Description
Submit your diagnosis for the client in the case. Follow the guidelines below.
The diagnosis should appear on one line in the following order.
Note: Do not include the plus sign in your diagnosis. Instead, write the indicated items next to each other.
Code + Name + Specifier (appears on its own first line)
Z code (appears on its own line next with its name written next to the code)
Then, in 1–2 pages, respond to the following:
Explain how you support the diagnosis by specifically identifying the criteria from the case study.
Describe in detail how the client’s symptoms match up with the specific diagnostic criteria for the disorder (or all the disorders) that you finally selected for the client. You do not need to repeat the diagnostic code in the explanation.
Identify the differential diagnosis you considered.
Explain why you excluded this diagnosis.
Explain the specific factors of culture that are or may be relevant to the case and the diagnosis, which may include the cultural concepts of distress.
Explain why you chose the Z codes you have for this client.
Remember: When using Z codes, stay focused on the psychosocial and environmental impact on the client within the last 12 months.
Unformatted Attachment Preview
The Case of Emma
Intake Date: February xxxx
IDENTIFYING/DEMOGRAPHIC DATA: This was an emergency, voluntary
admission for this 28-year-old single white female. This was her fourth psychiatric
hospitalization. Emma lives with a 24-year old female roommate in New York
City. She has a bachelor’s degree in art history and is employed by a major New
York museum. Emma is of Jewish ancestry.
CHIEF COMPLAINT/PRESENTING PROBLEM: “My therapist said I was
decompensating because I broke my leg, and I was despondent.”
HISTORY OF PRESENT ILLNESS: Emma reported that she began a special
diet and, although she was supposed to be eating 600 calories a day, she was only
eating between 200 and 400 calories a day. She also admitted to purging and
frequent use of laxatives. Emma reported her weight was being monitored, and she
had lab work done to be sure she remained healthy. In 3 months, Emma lost
approximately 80 pounds.
Emma reported that she has a very stressful job. She stated that approximately one
month prior to admission, she started to “decompensate” and had difficulty
maintaining control at work. She had several altercations with coworkers. One
week prior to admission, Emma reported that her NA sponsor “said something
nasty, and I lost it.” According to her mother, the sponsor made a reference to
Emma being overweight. Emma reported that she was angry and “hit everything I
knew I could—but that did not help.” She then kicked a brick wall, fracturing her
right leg. Emma also reported being under stress due to applying for her master’s
degree in art history and difficulties with her boyfriend.
Emma complained of depression with insomnia and sleeping only a few hours per
night, feeling confused, decreased concentration, irritability, anger, and frustration.
She admitted to suicidal ideation. She complained of feeling paranoid over the past
few weeks and believed the police were after her and that she heard them outside
her door. She believed the police had her under surveillance. Emma complained of
a fear of dirt, taking time to frequently bathe and brush her teeth. Emma reported
she was emotionally abused as a child and thinks she suffered from post-traumatic
stress disorder, but she denied a history of flashbacks or nightmares. She also
thinks she had panic attacks and said she controlled them by taking Klonopin, but
there was no clear information about this. She reported a history of bulimia since
the age of 17.
PAST PSYCHIATRIC HISTORY: Emma’s mother reported that Emma saw a
clinical social worker briefly when Emma was 10 years old. Emma reported that
she was hospitalized at a New York hospital 3 years ago for 3 months. Six months
after that, Emma took an overdose of Halcion and was treated at the same hospital,
and then was transferred to a state hospital. After discharge in the next month,
Emma attended a partial hospitalization program for drugs and alcohol every day
for 5 weeks. She has been seeing a psychiatrist for the past 2 years on an outpatient
basis. Emma sees a clinical social worker weekly.
SUBSTANCE USE HISTORY: Emma reported a history of drug and alcohol
use, but she stated that she has been clean and sober for two years. Emma
admitted to using marijuana, cocaine, opiates, and hallucinogens in the past. She
denied IV drug use but admitted to “skin popping” cocaine. Emma has abused
alcohol in the past. According to her mother, Emma has also abused prescription
medications in the past. Emma reported that she has been sober for the past 2 years
and attends AA and NA meetings regularly. Emma was treated for alcohol and
cocaine use.
PAST MEDICAL HISTORY: At 17 years old, Emma suffered from bulimia
with bingeing, purging, and the use of laxatives. She reported she had not purged
for 3 years until she began the new diet 3 months ago. Although Emma is currently
not bingeing, she admitted to purging and using laxatives. Emma is allergic to
penicillin and has a lactose intolerance. She wears glasses for reading.
FAMILY HISTORY INCLUDING MEDICAL AND PSYCHIATRIC:
Emma’s parents were married when her mother was 19 years old, and Emma was
born the following year. Emma’s mother described Emma as a wonderful, eventempered, and happy baby. Two years later, Emma’s sister was born. Mother
stated Emma’s personality changed. She became stubborn and difficult. Emma’s
mother said that Emma began biting and having temper tantrums and has been
moody since then. Emma’s mother stated her marriage was conflicted because she
has a communication problem with her husband and he was “never an active
parent.” Emma’s mother reported that Emma “adores her father” because he is not
the disciplinarian. When Emma was 12 years old, her parents separated for 2
weeks. Emma reported her mother quit college after Emma’s birth and returned to
college after her sister’s birth. She said her father worked all the time, and there
was a housekeeper who cared for the children.
Emma reported that the family moved to Arizona when Emma was in sixth grade,
where she began using marijuana that she reported stealing from her parents. The
family returned to New York when Emma was in seventh grade.
Emma is currently applying for admission to graduate school and has taken some
courses toward her master’s degree. Emma was always an athlete (soccer) in
school, and according to her mother, she was a champion.
Currently, Emma is friendly with her roommate but does not have any other
friends. “I don’t trust anybody.” Emma’s mother reported that when Emma lived in
Connecticut during college, Emma had many friends and was active in NA and
AA.
CURRENT FAMILY ISSUES AND DYNAMICS: Emma has close contact
with her parents but less contact with her sister. The family celebrates the Jewish
holidays and gets together for those activities.
MENTAL STATUS EXAM: Emma presented as an overweight, somewhat
disheveled, white female who had a cast on her right leg. She was relaxed but very
restless during the interview. Her facial expression was mobile. Her affect during
the initial interview was constricted and her mood dysphoric. Emma’s speech was
pressured and often circumstantial or tangential, and she spoke in a loud voice.
At times her thinking was logical, and at other times it was illogical. Althoug
Emma denied hallucinations she complained of hearing policemen outside her door
prior to admission. She denied homicidal ideation and initially admitted to suicidal
ideation but then denied this.
Emma was oriented to person, place, and time. Her fund of knowledge was
excellent. Emma was able to calculate serial sevens easily and accurately. Emma
repeated 7 digits forward and 3 in reverse. Her recent and remote memory was
intact, and she recalled 3 items after five minutes. Emma was able to give
appropriate interpretations for 3 of 3 proverbs. Her social and personal judgment
was appropriate. Emma’s three wishes were: “To be skinny, to have a big house
where I can take in all the stray cats, and for a million more wishes.” When asked
how she sees herself in 5 years, Emma replied, “Hopefully graduating from
graduate school.” If Emma could change something about herself, she would
“make myself thin.”
Purchase answer to see full
attachment
