Abnormal Behavior – Case Study-Car Salesman
I need this back ASAP! Please list at least two references diagnosis code and v codes.
Diagnosis is one of the following
1.Physical Disorders and Health Psychology
2. Anxiety, Trauma- and Stressor-Related
and Obsessive-Compulsive and Related Disorders
3. Somatic Symptom and Related Disorders and Dissociative Disorders
4. Eating and Sleep-Wake Disorders
5. Neurodevelopmental Disorders and Conduct Disorder
6. Mood Disorders and Suicide
A 29-year-old car salesman was referred by his current girlfriend, a psychiatric nurse, who suspected he had a mood disorder, even though the patient was reluctant to admit that he might be a moody person. According to him, since the age of 14, he has experienced repeated alternating cycles that he terms “good times and bad times.” During a bad period, usually lasting four to seven days, he oversleeps 10-14 hours daily, lacks energy, confidence, and motivation—“just vegetating,” as he puts it. Often he abruptly shifts, characteristically upon waking up in the morning, to a three-to-four day stretch of overconfidence, heightened social awareness, promiscuity, and sharpened thinking—“Things would flash in my mind.” At such times he indulges in alcohol to enhance the experience but also to help him sleep. Occasionally the good periods last seven to ten days, but culminate in irritable and hostile outbursts, which often herald the transition back to another period of bad days. He admits to frequent use of marijuana, which he claims helps him adjust to daily routines.
In school, As and Bs alternated with Cs and Ds, with the result that the patient was considered a bright student whose performance was mediocre overall because of unstable motivation. As a car salesman his performance has also been uneven, with good days canceling out the bad days; yet even during his good days, he is sometimes perilously argumentative with customers and loses sales that appeared sure. Although considered a charming man in many social circles, he alienates friends when he is hostile and irritable. He typically accumulates social obligations during the bad days and takes care of them all at once on the first day of a good period.
The Case of Ellen Waters Ellen Waters’ counselor referred her for a medication consultation because of her continuing depressed mood and panic attacks. She is a 37-year-old, part-time graduate student who lives alone and supports herself by working as a home health aide. She completed the course work for a Ph.D. in sociology 3 years ago, but has not yet begun her dissertation.
Ellen is indeed an unhappy-looking woman, and describes being unhappy through much of her life, with no long periods of feeling really good. Her father had a history of alcohol problems, and there was always a great deal of strife in her parents’ marriage. She denies sexual or physical abuse, but feels that her parents were “emotionally abusive” to her. She was first referred for treatment after she made a suicide attempt at age 14, and there have been many times over the years during which her usual low-level depression has become considerably worse, but she has not sought treatment.
Two years ago, when she had been seeing her current boyfriend for about 4 years, it finally became clear that he was unwilling to marry her or live with her. She began to get more depressed and to experience acute panic attacks, and it was at that time that she entered counseling.
In the month before the consultation, she says she was depressed most of the time. She had gained about 10 pounds because she was constantly nibbling on chips or cookies or making herself peanut butter sandwiches. She often awakened in the middle of the night, was unable to go back to sleep for hours, and then overslept the following day, often sleeping up to 18 hours. She says she feels like dead weight, her legs and arms are heavy, and she is always tired, she ruminates about her own failures and cannot concentrate on any serious reading. Although she often wished to be dead, she has not made any recent suicide attempts.
Ellen’s mood is clearly reactive to favorable events. Small attentions from her therapist of her boyfriend can cause her to feel really good for hours at a time. She has an equally extreme reaction to any sort of rejection. If a friend does not return a call, or if someone appears romantically interested then withdraws, she feels devastated.
Although Ellen reports chronic depression, when she is asked about “high” periods, she describes many episodes of abnormally elevated mood that have lasted for several months. During these times she would function on 4 or 5 hours of sleep a night, run up huge telephone bills, and feel that her thoughts were speeded up. She was able to get a lot done, but her friends were obviously concerned about the change in her behavior, urging her to “slow down” and “calm down.” She has never gotten into any real trouble during these episodes.
Ellen meets the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5)(2013) criteria for hypomanic episode, A-F. Criteria: A– She experiences many episodes of abnormally elevated mood that have lasted for several months; B– She meets four of the seven symptoms (2- would function on 4 or 5 hours of sleep a night; 4- felt that her thoughts were speeded up; 6- was able to get a lot done; and 7- ran up huge telephone bills) … “which represent a noticeable change from usual behavior, and have been present to a significant degree” (APA, 2013, p. 132); C and D– friends were obviously concerned about the change in her behavior, urging her to “slow down” and “calm down”; E– has never gotten into any real trouble during these episodes; and F– There are no reports of any medications or other substances that might cause the episode.
Ellen meets the criteria for major depressive episode (DSM-5), A-C. Criteria: A– She meets six of the nine symptoms (1- was depressed most of the time for a month; 3- gained about 10 pounds; 6- always tired; 7- ruminates about her failures; 8- cannot concentrate on any serious reading; 9- often wished to be dead without any specific plans to commit suicide); B– She sought counseling for the continuing depressed mood; C– There are no reports of medications or other substances that might cause the episode. Medical tests should be conducted to eliminate any physiological condition that might cause this episode.
Ellen meets the criteria for Bipolar II Disorder A-D. Criteria: A– She has experienced a hypomanic episode; B– She has never had a manic episode; and C– Her hypomanic and depressive episodes are not better explained by: schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder or other specified or unspecified schizophrenia spectrum and other psychotic disorders; D– The symptoms of depression cause clinically significant distress.
Ellen’s current episode is depressed with moderate severity. Her symptoms fall between the mild and severe levels of severity. She has one more than the minimum number of symptoms for both hypomanic episode and major depressive episode so, the symptoms are not excessive.
Specifier- with atypical features, Criteria A-C (DSM-5, pp. 151-152). Criteria: A– Her mood is clearly reactive to favorable events; B– She meets three of the four symptoms (1- gained about 10 pounds, constantly nibbling on chips or cookies or making herself peanut butter sandwiches, 3- feels like dead weight, her legs and arms are heavy; and 4- She has an extreme reaction to any sort of rejection. If a friend does not return a call, or if someone appears romantically interested then withdraws, she feels devastated.); C– Criteria are not met for with melancholic features or with catatonia. In addition, a condition worth noting is Ellen’s report of parental emotional abuse so the V- code V15.42, personal history of psychological abuse in childhood, is included with the diagnosis of bipolar II disorder (American Psychiatric Association, 2013). As noted in the DSM-5 on page 138 (American Psychiatric Association, 2013) about 1/3 of individuals have a history of suicide attempts which Ellen has admitted accordingly a safety plan would need to be discussed. Since Ellen reported panic attacks in the past and anxiety disorders are often comorbid with bipolar II disorders, I considered panic disorder but subsequently discarded that idea as Ellen is not reporting current panic attacks. Ellen does not meet the criteria for bipolar I disorder as she did not meet the criteria for manic episode because she doesn’t meet criterion C under manic episode.
Does not met the criteria specifier (criterion B, hypomania episode or depressive episode) with mixed features because her symptoms are mostly subjective in nature.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.), pp. 132-139, 151. Arlington, VA: American Psychiatric Association Publishing.