Identify the symptoms or “red flags” in the case study that may be evaluated for a possible mental health disorder. Should the social worker have shared this suspected diagnosis based on the limited assessment with Ms. Evans at this time?

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A diagnosis is powerful in the effect it can have on a person’s life and treatment protocol. When working with a client, a social worker must make important decisions—not only about the diagnostic label itself but about whom to tell and when. In this Discussion, you evaluate the use and communication of a diagnosis in a case study.

To prepare: Focus on the complex but precise definition of a mental disorder in the DSM-5 and the concept of dimensionality both there and in the Paris (2015) and Lasalvia (2015) readings. Also note that the definition of a mental disorder includes a set of caveats and recommendations to help find the boundary between normal distress and a mental disorder.

Then consider the following case:

Ms. Evans, age 27, was awaiting honorable discharge from her service in Iraq with the U.S. Navy when her colleagues noticed that she looked increasingly fearful and was talking about hearing voices telling her that the world was going to be destroyed in 2020. With Ms. Evans’s permission, the evaluating [social worker] interviewed one of her closest colleagues, who indicated that Ms. Evans has not been taking good care of herself for several months. Ms. Evans said she was depressed.

The [social worker] also learned that Ms. Evans’s performance of her military job duties had declined during this time and that her commanding officer had recommended to Ms. Evans that she be evaluated by a psychiatrist approximately 2 weeks earlier, for possible depression.

On interview, Ms. Evans endorsed believing the world was going to end soon and indicated that several times she has heard an audible voice that repeats this information. She has a maternal uncle with schizophrenia, and her mother has a diagnosis of bipolar I disorder. Ms. Evans’s toxicology screen is positive for tetrahydrocannabinol (THC). The evaluating [social worker] informs Ms. Evans that she is making a tentative diagnosis of schizophrenia.

Source: Roberts, L. W., & Trockel, M. (2015). Case example: Importance of refining a diagnostic hypothesis. In L. W. Roberts & A. K. Louie (Eds.), Study guide to DSM-5 (pp. 6–7). Arlington, VA: American Psychiatric Publishing.

Study Guide to DSM-5(r), by Roberts, M.; Louie, A.; Weiss, L. Copyright 2015 by American Psychiatric Association. Reprinted by permission of American Psychiatric Association via the Copyright Clearance Center.

By Day 3

Post a 300- to 500-word response in which you discuss how a social worker should approach the diagnosis. In your analysis, consider the following questions:

  • Identify the symptoms or “red flags” in the case study that may be evaluated for a possible mental health disorder.
  • Should the social worker have shared this suspected diagnosis based on the limited assessment with Ms. Evans at this time?
  • Explain the potential impact of this diagnosis immediately and over time if the “tentative” diagnosis is a misdiagnosis.
  • When may it be appropriate to use a provisional diagnosis?
  • When would you diagnosis as other specified and unspecified disorders?

 

Required Readings

American Psychiatric Association. (2013i). Introduction. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.Introduction

Barsky, A. (2015). DSM-5 and the ethics of diagnosis. The New Social Worker. Retrieved from https://www.socialworker.com/feature-articles/ethics-articles/dsm-5-and-ethics-of-diagnosis/

Neukrug, E. S., & Fawcett, R. C. (2015). Diagnosis in the assessment process. In E. S. Neukrug & R. C. Fawcett, Essentials of testing and assessment: A practical guide for counselors, social workers, and psychologists (3rd ed., pp. 43–58). Stamford, CT: Cengage Learning.
Neukrug, E. S., & Fawcett, R. C. (2015). Diagnosis in the assessment process. In E. S. Neukrug & R. C. Fawcett, Essentials of testing and assessment: A practical guide for counselors, social workers, and psychologists (3rd ed., pp. 43–58). Stamford, CT: Cengage Learning.

Paris, J. (2015). The intelligent clinician’s guide to the DSM-5 (2nd ed.). New York, NY: Oxford University Press

Chapter 6, “Dimensionality” (pp 84–101)

Required Media

Accessible player –Downloads–Download Video w/CCDownload AudioDownload TranscriptLaureate Education (Producer). (2018d). Impact of the DSM-5: Organization, Develpment, Strengths and Limitations [Audio podcast]. Baltimore, MD: Author.

