Respond To Three Classmates' Case Conceptualizations For KA ✓ Solved

Respond to three classmates' case conceptualizations for Ka

Respond to three classmates' case conceptualizations for Ka-Sean. For each classmate, identify other diagnoses to consider (differential diagnosis) and discuss either a cultural or ethical consideration pertinent to the diagnosis. Case summary: Ka-Sean is a 25-year-old African American lesbian enrolled in a graduate counseling program, living with her partner. She reports chronic excessive worry for at least two years ('the flooding'), restlessness, muscle tension, fatigue, insomnia, gastrointestinal symptoms, difficulty concentrating, perfectionism, and episodic severe anxiety with chest tightness, palpitations, shaking and shortness of breath occurring once to twice monthly with several ER visits fearing heart attack. She has a history of self-injurious behavior around her mother's death, a reduced support network, quit a job due to anxiety, and is prescribed alprazolam. Classmates' diagnostic impressions include F41.1 Generalized Anxiety Disorder and Panic Attacks; one classmate noted a stomach ulcer. Instructions: Using DSM-5 criteria, respond separately to classmates A. Carr, C. Rob, and L. Sha. For each classmate provide: (a) additional differential diagnoses to consider with brief rationale; (b) one cultural or ethical consideration relevant to diagnosis or treatment; (c) recommended next assessment steps and treatment planning, with scholarly support.

Paper For Above Instructions

Overview

This response evaluates the three classmates' conceptualizations of Ka-Sean (all identifying generalized anxiety disorder [GAD] with panic features) and provides differential diagnostic considerations, one cultural or ethical factor per classmate, and recommended next assessment and treatment steps grounded in DSM-5 criteria and current literature (APA, 2013; Craske et al., 2017).

Response to Classmate A. Carr

Additional differential diagnoses to consider

1. Major Depressive Disorder (MDD), single or recurrent: Ka-Sean describes a "very dark" period after her mother's death and self-injurious behavior; depressed mood, anhedonia, and concentration problems can overlap with GAD and should be screened (APA, 2013). 2. Posttraumatic Stress Disorder (PTSD) or Persistent Complex Bereavement Disorder: Given bereavement and self-injury after her mother’s death, traumatic grief reactions or PTSD-related hyperarousal can mimic anxiety and panic symptoms (APA, 2013). 3. Substance/medication-induced anxiety disorder: Chronic benzodiazepine use (alcohol or escalation of Xanax) or withdrawal can exacerbate anxiety and panic-like symptoms; assess medication use and adherence (Bandelow et al., 2017). 4. Medical causes (hyperthyroidism, cardiac arrhythmia, POTS): Recurrent chest tightness and ER visits require medical rule-out for endocrine or cardiac contributors (Craske et al., 2017).

Cultural or ethical consideration

Consider intersectional minority stress: as an African American lesbian, Ka-Sean may experience compounded stigma, discrimination, and microaggressions that intensify anxiety and reduce help-seeking (Meyer, 2003; Sue et al., 2007). Ethically, clinicians must ensure culturally competent, affirmative care that respects sexual identity and racial/cultural context and addresses potential mistrust of medical/mental health systems.

Assessment and treatment recommendations

Assessment: Administer standardized measures (GAD-7, PHQ-9, PTSD Checklist), screen for substance use and benzodiazepine dependence, obtain recent medical workup including thyroid function and cardiac evaluation, and a suicide/self-harm risk assessment given past self-injury (Nock, 2009). Treatment: First-line psychotherapy is cognitive behavioral therapy (CBT) with worry exposure and relaxation training; consider evidence-based panic targeting (interoceptive exposure) if panic attacks are prominent (Craske et al., 2017). Given benzodiazepine prescription, coordinate with PCP about tapering and consider SSRI/SNRI pharmacotherapy when indicated (Bandelow et al., 2017). Provide psychoeducation about minority stress and bereavement, and involve grief-focused interventions if needed.

Response to Classmate C. Rob

Additional differential diagnoses to consider

1. Obsessive-Compulsive Disorder (OCD) or obsessive–compulsive traits: The “flooding” of repetitive intrusive questions and perfectionism may reflect obsessive rumination rather than generalized worry; assess for compulsions or neutralizing behaviors (APA, 2013). 2. Social Anxiety Disorder: Performance-related worry in the graduate program and reassurance-seeking might indicate social performance anxiety in addition to generalized worry. 3. Attention-Deficit/Hyperactivity Disorder (ADHD), inattentive presentation: Persistent concentration difficulties and perfectionism can be secondary to untreated ADHD and worsen anxiety; screen if onset predates anxiety symptoms (Kessler et al., 2005).

Cultural or ethical consideration

Culturally, perfectionism and pressure to perform academically may be influenced by family expectations and cultural values; ethically, respect confidentiality about sexual orientation in academic contexts and explore safety concerns related to disclosure to family members who opposed her relationship.

