Week 7 Complex Case Study Presentation Instructions Answer

Week 7 Complex Case Study Presentationinstructionsanswer The Quest

Consider the following questions when providing your responses to the case study presentation: 1. Based on this client’s reported symptoms and her background history, what other diagnoses could be given, and why? 2. What other pharmacological and/or nonpharmacological treatments might this client benefit from? Provide an explanation. 3. What types of community resources are available in your area that would meet this client’s emotional and/or social needs?

Paper For Above instruction

The complex case of AK, a 13-year-old girl exhibiting aggressive and mood-related behaviors, demands a comprehensive clinical assessment. Her presentation encompasses recurrent temper outbursts, impulsivity, emotional dysregulation, and behaviors consistent with Intermittent Explosive Disorder (IED). Her background of early neglect, physical abuse, prenatal substance exposure, and familial psychiatric history further complicate her diagnostic picture. This case echoes the intricate interplay between neurodevelopmental, mood, and trauma-related factors, which necessitate a nuanced approach to diagnosis and intervention.

Initially, the primary diagnosis of IED appears appropriate given her recurrent episodes of impulsive aggression, which are disproportionate to the precipitating stressor and impair her functioning within her family environment. However, comorbid or alternative diagnoses must be considered, especially given her symptoms of mood fluctuation, sleep disturbances, and past mood diagnoses. Bipolar disorder, particularly Bipolar II or cyclothymic disorder, presents as a differential diagnosis. The reported mood swings lasting a few days, coupled with episodic sadness and guilt, could suggest underlying mood instability, often observed in adolescent bipolar disorder (Leibenluft, 2017). However, her current presentation lacks clear episodic euphoria or grandiosity, and her mood is typically euthymic in between outbursts, which diminishes the likelihood of bipolar diagnosis but warrants ongoing assessment.

Additionally, Oppositional Defiant Disorder (ODD) may be considered due to her defiance, temper, and oppositional behaviors. Her defiant attitude towards her parents, frequent arguing, and refusal to perform chores meet ODD criteria (American Psychiatric Association, 2013). Nevertheless, the severity and frequency of her aggressive outbursts, coupled with self-injurious thoughts, point towards a more pervasive disruptive behavior disorder, necessitating differentiation from Conduct Disorder. Unlike Conduct Disorder, which involves more intentional harm and rule violations across settings, AK’s behaviors are primarily confined to the home environment, and there is no evidence of persistent violation of others' rights or theft. Therefore, Conduct Disorder is less appropriate but remains a differential for ongoing assessment.

Trauma-related disorders, such as Post-Traumatic Stress Disorder (PTSD) or Adjustment Disorder, also merit consideration. Her history of childhood neglect, physical abuse, foster care, and prior hospitalizations for behavioral issues could contribute to trauma-related symptomatology. Although she does not currently endorse intrusive memories or hyperarousal characteristic of PTSD, her history suggests trauma’s ongoing influence, potentially manifesting as emotional dysregulation and impulsivity (Cloitre et al., 2019). An accurate diagnosis must include careful assessment of trauma history alongside her present symptoms.

From a treatment perspective, pharmacological interventions targeting her aggression, mood instability, and impulsivity are essential. Although she is on Aripiprazole (Abilify) with minimal benefit, other medication options should be considered. Selective Serotonin Reuptake Inhibitors (SSRIs), notably fluoxetine, have demonstrated efficacy in reducing impulsive aggression and irritability in similar populations (Coccaro & Grant, 2019). SSRIs also address co-occurring anxiety and depressive symptoms, which she reports, even if intermittently. Moreover, mood stabilizers such as lithium or valproate could be beneficial, especially if mood dysregulation intensifies or bipolar features emerge. Guanfacine, an alpha-2 adrenergic agonist, has shown promise in reducing impulsivity and aggression, and her recent medication trial indicates the importance of monitoring its effectiveness (Harricharan & Adcock, 2018).

Nonpharmacological treatments are equally vital. Cognitive Behavioral Therapy (CBT), especially modules focusing on anger management, emotional regulation, and impulse control, can equip AK with skills to recognize triggers and employ coping strategies. McCloskey et al. (2022) demonstrated the effectiveness of CBT in reducing impulsive aggression in adolescents with IED. Art therapy, which she enjoys, provides a benign outlet for emotional expression and can reduce feelings of isolation while fostering self-efficacy (Rastogi & Kempf, 2022). Family-based interventions like Structural Family Therapy (Fisher, 2017) are also recommended to address familial dynamics, boundaries, and communication patterns that may perpetuate her behavioral issues.

Community resources tailored to AK’s emotional and social needs should include multidisciplinary services such as outpatient mental health programs, trauma-focused therapy, support groups for adoptive families, and in-home therapeutic services (Puhalla et al., 2020). School-based mental health initiatives and social skills training can help her navigate peer relationships better. Furthermore, engagement in extracurricular activities like sports and arts can promote social integration, build self-esteem, and reduce feelings of loneliness. Local community centers or youth organizations often provide such programs, facilitating peer support and offering structured environments conducive to her development.

In conclusion, AK’s presentation underscores the importance of a multidimensional assessment that considers her complex trauma, developmental history, and current functional impairments. A combination of targeted pharmacotherapy, evidence-based psychotherapy, and community supports can address her impulsivity, emotional dysregulation, and social needs. Ensuring ongoing assessment and flexibility in her treatment plan are essential to adapt interventions as her developmental and psychological needs evolve.

References

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
• Cloitre, M., et al. (2019). Traumatized children and adolescents: Risk, resilience, and treatment. Journal of Trauma & Dissociation, 20(2), 279-284.
• Coccaro, E. F., & Grant, J. E. (2019). Pharmacological treatment of impulse control disorders. In APA handbook of psychopharmacology (pp. 267-280). American Psychological Association.
• Fisher, U. (2017). Use of structural family therapy with an individual client diagnosed with intermittent explosive disorder: A case study. Journal of Family Psychotherapy, 28(2), 150–169.
• Harricharan, S., & Adcock, L. (2018). Guanfacine hydrochloride extended-release for attention deficit hyperactivity disorder: A review of clinical effectiveness, cost-effectiveness, and guidelines. Canadian Agency for Drugs and Technologies in Health.
• Leibenluft, E. (2017). Severe mood dysregulation, irritability, and related conditions in youth: What do they tell us about bipolar disorder? Bipolar Disorders, 19(2), 84–97.
• McCloskey, M. S., Chen, E. Y., Olino, T. M., & Coccaro, E. F. (2022). Cognitive-behavioral versus supportive psychotherapy for intermittent explosive disorder: A randomized controlled trial. Behavior Therapy, 53(6), 1133–1146.
• Puhalla, A. A., Berman, M. E., Coccaro, E. F., Fahlgren, M. K., & McCloskey, M. S. (2020). History of childhood abuse and alcohol use disorder: Relationship with intermittent explosive disorder and intoxicated aggression frequency. Journal of Psychiatric Research, 125.
• Rastogi, M., & Kempf, J. K. (2022). Art therapy for psychological disorders and mental health. Foundations of Art Therapy. Academic Press.