Week 6 Discussion Response to Classmates

I NEED THIS 10/10/2020 BY 5PM

Please no plagiarism and make sure you are able to access all resources on your own before you bid. You need to have scholarly support for any claim of fact or recommendation regarding treatment. Grammar, Writing, and APA Format: I expect you to write professionally, which means APA format, complete sentences, proper paragraphs, and well-organized and well-documented presentation of ideas. Remember to use scholarly research from peer-reviewed articles that are current. Sources such as Wikipedia, Ask.com, PsychCentral, and similar sites are never acceptable. Each classmate’s document is attached so please respond separately.

Read your classmates' postings. Respond to your classmates' postings.

• Other diagnoses that your colleague should consider further in their ongoing work (i.e., potential differential diagnostic considerations)


• Either a cultural or ethical consideration that may be pertinent to the diagnosis

1. Classmate (A. Carr)

Case Conceptualization:

Andrew is a 15-year-old Caucasian male who has recently been expelled from school after a physical altercation with another student and threatening to kill them. Andrew was found with a small knife in his possession and taken into custody, where he was later released to an intensive treatment center for a psychiatric assessment. Andrew is often getting is physical altercations with his peers and is said to have very few, if any, real friends. Many of the people he hangs out with are known for possessing drugs, getting into fights, and illegal behaviors. These behaviors became apparent when Andrew was in late elementary to early middle school, where he became aggressive, and started cheating, stealing, fighting, and sniffing substances. At the age of 11, he was court ordered to a residential treatment center after assaulting a girl at school. Andrews parents are known to be neglectful. His father works two jobs, day shift and night shift, while his mother works night shift at a local gas station 5 days a week. On their off time, they want nothing to do with their five children. Andrew is often responsible for taking care of his younger siblings which makes him angry and resentful. When Andrews father is not working, he drinks so heavily that he becomes aggressive, usually targeting Andrew and his mother with abuse. Andrews mother has been involved in his inpatient therapy and expresses that as a child, Andrew would often catch animals and severely hurt or murder them. She said that he showed zero emotion while doing so and that the animals got larger as he grew older. His symptoms date back to around age six.

Diagnostic Impressions:

F91.1 Conduct Disorder, Childhood-Onset Type with Limited Prosocial Emotions, Severe.

Rational for Diagnostic Impressions:

Based on case presentation, Andrew appears to be demonstrating symptoms consistent with F91.1 Conduct Disorder. Andrew meets eight of the fifteen criteria for this disorder, only three are required. Criteria met includes threatening others (A1), initiating physical fights (A2), used a knife in a physical altercation (A3), has been physically cruel to people (A4) and animals (A5), forced sexual activity at age 11 with a girl at school (A7), Stealing without confrontation (A12), truancy at school (A15), and impairment in social and academic functioning (B) (American Psychiatric Association, 2013). In the last 12 months, Andrew demonstrated at least five of these criteria including criterion A1, A2, A3, A4 and A15. Andrew’s mother shared that she witnessed him emotionlessly catching and killing frogs at age 6 and moving on to larger animals as he grew older. This indicated a childhood-onset type where individuals show at least one symptom of the disorder before the age of 10 (American Psychiatric Association, 2013). Andrew also displays two of the specifying factors of limited prosocial emotions. He expresses lack of remorse or guilt for his actions against others and animals, this includes his most previous altercation of threatening another student’s life. He also expresses a lack of empathy which can be seen in his disregard for the feelings of those he harms. He also meets this specifier by being more concerned about himself when it comes to the care of his four younger siblings. Andrews condition would be considered severe because he meets the majority of the criteria presented and has exhibited forced sexual activity, physical cruelty, and use of a weapon (American Psychiatric Association, 2013). Andrew’s severity with aggression evolved very quickly, as seen in his disruptive behaviors of sexual assault, physical assault, attack with weapons, and murder (of animals) before late adolescence (Playo, 2018). Because childhood-onset types typically experience a worsening of symptoms as they enter adulthood, Andrew may exhibit comorbidity for F60.2 Antisocial Personality Disorder as he reached age 18 (American Psychiatric Association, 2013). He also shows many if not all of the symptoms for F91.3 Oppositional Defiant Disorder, but differs because his symptoms are of a more severe nature and include aggression towards people and animals (American Psychiatric Association, 2013).

