Discussion: Applying Differential Diagnosis to Depressive and Bipolar Disorders

Analyze a case study focused on a depressive disorder or bipolar disorder utilizing steps of differential diagnosis
Analyze lived experiences of depression
Evaluate cases to determine accurate mood disorder diagnosis

Post a 300- to 500-word response in which you address the following:
Provide the full DSM-5 diagnosis for the client. For any diagnosis that you choose, be sure to concisely explain how the client fits that diagnostic criteria. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, medical needs, and the Z codes (other conditions that may be a focus of clinical attention). Keep in mind a diagnosis covers the most recent 12 months.
Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis.
Recommend a specific evidence-based measurement instrument to validate the diagnosis and assess outcomes of treatment.
Describe your treatment recommendations, including the type of treatment modality and whether or not you would refer the client to a medical provider for psychotropic medications.

CASE of CORNELL

INTAKE DATE: May 2020

IDENTIFYING/DEMOGRAPHIC DATA:

     This is a voluntary admission for this 32 year old Black male. This is Cornell first psychiatric hospitalization. Cornell has been married for 13 years and has been separated from his wife for the past three months. He has currently been living with his sister. His family residence is in Nashville, TN where his wife, two daughters and son reside. Cornell graduated high school then attended a technical school for computers. In the past, Cornell worked for seven years at the front desk of a hotel. For the past three years ,Cornell has been employed at a local print shop. Religious affiliation is Baptist.

  CHIEF COMPLAINT/PRESENTING PROBLEM:

     "I need to learn to deal with my wife wanting a divorce."

  HISTORY OF PRESENT ILLNESS:

     This admission was precipitated by Cornell increased depression with passive suicidal ideation in the past three months prior to admission. He identifies a major stressor of his wife and three children leaving him three months prior to admission. Cornell has had a past history of alcohol binges but rarely drinks now. Cornell was starting vacation from work just prior to admission and recognized that if he did not come to the hospital, he did not know what would happen. Cornell reports that in the past three months since separating from his wife, he has experienced sad mood, fearfulness, and passive suicidal ideation. He denies a specific suicidal plan. Wife reports that during these past three months prior to admission, Cornell made a verbal suicide threat.

     Cornell reports he has been increasingly withdrawn/non-communicative. His motivation has decreased and he finds himself "sitting around and not interested in doing chores at home". He reports decreased concentration at work and increased distractibility. Cornell has experienced increased irritability, decreased self esteem, and feelings of guilt/self blame. There is no change in appetite. Cornell states for many years he doesn’t sleep, having a past history of working double shifts when requested. Cornell reports his normal sleep pattern for many years has been generally three hours of unbroken sleep. He then feels tired and ends up sleeping more than his average pattern.  Wife denies any violence towards her.

     Cornell denies suicidal ideation at the present time while on the evaluation unit.

PAST PSYCHIATRIC HISTORY:

     Cornell was seen on an outpatient basis by Dr. S, for a period of two months prior to admission. He was being seen for individual counseling because of the marital problems and depression. Dr. S recently referred Cornell for inpatient treatment.

When asked if Cornell ever had these feelings before he remembers in high school his senior year was tough. He would miss a lot a classes because he could not get out of bed. He stopped hanging around with his friends. He remembers feeling down but did not know why. He lost some weight. Right after the holidays, he started feeling better, picked up his grades, and graduated successfully.

SUBSTANCE USE HISTORY:

Cornell reports a history of some alcohol binges in the past. He began drinking beer in 2009.  Cornell’s pattern of drinking was to get drunk with his social group approximately twice per month. He denies a history of blackouts. He admits to the alcohol binges in the past. Cornell rarely drinks now.

PAST MEDICAL HISTORY:

     Cornell reports having been involved in a motor vehicle accident with loss of consciousness in 2005. He states he has no memory of the accident. Cornell had a past history of fractured toes with pins being inserted in the third and fourth digits in his right foot after an accident in which he crushed his foot playing sports. Cornell denies a past history of seizures.

     Cornell smokes approximately two packs of cigarettes per day. Cornell is allergic to Codeine.

FAMILY MEDICAL AND PSYCHIATRIC HISTORY:

     Father and grandfather have a history of cardiovascular disease.

     Cornell reports that while growing up his parents maintained a satisfactory relationship. Father reportedly worked nights and slept during the day. Cornell did not have much contact with his father but now enjoys a close relationship with his father. He states he has always had his parents support.

     During Cornell’s school years, he reports he was an underachiever in elementary school. He denies having had a history of discipline problems or hyperactivity. He states he did well in high school and earned grades of A’s and B’s. Cornell played football in HS.

         Cornell has been married for 13 years and has recently been separated for the past three months. Cornell and his wife have three children including a daughter, age 12, a daughter, age 8, and a son, age 7. Cornell states he feels very invested as a parent and feels close to his children.

     Leisure time activities Cornell has enjoyed in the past include playing softball, skiing, reading, playing poker, and watching football.  His wife has complained that he is doing less of that now.  Cornell states he has several close friends.

CURRENT FAMILY ISSUES AND DYNAMICS:

Wife reports that Cornell’s difficulties began to get worse a few months ago when she decided to move out of the house due to Cornell’s increasing erratic behavior. She moved into her parents’ house and Cornell is living with his sister. Wife states that Cornell has been suffering from mood swings. At one point, after threats from his wife, Cornell told her that he had gone to a clinic for outpatient rehabilitation, but she did not believe him.

     Wife describes Cornell as "extremely depressed" now and says Cornell states, "life is over…I wish I was dead…don’t send the kids over to visit because I don’t want them to find my dead body…everything I touch turns to garbage. Wife adds that Cornell suffers from poor self-esteem and lack of sleep. On the positive side he is a good father, compassionate, creative, and could be an outstanding person.

     Wife reports Cornell always had a bad relationship with his mother. Cornell is close to his father who is reported to have an alcohol problem and was allegedly loud and intimidating.

     Cornell is currently employed by his wife’s father. Cornell states he has financial problems now due to paying for counseling and child support.

MENTAL STATUS EXAM:

Cornell presents as a casually dressed male who appears his stated age of 32. Posture is relaxed. Facial expressions are appropriate to thought content. Motor activity is appropriate. Speech is clear and there are no speech impediments noted. Thoughts are logical and organized. There is no evidence of delusions or hallucinations, which Cornell denies. Cornell admits to a recent history of passive suicidal ideation without a plan, but denies suicidal or homicidal ideation at the present time. His wife has observed a history of notable mood swings. No manic-like symptoms are observed at the time of this examination.

     On formal mental status examination, Cornell is found to be oriented to three spheres. Fund of knowledge is appropriate to educational level. Recent and remote memory appear intact. Cornell was able to calculate serial 7’s. In response to three wishes, Cornell replied "I wish that my marriage would work out and that my kids would be happy and that someone would give me a million dollars.”