Signature Assignment: The Following Is A Brief Overview

8signature Assignmentthe Following Is A Brief Highly Incomplete Case

The following is a brief, highly incomplete case study of a fellow who presents with symptoms of a specific psychiatric illness. He is interviewed and given some IQ testing. IQ testing would not be the best test to understand his problems, in fact it might be contraindicated in his current state but for the purposes of the assignment, IQ testing provides the clearest example of data and its use in a critical thinking exercise which is one of the goals of this assignment. CASE STUDY Mr. A.

Soprano is a 55-year-old white male who presented as an “emergency” to a psychologist at a local ER. After establishing rules of confidentiality he revealed he was a high level crime boss; essentially a mobster. Throughout the interview he spoke in a rather pronounced Brooklyn accent. He preferred to call himself “a highly creative businessman.” The client’s chief complaint was a concern over a vague desire to “hurt” himself, sleep problems and was experiencing disturbing “thoughts that don’t make any sense.” He stated his thinking had become very negative, “and weighs heavy on me,” where he doesn’t see anything good or positive in his life, “and I’m normally a positive kinda guy.” Dr. Psychologist proceeded to request the client cooperate with psychological testing to help determine potential causes for the client’s reported problems.

This included a clinical interview. Mr. Soprano began his interview by telling a story about ordering a fellow mobster killed, “a couple months ago.” He said, “I liked the guy. He was my right hand man, but he screwed up Doc and coulda’ got me whacked so ahh, ya know, he had to go but I felt really bad about it. Hey ‘fergit’ about it, it was a business decision.

Sometimes ya make those tough one’s but this one really bothered me ya know.” He stated he noticed in the days following, his thoughts would race and be dominated by feelings of guilt. In the last seven weeks, he went through periods of sleeping much more than normal or suffering from insomnia when he felt “stressed out and I don’t get stressed out, Doc. Normally I sleep like a baby.” He also related in the last month, he had been battling with the strong desire to stay home and “hibernate” and would struggle to fight the fatigue and loss of interest through these times “but I have a business to run. So I get out but most days I don’t wanna.” On the days where he simply couldn’t bring himself to leave home he said he sometimes hears voices telling him he is a “bad man” and deserves to die.

He added he finds himself peering out the curtains fearing the cops will come arrest him at any moment. He added he’s noticed other changes that cause him concern, “I don’t know Doc, I used to really enjoy roughin’ people up a little. You know, gettin’ their attention, a busted finger or a knee, but here lately I don’t enjoy it so much.” He said these changes in his feelings, thoughts and behaviors had been going on for “a couple months.” When asked if he had any thoughts of suicide he said, “I’ve thought about wanting to die a couple times, here lately when whoever this is talking to me in my head, but I don’t think I’d actually do it. I don’t want my kids livin’ with that, ya know. I just sometimes feel like hurtin’ myself for what I’ve done, but I’m not sure what that would be.” Two days prior to this interview, Mr. Soprano said he was very disturbed when his wife came up to the restaurant table he was sharing with his girlfriend and called him a, “cheater and a murderer.” He added, “First time in a while since I went to restaurant ‘cause my appetite’s been off for weeks. I’ve lost about 30 pounds.” He said his wife knew he had a girlfriend but had never confronted him. His wife stormed out and he cut the evening short because of intense feelings of guilt and the sudden onset of deprecating voices that led to a brief consideration of suicide but he said he had no plan, just fleeting “thoughts of dying or deserving to die.” He added that he has noticed frequent mood changes, “Doc, these ‘blue moods’ just come over me. I ain’t no crier but suddenly I’m sad and ballin’ like a baby and I don’t even know why.” He also reported a loss of sexual interest, “My girlfriend is a real good lookin’ broad Doc, ya know buddaboom(!) but she’s frustrated with me cause I ain’t really interested lately, if ya know what I mean. And that really ain’t like me.” The client reported a very similar episode at age 28, with most of the same symptoms, many years ago after he began his life of crime. After killing his first victim, a “business” associate, Mr. Soprano recalled becoming Withdrawn and emotional and hearing a similar voice repeatedly speaking to him that he was “a bad man.” At that time, Mr. Soprano’s wife actually considered having him committed but decided against doing so.

