed with depression in college, after the death of her father from suicide. On examination, she was pacing angrily in the exam room. Her eyes appeared glazed and unfocused. She responded to the examiner’s entrance by sitting down and explaining that this was all a miscommunication, that she was fine and needed to get home immediately to tend to her business. She was speaking so rapidly, it was difficult for the examiner to interrupt.

She denied hallucinations, but admitted with a smile, to a unique ability to predict the stock market. She refused to be cognitively tested and she said, “I will not be a trained seal, a guinea pig, or a barking dog, thank you very much, and may I leave now?”

Sample Paper For Above instruction

Introduction

The case of Nancy Ingram presents a complex clinical picture that requires careful assessment of her psychological state, psychosocial factors, and potential diagnoses according to DSM-5 criteria. Her history of depression, current presentation of mood disturbance, behavioral disinhibition, and possible manic or hypomanic symptoms suggest the need for comprehensive differential diagnosis. Additionally, her recent behavioral changes, family history, and cultural context must be explored to develop an effective treatment plan that addresses her needs and strengths.

Presenting Problems and DSM Diagnoses

Nancy’s presenting problems include persistent mood disturbance characterized by episodes of tearfulness, explosiveness, sleep disturbance, and heightened activity. Her recent behavior of working obsessively on a stock-picking blog, working around the clock, and expressing grandiosity about her predictive abilities indicate possible manic or hypomanic episodes. Her prior diagnosis of depression suggests a mood disorder, potentially bipolar disorder. The prominent features in her current state—distractibility, rapid speech, decreased need for sleep, and hyperactivity—align with criteria for a manic episode as per DSM-5, while her history of depressive episodes corresponds with bipolar I or II disorder.

Based on the DSM-5, her primary diagnosis might be Bipolar I Disorder, current episode manic, considering her irritable mood, increased activity, and grandiosity. Alternatively, if her episodes are less severe and her mood disturbances are shorter, a diagnosis of Bipolar II Disorder with hypomanic episodes could be considered. Differential diagnoses such as substance use disorder, other mood disorders, or psychosis must also be evaluated, but there is no explicit evidence of substance abuse or psychosis in this case.

Predisposing Factors

Nancy’s lifelong risk factors include her traumatic bereavement following her father’s suicide, which predisposed her to depression. Her prior diagnosis indicates vulnerability to mood dysregulation, possibly influenced by genetic or biological factors prevalent in mood disorders. Psychosocial stressors such as balancing work and family responsibilities, along with societal expectations, may contribute to her vulnerability. Her cultural background, not specified, could influence her mental health stigma or coping mechanisms, affecting her help-seeking behavior. Her high-pressure career may also be a biological and psychosocial precipitant for mood episodes.

Precipitants

The trigger for her current episode appears to be increased stress and possible burnout, exacerbated by her obsessive focus on stock trading and creating an out-of-character blog. The recent recognition of her unusual behavior by her husband likely heightened her stress and possibly triggered a manic episode. Her recent engagement in risky activities and disruptions to sleep are typical precipitating factors for mood episodes, especially in bipolar disorder.

Perpetuating Factors

Nancy's behavior of neglecting responsibilities, working excessively, and engaging in risky behaviors maintains her current episode. Her refusal to accept cognitive testing and her dismissive attitude toward mental health suggest possible resistance to treatment, which can hinder recovery. Her familial and occupational pressures may continue to contribute to her instability. Without intervention, her episodes could worsen or become more frequent, leading to impairment in her personal and professional life.

Protective/Positive Factors

Her prior diagnosis of depression indicates some insight and history of mental health issues, which can be a foundation for treatment engagement. Support from her family, especially her husband, and her role as a mother are significant social resources. Her skills in stock analysis suggest intelligence and insight into her environment, which can be harnessed therapeutically. Her previous depression suggests resilience and the possibility of recovery with appropriate intervention.

Conclusion

The case of Nancy Ingram illustrates a complex mood disorder, likely bipolar disorder, with recent manic features overlaying her history of depression. Assessment must carefully differentiate between mood episodes, rule out substance or psychotic disorders, and consider cultural and psychosocial factors. A comprehensive treatment plan should include pharmacotherapy, psychoeducation, and supportive therapy tailored to her specific needs and strengths to facilitate stability and recovery.

References

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