Case Study Coun 646

(4) impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). (5) recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior. (6) affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days). (7) chronic feelings of emptiness. (8) inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights). (9) transient, stress-related paranoid ideation or severe dissociative symptoms” (Disorders | BehaveNet).

31 y/o AA male patient seen today for psychiatric-mental health assessment. He is awake, alert and oriented x4. He is calm, cooperative and follows commands during assessment. The patient reports he is depressed, difficulty sleeping and nightmares at night. The patient explained his depression is as a result of deep thinking from a news he received two days ago from his elder brother that his mother is ill. Stressors identified by the patient include losing his job a week ago before the news about his mother; his wife is 6-months pregnant with their first child, who currently works part-time at her present job; patient relates difficulty paying monthly bills and inability to provide adequately for his family as a man. The patient denies mood swings, suicidal/homicidal thoughts and ideation. Patient reports his spouse is at work at the moment and he does not want to put stress on his wife due to her current condition. Patient denies been hospitalized for depression or psychiatric illness; and denies family history of mental illness. Patient reports he is seeking help because he does not like feeling this way using terms of “helpless and loss of worth from his spouse”. Patient reports he needs help with his depression and nightmares before his current condition get out of hands and ruined his marriage.

I believe that the dilemma is simple: a student challenges the school official authority. I said simple because not for the dilemma’s complexity rather for the regularity with which a young behave in a rebellious manner.

The treatment of choice for the MDD, MDD Recurrent, and Dysthymia; will be Psychotropic medication, CBT, Interpersonal Treatment,

feeling “on edge” all of the time, having difficulty sleeping, being easily startled, or prone to sudden outbursts

Many of the problems that Carl has found concerning the new employee orientation could have been avoided. Carl is a recently hired employee himself. He should have kept up with the progress of the new employee orientation and checked on the files for the applicants. ABC, Inc. should also have made sure that their new employee was capable of doing his job efficiently. If Carl had stayed on top of his project, the problems that he faced would not have occurred.

| A. Excessive anxiety and worry (apprehensive expectation) about two (or more) domains of activities or events (for example, domains like family, health, finances, and school/work difficulties)B. The excessive anxiety and worry occur on more days than not for three months or more (APA, 2000) Examination of Classifications and SymptomsC. The anxiety and worry are associated with one or more of the following symptoms: 1. Restlessness or feeling keyed up or on edge2. Being easily fatigued3. Difficulty concentrating or

You are working in the internal medicine clinic of a large teaching hospital. Today your first patient is 70-year-old J.M, a man who has been coming to the clinic for several years for management of CAD and HTN. A cardiac catheterization done a year ago showed 50% stenosis of the circumflex coronary artery. He has had episodes of dizziness for the past 6 months and orthostatic hypotension, shoulder discomfort, and decreased exercise tolerance for the past 2 months. On his last clinic visit 3 weeks ago, a CXR showed cardiomegaly and a 12-lead ECG showed sinus tachycardia with left bundle branch block. You review his morning blood work and initial assessment.

The patient remains delusional, agitated and guarded, he always depressed, isolate and withdrawn. He still have disorganized thought and still has inappropriate emotional response because o the voices in his head. He stated that "I am so afraid of the voices in my head, they wont stop unless I'll follow them, I am afraid of dying but I think I would be better off dead, I have no choice but to follow the voices". He still insisting he will follow his belief. He remains sad and anxious, still showing self isolation and still cannot think for personal safety. His judgment, insight and impulse control are still poor. He remains a danger to self and a danger to self. He still needs an inpatient psychiatric hospital level of care as he refuses to

The client has high motivation for treatment within MRFH. The client was diagnosed with Alcohol Use Disorder: Severe and Cocaine Use Disorder (crack): Moderate. The client sought treatment at MRFH when he realized he had lost control of using alcohol and crack cocaine. The client stated he attended the MRFH program in the 1980 's but does not remember the exact date of attendance. The client stated he was diagnosed with Mild Depression by a primary care physician when he was 56-years-old. The client reports he has no history of suicidal or homicidal attempts, and currently denies having any suicidal ideations or homicidal ideations. The client stated one to two times per week he experiences muscle tension and worrying about things that he often realizes have no significance. The client stated prior to the age of 18-years-old, "I would knock over my neighbors mailboxes and destroy their gardens, because they would make my parents aware of my wrong doings and that was way of getting them back." The client stated, there was one time that I started a fire and blamed it on my brother. I would break things as well and blame someone else. The client stated if there was an event taking place that he wanted to participate in, he would rush and complete what he was doing so he could become involved in other events taking place around him. The client stated, "I started using drugs and alcohol without thinking about what the consequences. The client appeared to be oriented to the

In the beginning of April ABC, Inc. hired Carl Robins as their new campus recruiter. Carl was new to his position, but that did not stop him from striving to be a great recruiter right from the start. Carl successfully hired 15 new trainees to work for Monica Carrols the Operations Supervisor. Monica checked in with Carl to advise him of all the steps that are necessary to complete before the trainees could start working for the company. Carl felt confident about the situation and assured Monica that everything would be arranged in plenty of time. The goal is to have the trainees working by July; the problem is that Carl has neglected to make the proper arrangements to ensure all tasks will be accomplished. This

symptoms of delusions (Frank, 1998). According to Foster and Levinson (1998) this client has a

296.32 (F33.1) Major Depressive Disorder, recurrent episode, moderate severity, with anxious distress. Ms. Client meets eight of the nine diagnostic criteria for Major Depressive Disorder (MDD). Specifically, during several periods of time she experienced depressed mood, diminished interest in things she enjoyed to do, hypersomnia, psychomotor agitation, fatigue, feelings of worthlessness, decreased concentration, and suicidal thoughts without intent. Additionally, as Ms. Client expressed, these symptoms are source of continuing distress and interfere with her academics and social functioning. Also, her symptoms started four years prior to the psychological assessment and persisted intermittently since then, lasting for several weeks to several months, with the most recent period of extended length (enduring two weeks) approximately one year ago. Since the last episode she has experienced these symptoms for two to three days at a time. Although the last episode that met the criterion of two weeks duration occurred approximately a year ago, the symptoms have not disappeared, but they occur periodically since then and when they do, they cause considerable distress and impairment in functioning. Thus, the disorder cannot be coded as ‘in partial or full remission’. The specifier ‘with anxious distress’ was given, because Ms. Client reports feelings of difficulty in concentration because of worry and restlessness.

Treatments include medication, supportive psychotherapy and occasionally ECT. Medications include lithium, anticonvulsant drugs (carbamazepine (Tegretol), valproate (Depakote), gabapentin (Neurontin) and lamotrigine Lamictal), antidepressants (such as bupropion (Wellbutrin)or sertraline (Zoloft)), neuroleptics (e.g. haloperidol) and benzodiazepines (e.g. lorazepam) Treatment choices depend on the

The majority of our sessions, David had talked about how his anxiety “controlled his life.” He referenced numerous times in his life, past and current, where he “froze” or had “panic attacks so severe” that he didn’t know if he would survive. Depression was of a similar nature, though less apparent. He discussed feelings of worthlessness and feeling so depressed he would not get out of bed for the entire day. Addressing these negative mood reactions has been key to his success in treatment.