Question

Hi! Below is the case study and I want to make sure I'm on the right track. I bolded the questions I'm interested in (1-5). Looking for people who are familiar with the DSM-5/abnormal psychology and able to answer all questions completely. Thank you!

Questions:

1. Diagnosis; what is the evidence for it?

2. Treatment; typical treatment used for this diagnosis AND most effective treatment. IF the person is in treatment, what should we target first in terms of symptoms? How likely are they to stay in treatment and how likely are they to recover? Are meds involved and if so, what broad “type” of meds work for this disorder,?

3. Differential diagnosis (why is it this disorder and not this disorder)

4. Does the person have more than one diagnosis, what would DSM say about the criteria for diagnosing that

5. What would the primary causal theories be?

CASE STUDY:

Paul is a 30 year old engineer who is quite successful and lives in New York with his girlfriend. He normally loves his life, but over the past four or five months he just can’t seem to get excited or happy about anything. He has a lot of work issues - the company was sold and the owners, who were his friends, pretty well just took the money and ran - leaving all the employees (including Paul) in chaos (with the new owners) .Paul is now very unhappy at work and most of the other employees (all of his friends) have left for new jobs, but Paul just can’t seem to get his act together to even look for a new job. His girlfriend notes that he is moody, irritable and always tired, he never wants to go out and he has stopped exercising and stopped pretty well all of his fun hobbies or activities. He does not even enjoy taking his dog out for a walk, and his dog was always his favorite thing in the world (next to his girlfriend). Mostly Paul just seems to sit around on the couch watching television and doing nothing when he is not at work. He does not drink or do drugs, but he does not eat healthy either. He has gained 20 pounds is six months and he does not really care. He says that he often thinks that he would be better off dead. Medically he is fine and he has tons of money and lots of friends who care about him and he even has a great family who are in frequent contact with him. His girlfriend is concerned, as is his family, as Paul does not seem to be “snapping out of it”. They send him to a psychologist to try to figure out what is wrong (his medical doctor said there were no medical problems evident).

Answer 1

1. A traditional basis for decision making in clinical practice is what we term diagnosis. The lack of evidence about future benefits and harms of these decisions for patients diagnosed with and without disease. It is proposed that a model of clinical practice focused on patient prognosis and predicting the likelihood of future outcomes may be more useful. Diagnosis on disease can provide crucial information for clinical decisions that influence outcome in serious acute illness. However, the central role of diagnosis in clinical practice is challenged by evidence that it does not always benefit patients and that factors other than disease are important in determining patient outcome. The concept of disease as a dichotomous ‘yes’ or ‘no’ is challenged by the frequent use of diagnostic indicators with continuous distributions, such as blood sugar, which are better understood as contributing information about the probability of a patient’s future outcome. Moreover, many illnesses, such as chronic fatigue, cannot usefully be labelled from a disease-diagnosis perspective. In such cases, a prognostic model provides an alternative framework for clinical practice that extends beyond disease and diagnosis and incorporates a wide range of information to predict future patient outcomes and to guide decisions to improve them. Such information embraces non-disease factors and genetic and other biomarkers which influence outcome. Patient prognosis can provide the framework for modern clinical practice to integrate information from the expanding biological, social, and clinical database for more effective and efficient care.

2. Paul seems to be suffering from what we commonly called amziety or depression disorder and the treatment would involve extensive suppoty, counselling and few medications which can help elevate his mood and try doing something productive rather than just viling away his time feeling low and lost. Medicines can only do 20% of the job but support from family, friends and loved one increase the chances of his recovery better, He needs to feel an inner dsire to recupperate from the pain he has been wallowing in and that is when he will get better and open the doors of darkness to a world of light and unending opportunities.

3. There is nothing like a disorder here, tensiion, stress and depression are just like any other ailment like typhoid or diabetes and with time and medication and counselling it gets better.

4. DSM has many reasons to identify this is a serious disorder of major depression disorder but as a counsellor or therapist we can see through Paul as having just a low phase in life which we all encounter at some point in our lives and help him get through it one step at a time

5. There are no primal theories, its just a phase and it shall pass. Refer suggestion mentioned above