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Subjective: Client complains about extreme stress caused by effort having to be made to do well in Engineering classes and needing to attend tutorials. The client complains about not feeling supported and feeling pressure to do well from their family. The client has been self harming almost daily, drinking five days a week. The client complains about struggling to make friends and feeling pressured to drink to fit in. The client reports a prior history of self-harm when stressed with school work.

Objective: Client appears anxious, visibly distraught as evidenced by the initial refusal to sit down and pacing in front of the desk for several minutes before finally sitting down. Lab work and physical exam has not yet been confirmed. Assessment/Problem List: The client appears to lack healthy coping skills necessary to manage stressors. The client uses substance and self-harm (cutting) to alleviate stress. Provisional diagnosis: F10.20 Alcohol Use Disorder, Severe and F43.23 Adjustment Disorder with mixed anxiety and depressed mood.

The client’s recent suicide attempt warrants the client be admitted for direct observation under hospitalization until the client is stabilized. Plan: Initiate weekly counseling, post client stabilization post hospitalization for recent suicide attempt. Client to engage in weekly CBT and mindfulness based approaches in counseling.

Paper For Above instruction

Introduction

Adolescent mental health issues have become increasingly prevalent, with stress, self-harm, and substance use presenting significant challenges. The case described involves a young client experiencing severe stress related to academic pressures, familial expectations, and social difficulties, culminating in a recent suicide attempt. This essay explores the multifaceted nature of such mental health issues, emphasizing assessment, diagnosis, and intervention strategies, including counseling and hospitalization, grounded in contemporary psychological theories and evidence-based practices.

Assessment of Presenting Problems

The client exhibits signs of extreme stress evidenced by anxious behavior, pacing, and initial refusal to sit. The subjective complaints include academic pressure, lack of perceived social support, familial stress, and substance use, which collectively suggest maladaptive coping mechanisms. The history of self-injury and alcohol misuse indicates unresolved emotional distress and a potential cycle of self-destructive behavior. The objective signs, such as agitation, reinforce the need for urgent intervention.

Diagnosis and Theoretical Framework

The provisional diagnoses of Severe Alcohol Use Disorder (F10.20) and Adjustment Disorder with mixed anxiety and depressed mood (F43.23) align with the clinical presentation. These fall within the broader framework of the biopsychosocial model, which considers biological predispositions, psychological processes, and social influences. Social learning theory can explain the client’s normalization of drinking to fit in socially, while cognitive-behavioral models help understand the maladaptive thought patterns contributing to the client’s stress and self-harming behaviors.

Interventions and Treatment Plan

Given the severity of the client’s presentation, a multi-tiered intervention approach is warranted. Immediate hospitalization provides a safe environment for stabilization and close monitoring, particularly due to the recent suicide attempt. Post-hospitalization, ongoing weekly counseling focusing on cognitive-behavioral therapy (CBT) and mindfulness techniques is critical in addressing both the underlying emotional distress and maladaptive coping mechanisms.

Cognitive-behavioral therapy has a robust evidence base for treating adolescent depression, anxiety, and substance use (Weisz et al., 2017). CBT aims to modify distorted thought patterns, enhance emotional regulation, and improve problem-solving skills. Mindfulness-based approaches foster self-awareness and emotional resilience, which are crucial for adolescents navigating academic and social pressures (Kabat-Zinn, 2013).

Additionally, family therapy may be beneficial to address familial pressure and support systems, which play a vital role in adolescent mental health (Robin & Foster, 2019). Social skills training may help the client develop healthier peer relationships and reduce reliance on drinking to fit in. Psychoeducation about substance use and self-harm can empower the client and caregivers with coping strategies and risk management skills.

Preventive and supportive measures, including school-based interventions and peer support groups, are essential for ongoing resilience. School counselors can facilitate accommodations for academic stress and social challenges, fostering an environment conducive to mental well-being (McGregor et al., 2018).

Conclusion

This case exemplifies the complex interplay between academic stress, social pressures, and mental health in adolescence. The comprehensive treatment plan—comprising hospitalization, evidence-based psychotherapy, family involvement, and school support—aims to promote stabilization, develop healthy coping skills, and prevent recurrence of self-harm and suicidal behaviors. Future efforts should focus on early identification and holistic care strategies that address the psychological, social, and biological factors influencing adolescent mental health.

References

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