Assessment and treatment recommendations

Assessment: Use structured clinical interview (e.g., MINI or SCID) to clarify comorbid OCD, social anxiety, and ADHD; assess functional impairment in academic settings and social support. Treatment: CBT tailored to GAD with modules for intolerance of uncertainty, worry exposure, and decision-making skills may reduce "analysis paralysis" (Craske et al., 2017). For perfectionism and performance anxiety, integrate behavioral experiments and skills training. If ADHD suspected, consider neurocognitive testing and coordinate pharmacologic and behavioral strategies. Monitor benzodiazepine use and consider SSRI initiation for long-term management (Bandelow et al., 2017).

Response to Classmate L. Sha

Additional differential diagnoses to consider

1. Gastrointestinal condition contributing to anxiety (e.g., peptic ulcer disease, functional dyspepsia): Somatic symptoms like abdominal distress and a documented stomach ulcer (K25) might both result from and exacerbate anxiety—coordinate medical care (NICE, 2011). 2. Medical anxiety disorder (health anxiety): Recurrent ER visits for fear of heart attack suggest illness anxiety that may co-occur with panic; screen for hypochondriasis/illness anxiety disorder. 3. Complex bereavement or adjustment disorder with anxious mood: The temporal relation with bereavement and self-injury suggests grief-focused diagnoses should be considered (APA, 2013).

Cultural or ethical consideration

Ethically, clinicians should consider culturally-informed grief expressions and somatic presentations common in some communities; ensure that somatic complaints are not dismissed as “just anxiety” and that cultural idioms of distress are validated (Sue et al., 2007).

Assessment and treatment recommendations

Assessment: Obtain collaborative medical records regarding the ulcer and ER visits, screening for health anxiety and suicidal ideation. Use interoceptive exposure for panic symptoms and CBT-Health Anxiety protocols when health anxiety is significant (Craske et al., 2017). Address sleep disturbance with CBT for insomnia (CBT-I) and consider gradual benzodiazepine taper with substitution of evidence-based antidepressants if pharmacotherapy indicated (Bandelow et al., 2017). Integrate grief-focused therapy or complicated grief interventions if bereavement symptoms persist (Nock, 2009).

Shared clinical priorities and ethics

Across all responses, priorities are to: (1) rule out medical contributors to somatic symptoms, (2) evaluate comorbid disorders (depression, PTSD, OCD, ADHD, health anxiety), (3) assess benzodiazepine dependence and plan safe tapering when appropriate, (4) deliver culturally competent, LGBTQ-affirmative care that addresses minority stress, and (5) use evidence-based psychotherapies (CBT, interoceptive exposure, grief work) and consider SSRI/SNRI pharmacotherapy when indicated (APA, 2013; Craske et al., 2017; Meyer, 2003).

Conclusion

Ka-Sean’s presentation is consistent with GAD with panic features, but a careful differential diagnosis is essential given overlapping symptoms, medical comorbidity, and social-cultural factors. Assessment should combine standardized instruments, medical collaboration, and culturally informed interviews. Treatment should prioritize CBT-based interventions, careful medication management, and attention to minority stress and bereavement-related issues (Craske et al., 2017; Meyer, 2003).

References

  1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  2. Kessler, R. C., Chiu, W. T., Demler, O., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602.
  3. Craske, M. G., Stein, M. B., Eley, T. C., Milad, M. R., Holmes, A., Rapee, R. M., & Wittchen, H. U. (2017). Anxiety disorders. Nature Reviews Disease Primers, 3, 17024.
  4. Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697.
  5. Nock, M. K. (2009). Self-injury. Annual Review of Clinical Psychology, 5, 339–363.
  6. Bandelow, B., Reitt, M., Rover, C., Michaelis, S., Gorlich, Y., & Wedekind, D. (2017). Efficacy of treatments for anxiety disorders: A meta-analysis. International Journal of Neuropsychopharmacology, 20(11), 1–16.
  7. National Institute for Health and Care Excellence (NICE). (2011; updated 2019). Generalised anxiety disorder and panic disorder in adults: management. NICE Clinical Guideline CG113.
  8. Sue, D. W., Capodilupo, C. M., Torino, G. C., Bucceri, J. M., Holder, A. M. B., Nadal, K. L., & Esquilin, M. (2007). Racial microaggressions in everyday life: Implications for clinical practice. American Psychologist, 62(4), 271–286.
  9. National Institute of Mental Health. (2018). Anxiety Disorders. Retrieved from https://www.nimh.nih.gov/health/topics/anxiety-disorders
  10. Wittchen, H.-U., & Jacobi, F. (2005). Size and burden of mental disorders in Europe—a critical review and appraisal of 27 studies. European Neuropsychopharmacology, 15(4), 357–376.

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