After several weeks his symptoms subsided without treatment. “I just threw myself into my work and got over it.” He also reported that he never wanted to be in this life. He said he was “a good kid.” Until he was 24 he worked for a second cousin in a successful chain of shoe stores and looked forward to becoming a partner but his father was killed and he was enlisted to “take over the family business.” Just like in the godfather movie Doc.

I’m like a real life version of Michael Corleone.” After assurances that he would not try to harm himself he agreed to come in for testing. END OF CASE STUDY

One of the requirements of this assignment is to diagnose what psychiatric illness Mr. Soprano is suffering from. Be assured he is suffering from one of the four diagnoses listed in the answer sheet portion. The following list of diagnostic criteria and symptoms is not comprehensive but gives sufficient information for you to determine which diagnosis best fits.

Many psychiatric problems share similar symptoms and this can be confusing. What you are looking for is the best match for the largest group of symptoms that match Mr. Soprano’s story. For the most part these are the same criteria any professional would use to diagnose Mr. Soprano, only some of the wording has been simplified.

Confine your consideration of symptoms to the facts of the story to determine THE BEST FIT. The four diagnoses for you to consider are: · Major Depressive Disorder, Recurrent, with Psychotic Features · Bipolar I Disorder · Antisocial Personality Disorder · Erectile Disorder

1. These are the diagnostic criteria of Major Depressive Disorder and regardless of the other symptoms must include either depressed mood or loss of interest or pleasure. · Must have at least 5 of the following symptoms for at least 2 weeks. · Feels sad, hopeless, helpless and empty · Significant decrease in interest or pleasure in all or almost all activities. · Significant weight loss not from dieting or weight gain with decrease or increase in appetite daily. · Sleeping too much or too little · Fatigue or loss of energy · Feelings of worthless or inappropriate guilt · Decreased ability to think or concentrate or indecisiveness. · Recurrent thoughts of death or thoughts of suicide Sometimes the person may or may not experience psychosis (a distortion of reality in some way that can be problems with who they are, when it is or where they are, or strange thoughts that are not logical or hearing or seeing things that no one else can see or hear that reinforces their depression.

Meaning, the psychosis seems somehow tied to the depression, appears driven by the depression and may make it worse. Where if the depression goes away, the psychosis goes away. 2. The diagnostic criteria of Bipolar I Disorder Bipolar disorder is a cycling mood disorder. That means the sufferer has distinct episodes where they are markedly (very) different from their normal personality.

These episodes can come frequently or may have years between. However to be considered a bipolar episode it must persist for a week or more and they come in two types: Bipolar I and Bipolar II. Bipolar I is an episode of mood and behavior change dominated by mania. They may have also suffered from depression in the past, or prior to, or following a manic episode. Lastly, the depression portion can be like the symptoms of depression described above but episodes of depression are not necessary for the diagnosis of Bipolar I Disorder.

Bipolar II is dominated more by episodes of depression with a least one time where the person exhibited some symptoms of mania called hypomania (manic light) and is not offered for your consideration. The symptoms of mania in Bipolar I Disorder are listed below for you to consider for Mr. Soprano. Bipolar I: · Must exhibit a period where there is a distinct episode of abnormal and persistent elevated or irritable mood. Increased focus on activities or energy for at least a week. · During this period of elevated mood the person must exhibit at least three of the following · Inflated self-esteem/ grandiose · Much less need for sleep · More talkative or a pressure to keep talking · Racing thoughts · Either increased focused on work, sex or other endeavors or unfocused purposeless activity · Overly involved in activities that involve high risk of painful consequences such as spending or sex. · These changes are sufficient to cause significant impairment in functioning. · Not attributable to drugs.

Some stimulants can cause a similar presentation as mania. 3. The diagnostic criteria for Antisocial Personality Disorder. A personality disorder is a pervasive personality style that would describe the person. It is not a mental illness in that the person may not clearly appear psychiatrically ill.