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

Paylo, V.E.K.M. J. (2018). Treating Those with Mental Disorders. [VitalSource Bookshelf]. Retrieved from https://bookshelf.vitalsource.com/#/books/9780134802893/

2. Classmate (J. Char)

Case Conceptualization

Andrew, is a 15-year old Caucasian male, is experiencing difficulty at home and at school. Andrew currently lives with both biologically parents and four siblings. Andew has demonstrated aggressive and threatening behavior with siblings, peers ans parens.

Andrew has displayed oppositional behavior (e.g., oppositional & aggressive ouburst, , stealing/fighting, and sniffing substances). He has experienced academic difficulties and he  failed the seventh grade. He has also experienced threatening and violent behaviors. His symptoms appear to have begun at age 5.

Diagnostic Impressions

(Be sure to use the ICD-10 code, name of the disorder, and all of the specifiers)

F91.1 Conduct Disorder, Childhood-Onset Type, Moderate

Rationale for Diagnostic Impressions

Based on the case presentation, Andrew appears to be demonstrating symptoms consistent with F91.9 Conduct Disorder. Andrew has demonstrated a repetitive and persistent pattern of violating the rights of others and age-appropriate norms (Criterion A) as evidenced by getting in aggressive conduct that causes or threatens physically harm to his peers, siblings and parents (Criterion A2), bullying peers (criterion A1), theft (Criterion A8).

The client is experiencing clinically significant distress (Criterion B) as evidenced by his difficulty at school. The client is 15-years-old and thus he fulfills Criterion C of the diagnosis (i.e., the client is under 18-years-old and does not meet criteria for Antisocial Personality Disorder). It appears that the client’s symptoms began at approximately age 5, and thus, the Childhood-onset type (i.e., one symptom before age 10) is most appropriate. At this time, it appears that the “moderate” severity specifier best describes the client’s symptoms. The client has stolen but without confronting his victim, has used a knife the threaten a peer, and has demonstrated oppositional behavior towards peers, parents and siblings.

3. Classmate (M. Tay)

Case Conceptualization

Andrew, a 15-year-old Caucasian male, is currently in a residential intensive treatment facility after a physical altercation at school. After investigation, a small knife was found, resulting in Andrew's expulsion. Andrew has demonstrated violent and aggressive behaviors (e.g., stealing, fighting, and killing animals). He has experienced academic difficulties (e.g., failing seventh grade, long absences from school for involuntary treatment). His symptoms began to appear at age 5. 

Diagnostic Impressions

F91.1 Conduct Disorder, Childhood-Onset Type, Severe

Rationale for Diagnostic Impressions

Based on the case presentation, Andrew appears to be demonstrating symptoms consistent F91.1 Conduct Disorder. Andrew has consistently demonstrated a violation of the rights of others and age-appropriate societal norms (Criterion A) as evidenced by physical altercations at school (Criterion A2), a knife being found in his possession (Criterion A3), harming/killing animals (Criterion A5), and stealing (Criterion A12). 

Andrew is experiencing significant impairment in his academic functioning (Criterion B) as evidenced by his slipping grades, failing of 7th grade, and absence due to involuntary admittance to psychiatric hospitals and his current expulsion.  Andrew is 15-years-old and meets Criterion C of the diagnosis (i.e., the client is under 18-years-old and does not meet the criteria for Antisocial Personality Disorder). Andrew's symptoms began around age 5, leaving the Childhood-onset type (i.e., one symptom before age 10) is an appropriate specifier. The "severe" severity specifier best describes Andrew's symptoms. The client has used physical cruelty against people and animals and had a weapon in his possession. 

References

Kress, V. E., & Paylo, M. J. (2019). Treating those with mental disorders: A comprehensive approach to case conceptualization and treatment (2nd ed.). New York, NY: Pearson.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.  

Required Resources

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

• Section II, “Neurocognitive Disorders” 


• Section II, “Elimination Disorders” 

Kress, V. E., & Paylo, M. J. (2019). Treating those with mental disorders: A comprehensive approach to case conceptualization and treatment (2nd ed.). New York, NY: Pearson.

• Chapter 12, “Disruptive, Impulse-Control, and Conduct Disorders, and Elimination Disorders” 

Handout: Case of Caden