University at Buffalo School of Social Work (Producer). (2014). Episode 139—Dr. Robert Keefe and Dr. Barbara Rittner: The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders: A conversation [Audio podcast]. Retrieved from http://www.insocialwork.org/episode.asp?ep=139

Singer, J. B. (Producer). (2016, January 25). Critiques of the DSM-5: Interview with Jeffery Lacasse, Ph.D. [Audio podcast]. Retrieved from http://www.socialworkpodcast.com/2016/01/DSM5critique.html/p>

Optional Resources

American Psychiatric Association. (2013n). Preface. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.x00preface

American Psychiatric Association. (2013s). Use of the manual. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.UseofDSM5

Lasalvia, A. (2015). DSM-5 two years later: Facts, myths and some key open issues. Epidemiology and Psychiatric Sciences, 24(3), 185–187. doi:10.1017/S2045796015000256

Paris, J. (2015). The intelligent clinician’s guide to the DSM-5 (2nd ed.). New York, NY: Oxford University Press

Chapter 3, “How Diagnostic Manuals Are Made” (pp. 33–55)

Wakefield, J. C. (2013b). DSM-5: An overview of changes and controversies. Clinical Social Work Journal, 41(2), 139–154. doi:10.1007/s10615-013-0445-2

Briefly describe what the DSM-5 is and how it is organized. In your description, define the concepts of spectrum and dimensionality as explained by Paris and in the DSM-5 introduction.

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Though the DSM-5 is the standard manual for mental illness diagnoses, it is not without weakness. In this Assignment, you analyze the strengths and limitations of the DSM-5 diagnostic system, and you differentiate between normal behavior and diagnosable symptoms using the concepts of dimensionality and spectrum.

To prepare: Review the concept of the dimensional approach with the DSM-5 and review the methods that the DSM-5 recommends to individualize where a person fits on a continuum of their illness in terms of subtypes, severity, and functional impairments. You will find these classifications in different parts of the manual and begin to be comfortable looking through it.

Next, imagine the following scenario:

You are a school social worker who has been asked to address a parent-teacher association meeting. Many parents in the audience have children who have been identified for special education services. They are confused about how to understand the diagnoses they are seeing. Others have worries about overdiagnosis. You have been advised that while these parents are generally well-informed, many don’t understand the dimensional or spectrum aspects. All are worried.

You will start your video with your introductory talk to the parents on these factors. After you provide your explanation, imagine that you open the meeting to questions. You will address the question noted below that is posed by a parent in the audience. Consider your audience, and practice explaining in terms a non-professional might understand. Do NOT read from the book.

Review the questions (in the Assignment instructions below) ahead of time and plan your answer before recording, as you will need to look up and integrate materials to answer the chosen question.

By Day 7

Submit a 3- to 5-minute video, considering the parents as your audience, in which you do the following:

  • Briefly describe what the DSM-5 is and how it is organized. In your description, define the concepts of spectrum and dimensionality as explained by Paris and in the DSM-5 introduction.
  • Explain why social workers and mental health professionals use diagnoses and what receiving a diagnosis means (and does not mean).
  • Explain general concerns about the risks of overdiagnosis and misdiagnosis versus not diagnosing. Also explain how diagnosis is connected to services.
  • Explain other details that might help your audience understand the strengths and weaknesses of the diagnostic system.
  • Provide a response to the following parental questions:
    • My teenager’s best friend died by suicide this year. It’s been months, and she doesn’t seem over it. Her teachers tell me she should get help for depression, but I think it’s just grief. She talks about her friend all the time and gets very upset. I am worried about her. Is it normal for her to still be feeling this way? I don’t want to put her on medication for normal feelings. What is the difference between grief and depression?

 

Required Readings

American Psychiatric Association. (2013i). Introduction. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.Introduction

Barsky, A. (2015). DSM-5 and the ethics of diagnosis. The New Social Worker. Retrieved from https://www.socialworker.com/feature-articles/ethics-articles/dsm-5-and-ethics-of-diagnosis/

Neukrug, E. S., & Fawcett, R. C. (2015). Diagnosis in the assessment process. In E. S. Neukrug & R. C. Fawcett, Essentials of testing and assessment: A practical guide for counselors, social workers, and psychologists (3rd ed., pp. 43–58). Stamford, CT: Cengage Learning.
Neukrug, E. S., & Fawcett, R. C. (2015). Diagnosis in the assessment process. In E. S. Neukrug & R. C. Fawcett, Essentials of testing and assessment: A practical guide for counselors, social workers, and psychologists (3rd ed., pp. 43–58). Stamford, CT: Cengage Learning.