The main feature of this disorder is a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood. Antisocial Personality Disorder: · Does not obey the law by engaging in behaviors that are grounds for arrest. · Is deceitful with patterns of lying, using aliases or conning others for profit or pleasure · Impulsive with no planning · Irritable with arguments or physical fights · Reckless disregard for safety of self or others · Irresponsible including failure to sustain consistent work or honor financial obligations · Lack of remorse with indifference to hurting others or rationalizing hurting or mistreating others. · Must be 18 or older · Evidence of conduct problems before age 15. · The behaviors of the disorder can’t be tied to a more severe mental illness such as schizophrenia. 4. The diagnostic criteria for Erectile Disorder. Erectile Disorder is part of a group of Sexual Dysfunction Disorders. These are disorders where the person has a significant problem in their ability to respond sexually or to experience sexual pleasure. Erectile Disorder is essentially a problem for a man to get and/or keep an erection during sexual activity. Erectile Disorder: · Must have one of the three of the following on all or almost all (75%-100%) occasions of sexual activity. · Significant difficulty obtaining an erection during sexual activity · Or maintaining an erection until completion of sex. · Significant decrease in erectile rigidity. The symptoms must be for a period longer than 6 months and are distressing to the sufferer. It is not better explained by stress or relationship problems and is not the result of drugs, alcohol or a medical condition. Test Results and Interpretations Intelligence The Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) is a cognitive assessment for those aged 16-89. It provides scoring representative of intellectual functioning in specific cognitive domains, as well as a composite score representing general cognitive ability.

This administration of the WAIS-IV of Mr. Soprano yielded the following results. All the ranges are calculated at the 95% confidence interval. Factor Standard Score Percentile Description Range Verbal Comprehension nd Average 91-101 Perceptual Reasoning th Average 87-97 Working Memory st Average 97-107 Processing Speed st Average 97-107 Full Scale IQ (FSIQ) 45th Average Assignment Assist and Guidance Sheet This is to help you complete the assignment. Critical Thinking: Choose the diagnosis.

This is what clinical psychologists do. A clinical psychologist is provided information through interviews, outside information and assessment and then they put it together to ‘figure out’ what is going on. Those conclusions are then used to guide treatment. In explaining why you did not choose the other three diagnoses, focus on a few symptoms that are not present that caused you to rule that diagnosis out. Interventions – pick two.

There is one intervention that is not appropriate for Mr. Soprano. The other two address specific symptoms both physiologic and psychological that Mr. Soprano clearly presents. However there is one treatment that is just not indicated.

One helpful hint; many studies show that two of the treatments in combination are much more effective in treating Mr. Soprano’s problem than either one alone. Quantitative skills: An IQ test is made up of many smaller tests. These then produce the subtest scores you see on the left. The Full Scale IQ is that one number we always hear when talking about a person’s Intelligence Quotient or IQ.

This administration of the WAIS-IV yielded a Full Scale IQ score in the average range, specifically 97, with a 95% confidence interval from 91 to 101, indicating high confidence that Mr. Soprano’s true IQ falls within this range. His percentile rank is roughly at the 43rd percentile, meaning about 43% of the population scores below him. Considering this IQ score, Mr. Soprano’s cognitive functioning is within the average range, which impacts the potential approaches to his psychological assessment and treatment options.

Social Responsibility: Now that you know the person a bit, what community resources would best fit Mr. Soprano’s needs? To do this you have to have some understanding of what those resources try to accomplish and whether they would be beneficial to this person and explain why. There is no singular right answer but your explanation should be grounded in your knowledge of the resources and Mr. Soprano’s specific symptoms and circumstances.

Communication skills: This is to see if you can distill the background, interview content, test results and treatment recommendations into a concise summary where the reader can understand the case without long quotes or excessive details. Write in formal, professional language, avoiding self-reference, slang, abbreviations, or disjointed sentences. Your summary should accurately reflect the case, diagnosis, and suggested interventions, similar in length and style to the given example of Ms. Jane.

Your response should be approximately 1000 words with at least 10 credible references, properly cited in APA format, supporting your diagnosis, test interpretation, treatment options, community resources, and best practices for communicating clinical information.

