Differential Diagnosis: What other diagnoses did you rule out? Why? (Give two diagnoses and two reasons for the rule out for each).

Psychology by Geoffrey

CASE I

 

The school referred Chad, six years of age, because “he requires constant supervision to keep him from disrupting classroom activities.”  He is also described as “stubborn, defiant, and quarrelsome,” and as having a very short attention span.  Every school he has attended has had the same complaints about his behavior:  he is overactive, uncontrollable, disruptive, and impulsive.  Chad’s mother talked to their church pastor about Chad’s behavior.  The pastor said that Chad’s presentation was normal because he was “just a boy” and that Chad just needed prayer and patience.  Chad’s mother has prayed over Chad but has seen no change in his behavior.  She is not sure if she should talk to her pastor again or seek mental health services because the pastor said it was normal. His mother states that at home Chad never kept still for any length of time; he is always running, jumping, rocking or fiddling with something.  She describes him as doing three or four things at a time without completing anything.  He has very poor judgment and goes off anywhere by himself and does whatever he wants to do.  He is extremely intrusive and disrupts any activity in which others are attempting to engage.  His mother feels that he demands her undivided attention.  Furthermore, she says, he is always provoking his older brother, and has a “wild” temper, which erupts very dramatically and suddenly and disappears in the same fashion. As an infant Chad was constantly climbing out of his crib and high chair.  As a toddler he was into everything and his parents made many visits to the emergency room because of his minor accidents.  He climbed a lot, jumped all over the furniture, and refused to stay in his playpen. During the evaluation Chad spent most of the time walking around the office or tilting a chair and leaning on its back, and rocking back and forth.  He acknowledged having some difficulties in school, but felt it was strictly because the other children picked on him.

 

 

  1. Write out the complete diagnosis covering all aspects of the client’s presentation (meaning you included specifiers- if applicable), also include V-codes if any apply.
  2. Detailed description of the criteria met for your diagnosis(es) and examples of how the client met each criterion (sign or symptoms).  (BULLET POINTS IS PREFERRED)
  3. Differential Diagnosis: What other diagnoses did you rule out? Why? (Give two diagnoses and two reasons for the rule out for each).
  4. Write a treatment plan for the case which includes:
    1. 3 Short-term goals and 3 long term goals/objectives
    2. Specify therapeutic interventions related to short or long term goals.  Give at least two interventions for each the short and long term goals.

 

CASE II

 

Ms. A, a moderately obese 32-year-old white woman, presented to her doctor in January 1997 for a refill of her estrogen replacement medication, which she had been taking since her hysterectomy for endometriosis after the birth of her fourth child in 1995. She complained of increasing problems with depressed mood. Ms. A related feeling “depressed and moody” since her teenage years. Her mood aberrations were not related merely to estrogen replacement or adherence problems. Ms. A denied current use of alcohol or illicit drugs and smoked cigarettes about 1 pack per day for 20 years. She also drank 1 or 2 servings of caffeinated beverages per day. A physical examination and routine laboratory work were unrevealing.

The next time Ms. A was seen a month later, she complained of increasing hypersomnia and daytime lethargy, increased appetite, frequent crying, headaches, and memory problems since her last appointment. However, during a follow-up appointment two weeks later, she indicated that things had changed. She now only needed 3 to 4 hours of sleep per night. Ms. A described feelings of elation, inflated self esteem, and of having her mind filled with ideas and activities, racing from one thought to another and easily distracted. She had become markedly more talkative and social. Those around her noticed her behavior as distinctly different than usual. However, this sudden change sometimes lasted about 4-5 days, ended suddenly, and was followed by a steady decline in energy and motivation over the next several weeks.  When she felt a decline in energy, she would also experience feeling very sad and in a depressed mood.  She also felt a loss of energy, with lead her to feel worthless, and insomnia.  Ms. A also did not feel like eating during her decline in energy and had a very hard time concentrating.

 

When asked if she’d had episodes like this in the past, Ms. A described experiencing similar brief periods every 2 to 3 weeks, where she experienced the ups and downs.  The ups typically lasting from 4 to 5 days. She recognized these periods as being time limited and would try to make the best of them by shopping and doing housework, often late into the night.

 

  1. Write out the complete diagnosis covering all aspects of the client’s presentation (meaning you included specifiers- if applicable), also include V-codes if any apply.
  1. Detailed description of the criteria met for your diagnosis(es) and examples of how the client met each criterion (sign or symptoms).  (BULLET POINTS IS PREFERRED)
  2. Differential Diagnosis: What other diagnoses did you rule out? Why? (Give two diagnoses and two reasons for the rule out for each).
  3. Write a treatment plan for the case which includes:
    1. 3 Short-term goals and 3 long term goals/objectives
  1. Specify therapeutic interventions related to short or long term goals.  Give at least two interventions for each the short and long term goals.