Paris, J. (2015). The intelligent clinician’s guide to the DSM-5 (2nd ed.). New York, NY: Oxford University Press

Chapter 6, “Dimensionality” (pp 84–101)

Required Media

Accessible player –Downloads–Download Video w/CCDownload AudioDownload TranscriptLaureate Education (Producer). (2018d). Impact of the DSM-5: Organization, Develpment, Strengths and Limitations [Audio podcast]. Baltimore, MD: Author.

University at Buffalo School of Social Work (Producer). (2014). Episode 139—Dr. Robert Keefe and Dr. Barbara Rittner: The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders: A conversation [Audio podcast]. Retrieved from http://www.insocialwork.org/episode.asp?ep=139

Singer, J. B. (Producer). (2016, January 25). Critiques of the DSM-5: Interview with Jeffery Lacasse, Ph.D. [Audio podcast]. Retrieved from http://www.socialworkpodcast.com/2016/01/DSM5critique.html/p>

Optional Resources

American Psychiatric Association. (2013n). Preface. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.x00preface

American Psychiatric Association. (2013s). Use of the manual. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.UseofDSM5

Lasalvia, A. (2015). DSM-5 two years later: Facts, myths and some key open issues. Epidemiology and Psychiatric Sciences, 24(3), 185–187. doi:10.1017/S2045796015000256

Paris, J. (2015). The intelligent clinician’s guide to the DSM-5 (2nd ed.). New York, NY: Oxford University Press

Chapter 3, “How Diagnostic Manuals Are Made” (pp. 33–55)

Wakefield, J. C. (2013b). DSM-5: An overview of changes and controversies. Clinical Social Work Journal, 41(2), 139–154. doi:10.1007/s10615-013-0445-2

 Explain the benefits and limitations of your recommendations. Justify  your recommendations based on the Learning Resources and current  literature.

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Neurobiology Considerations Case Study: SuzySuzy is a 27-year-old Caucasian woman with no children. At age 8, she witnessed her mother’s overdose of prescription pain medication. Her mother subsequently recovered but was addicted to prescription pain medication throughout Suzy’s childhood. Suzy’s father did not live with them. Suzy’s mother suggested that this was because of his alcoholism. Rage-filled fights between her parents were commonplace for Suzy since she was an infant. Over the last several years, Suzy has become increasingly anxious. It seems that she is always on edge and worried. In fact, her doctor suspects she may have generalized anxiety disorder. She has been referred to your counseling clinic in hopes of getting better. During the first session, you learn that Suzy abuses alcohol frequently—six to seven drinks at least three times per week. Suzy believes she will have trouble coming to counseling if she does not have medication to help calm her down enough to “sit still.”

Developing appropriate pharmacological treatment  plans requires medical and mental health professionals to consider all  potential factors that may be contributing to the client’s  psychopathology. Contributing factors may include family history of  mental illness (Preston, O’Neal, & Talaga, 2010), personal history,  life circumstances, and drug abuse. Additionally, neurotransmitter  malfunctions (genetic or self-induced) may manifest as diagnosable  mental illnesses. Mental health care teams (e.g., counselors, medical  doctors, psychiatrists, psychologists, social workers, and support  teams) need to consider all of these factors in diagnosing and treating  psychopathology.

For this Discussion, review  the document “Neurobiology Considerations Case Study: Suzy” found in  this week’s Learning Resources and consider the recommendations you  might make to treat Suzy.

Post a brief description of the  possible pharmacological recommendations for treating Suzy. Explain any  neurobiological considerations that inform your recommendations.  Explain the benefits and limitations of your recommendations. Justify  your recommendations based on the Learning Resources and current  literature.

Be sure to support your postings and responses with specific references to the Learning Resources.