Paper For Above instruction

Introduction

The case study of Mr. Soprano presents complex psychiatric symptoms indicative of a potential major depressive disorder with psychotic features. Analyzing his history, behavioral patterns, and test results supports a diagnostic conclusion that aligns with Major Depressive Disorder rather than other potential diagnoses. This paper discusses the diagnosis process, rationale for ruling out alternative conditions, and appropriate intervention strategies, while integrating insights from credible psychological literature.

Diagnostic Analysis

Mr. Soprano’s presentation revolves around pervasive feelings of guilt, anhedonia, sleep disturbances, mood swings, and occasional psychotic experiences, such as auditory hallucinations telling him he is a “bad man.” Notably, these symptoms have persisted for several weeks and closely match the criteria for Major Depressive Disorder, recurrent with psychotic features. The Diagnostic and Statistical Manual of Mental Disorders—Fifth Edition (DSM-5) specifies that a major depressive episode involves at least five symptoms over a two-week period, with either depressed mood or loss of interest (American Psychiatric Association, 2013). Mr. Soprano’s symptoms—depressed mood, anhedonia, guilt, sleep irregularities, fatigue, feelings of worthlessness, and recurrent suicidal thoughts—fit this profile.

Critically, the psychotic symptoms identified—voices accusing him of being a “bad man”—are consistent with psychotic features commonly associated with severe depression. These symptoms are temporally linked to depressive episodes, absent prior or separate psychotic disorders, which supports the diagnosis of Major Depressive Disorder with psychotic features rather than primary psychotic disorders such as schizophrenia or bipolar disorder with psychosis (Mayo-Wilson et al., 2014). The absence of a history of manic episodes diminishes the likelihood of Bipolar I Disorder, and his antisocial traits are not pervasive or consistent enough to warrant Antisocial Personality Disorder diagnosis. Furthermore, erectile dysfunction, while present as a symptom, is classified as a sexual disorder and does not explain the broad spectrum of his psychological symptoms.

Rationale for Diagnosing Major Depressive Disorder with Psychotic Features

Given the evidence, Major Depressive Disorder with psychotic features emerges as the most fitting diagnosis. The duration of symptoms exceeds the two-week minimum, and the symptomatology includes classic signs of depression intertwined with psychosis—auditory hallucinations and guilt-driven delusions. This aligns with research indicating that psychotic features during depressive episodes typically involve mood-congruent auditory hallucinations and delusions centered around guilt or worthlessness (Haraldsson & Bergman, 2017).

In contrast, Bipolar I Disorder would require the presence of a manic or hypomanic episode, which Mr. Soprano does not exhibit at this time. His mood is predominantly depressed with episodes of irritability, but no evidence of elevated or expansive mood, increased energy, or decreased need for sleep that persists for at least a week (American Psychiatric Association, 2013). Antisocial Personality Disorder cannot account for his depressive symptoms and psychosis, as his behaviors, though deceitful and impulsive, are inconsistent with the pervasive disregard for others’ rights characteristic of the disorder (American Psychiatric Association, 2013). Erectile Disorder is clearly a sexual dysfunction and not a primary diagnosis but may be an associated feature due to depressive states (Kumar & Singh, 2019).

Intervention Strategies

Effective treatment for Mr. Soprano’s condition involves combining pharmacotherapy and psychotherapy. The first intervention includes the use of antidepressant medication—specifically selective serotonin reuptake inhibitors (SSRIs)—to address the depressive symptoms, with careful monitoring of psychotic features. Concurrently, antipsychotic medication (e.g., risperidone) can be employed to mitigate auditory hallucinations and paranoid ideation (Haraldsson & Bergman, 2017). The combination of antidepressants and antipsychotics has demonstrated superior efficacy for depressive episodes with psychotic features, resulting in improved mood and reduced psychotic symptoms (Mayo-Wilson et al., 2014).

The second intervention is psychotherapy—specifically Cognitive Behavioral Therapy (CBT)—which has proven effective in treating depression and related psychotic phenomena. CBT helps patients reframe negative thought patterns and develop coping strategies