 

Lichtblau, L. (2011). Psychopharmacology demystified. Clifton Park, NY: Delmar, Cengage Learning.
Chapter 1, “Neuroanatomy and Neurophysiology” (pp. 1–18)

Preston, J. D., O’Neal, J. H., & Talaga, M. C. (2017). Handbook of clinical psychopharmacology for therapists (8th ed.). Oakland, CA: New Harbinger.
Chapter 3, “Neurobiology” (pp. 29–43)
Chapter 4, “Pharmacology” (pp. 45–56)
Chapter 9, “Anxiety Disorders” (pp. 107-122)

National Institute of Mental Health. (2016). Mental health medications: Overview. Retrieved from https://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml

National Institute of Neurological Disorders and Stroke. (2014). Brain basics: Understanding sleep. Retrieved on from http://www.ninds.nih.gov/disorders/brain_basics/understanding_sleep.htm#sleep_disorders

Document:  Neurobiology Considerations Case Study: Suzy (PDF)

Use this case study for this Week‘s Discussion and Assignment as you prepare a treatment plan for Suzy.

Identify one possible drug of addictive potential that may contribute to her mental health symptoms. Explain how your awareness of using the right drugs helps in advocating for clients through mental health treatment.

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Neurobiology Considerations Case Study: SuzySuzy is a 27-year-old Caucasian woman with no children. At age 8, she witnessed her mother’s overdose of prescription pain medication. Her mother subsequently recovered but was addicted to prescription pain medication throughout Suzy’s childhood. Suzy’s father did not live with them. Suzy’s mother suggested that this was because of his alcoholism. Rage-filled fights between her parents were commonplace for Suzy since she was an infant. Over the last several years, Suzy has become increasingly anxious. It seems that she is always on edge and worried. In fact, her doctor suspects she may have generalized anxiety disorder. She has been referred to your counseling clinic in hopes of getting better. During the first session, you learn that Suzy abuses alcohol frequently—six to seven drinks at least three times per week. Suzy believes she will have trouble coming to counseling if she does not have medication to help calm her down enough to “sit still.”  © 2014 Laureate Education, Inc.Page 1 of 1

An awareness of neurobiology and  neurotransmitters establishes the critical basis for mental health  professionals to understand the connection between psychopathology and  psychopharmacological interventions. Mental health professionals use  their awareness of the complex interactions between neurobiology,  neurochemistry, and psychotropic medications to conceptualize client  concerns and formulate treatment strategies.

For  this Assignment, review Suzy’s case study and consider the function of  neurotransmitters and the way client treatment may be affected by these  functions. As a mental health professional, how can you help Suzy  understand what might be going on in her brain while at the same time  advocating for her case?

By Day 7

In a 2-, APA-formatted paper, include the following:

As  a mental health professional, you are called upon to advocate for  clients in mental health settings. For this Assignment, imagine you have  been called into a panel discussion with the case study team for Suzy.  Your plan is to advocate for Suzy through her mental health treatment.  In your advocacy for Suzy, address the following:

  • Identify which neurotransmitters may be affected in Suzy’s case and  justify your selection based on evidence from the case and the Learning  Resources.
  • Identify three drugs that could be used to treat Suzy’s mental  health symptoms and explain how these drugs may affect her  neurotransmitter function.
  • Identify one possible drug of addictive potential that may contribute to her mental health symptoms.
  • Explain how your awareness of using the right drugs helps in advocating for clients through mental health treatment.

 

Lichtblau, L. (2011). Psychopharmacology demystified. Clifton Park, NY: Delmar, Cengage Learning.
Chapter 1, “Neuroanatomy and Neurophysiology” (pp. 1–18)

Preston, J. D., O’Neal, J. H., & Talaga, M. C. (2017). Handbook of clinical psychopharmacology for therapists (8th ed.). Oakland, CA: New Harbinger.
Chapter 3, “Neurobiology” (pp. 29–43)
Chapter 4, “Pharmacology” (pp. 45–56)
Chapter 9, “Anxiety Disorders” (pp. 107-122)

National Institute of Mental Health. (2016). Mental health medications: Overview. Retrieved from https://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml

National Institute of Neurological Disorders and Stroke. (2014). Brain basics: Understanding sleep. Retrieved on from http://www.ninds.nih.gov/disorders/brain_basics/understanding_sleep.htm#sleep_disorders

Document:  Neurobiology Considerations Case Study: Suzy (PDF)

Use this case study for this Week‘s Discussion and Assignment as you prepare a treatment plan for Suzy.