Week 9 Discussion Response to Classmates

I NEED THIS 10/31/2020 BY 12PM

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 is 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 diagnosis      considerations)


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

1. Classmate (A. Carr)

Case Conceptualization

Ka-Sean is a 25-year old lesbian African American who has saught counseling due to unmanagable anxiety. She is currently living with her partner and is enrolled in a graduate counseling program. She has attended counseling once, after her mother passed away. She describes this period of her life as “very dark” and talks about an emergence of self-injurious behaviors (cutting, burning, punching herself). Although she does not use this coping method anymore, she claims that her chronic worrying has become debilitating. Ka-Sean refers to her worrying as “the flooding” because she feels flooded with an overwhelming amount of unknowable questions. Since her mothers death, her father and sister are her main support system. Ka-Sean used to rely heavily on her partner, until she recently thought her partner was cheating on her. Her brother used to support her until she decided to move in with her girlfriend, which he vocally opposed. With that said, Ka-Sean’s support group has become rather small. Because of her excessive worrying and anxiety, Ka-Sean has began to feel the physical symptoms of stress. She reported feeling chronically restless, stomach issues, muscle tension, fatigue, and difficulties sleeping. Occasionally, she experiences deep anxiety that leads to tightness in her chest, heart palpitations, shaking and shortness of breath. This happened for the first time 2 years ago and has been reoccurring once to twice a month since. She has had multiple ER visits fearing that she is having a heart attack.

Diagnostic Impressions

F41.1 Generalized Anxiety Disorder

F41.0 Panic Disorder

Rationale for Diagnostic Impressions

Based on the case presentation, Ka-Sean displays many of the symptoms associated with F41.1 Generalized Anxiety Disorder (GAD). Ka-Sean’s excessive worry and anxiety has been apparent for a minimum of the last two years since her ER visit (Criterion A). She also finds it difficult to control the worry and “flooding” thoughts (Criterion B). She also noted that her anxiety and worry are at the source of her restlessness, fatigue, and sleep disturbance (Criterion C). Ka-Sean described her sleep cycles as battles; she often tosses and turns repetitively as she rattles her “to-do-list” off in her head. Ka-Sean’s anxiety, worry, and physical symptoms cause her a great deal of distress and impairment, which leaves her struggling to complete school assignments and socialize with her peers (Criterion D). Ka-Sean is currently taking Xanax, prescribed by her primary care physician, however, it does not seem to be causing her condition (Criterion E). Although Ka-Sean displays many symptoms associated with F41.0 Panic Disorder, her condition is not better explained as such (Criterion F).

Ka-Sean appears to be presenting co-occurring symptoms to GAD which are reflective of F41.0 Panic Disorder. She reported a few abrupt surges of symptoms including heart palpitations, shaking, shortness of breath, a fear of losing control, and tightness/discomfort in her chest (Criterion A), which have persisted once to twice a month for the last 2 years. After each attack, Ka-Sean’s worry increases because she fears losing control and having another panic attack during school or social events (Criterion B). Ka-Sean has not withdrawn from social activities or classes due to this fear. As stated above, the disturbance does not seem to attribute to the physiological affects of her Xanax prescription (Criterion C). Lastly, Ka-Sean’s symptoms and disturbance can not be better explained by any other phobic, obsessive or anxiety disorder (Criterion D).

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 (C. Rob)

Ka-Sean Conceptualization

(Include specific information about client symptoms and presenting concerns).

Ka-Sean is a 25 year old African American Lesbian. She is experiencing longstanding bouts of excessive anxiety. Ka-Sean lives with her partner in a large city. She lost her mother a few years ago and experienced an increased level of anxiety and self-injurious behaviors during that time period. She is the youngest of three children. She has a strained relationship with her brother whom she has not spoken to in a number of years. She has a stable and supportive relationship with her older sister and her father. Ka-Sean reports having excessive worry that dominants 80% of her awake time. Ka-Sean experiences physical symptoms associated with her excessive worrying which such as; muscle tension, difficulty with sleep, stomach issues, chest tightness and shortness of breath. She also reported having difficulty concentrating, making decisions and completing tasks. Ka-Sean often needs guidance and reassurance when making decisions.

Ka-Sean had to quit her job due to feeling overwhelmed and exuashted with making decisions and overanalyzing tasks. She is currently a student in a Graduate Counseling Program. Her classmates describe her as being a perfectionist. Additionally , Ka-Sean worries about her school work and often needs reassurance and guidance from her classmates and professor regarding her work and progress.

Diagnostic Impressions

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

F41.1 Generalized Anxiety Disorder with Panic Attacks

Rationale for Diagnostic Impressions

(Include the diagnostic impressions using the DSM-5 to link the client’s symptoms to the diagnostic criteria for each diagnosis that you render. If you do not render a diagnosis, you still must use the DSM-5 to explain why you chose not to render a diagnosis.)

Based on the case presentation, Ka-Sean appears to demonstrating symptoms consistent with F41.1 Generalized Anxiety Disorder with Panic Attacks. Ka-Sean has experienced excessive worry and anxiety occurring more day than not for at least 6 months about events, such as school and work performance(Criterion A) . The client reports having quitting her job due to “analysis paralysis” over anaylzing tasks and feeling overwhelmed by making decisions. Additionally the client has experienced significant anxiety while being student in a graduate program. The client expressed excessive procrastination and the need for reassurance from her professor and classmates. This presentation is consistent with Criterion A. Ka-Sean has expressed difficulty with controlling worry ( Criterion B) as evidenced by “the flooding” of thoughts and questions that run through her mind such as “ What if she (partner) doesn’t love me”. Ka-Sean has experienced difficulty concentrating or mind going blank (Criterion C3) muscle tension ( Criterion C5) and sleep disturbance (Criterion C6).

As a specifier , Ka-Sean also shows symptoms consistent with Panic Attacks. She has shown the abrubt surge from a calm to anxious state with the following symptoms; heart palpitations, shaking hands, shortness of breath, chest pain or discomfort (tightness) and fear of losing control. This is evidenced in an incident 2 years ago. Her partner had to take her to the emergency room because it was thought she could be having a heart attack. These incidents occur infrequently.

3. Classmate (L. Sha)

Case Conceptualization

Ka-Sean is a 25-year-old, single, Lesbian female resides with her significant other, whom she has known since her childhood and is unconditionally supportive. She has recently enrolled in a graduate school counseling program. She presents with anxiety with excessive worry, with a history of chronic restlessness, stomach issues, muscle tension, fatigue, and sleep disturbance due to ruminating thoughts and tossing and turning throughout the night. Also, she has difficulty concentrating and focusing, which has led to impairment at work and school, leading to quitting her job and difficulty completing school assignments. Ka-Sean has been observed as a “perfectionist” and controlling in that she has difficulty working with others on group assignments. She has difficulty making decisions and is unable to control her worries.

Ka-Sean reports that she experiences a “flooding” of worry where she experiences multiple thoughts that appear to be cognitive distortions about her circumstances that likely potentiates her anxiety.

Ka-Sean has experiences tightness in her chest, heart palpitations, shortness of breath, thoughts of losing control, with the onset being two years ago and now occur once or twice a month within others' presence and when alone. She is hypersensitive to these attacks and has an increase in worry after the attack occurs.

Her mother died a few years ago, and she characterized this time as a “dark period” with increased anxiety and engaging in self-injury with cutting, burning, and punching herself. As a result, she sought treatment due to these symptoms and issues of bereavement. There are no reports of these symptoms continuing to occur since that time.

Ka-Sean has recently been diagnosed with a stomach ulcer after reports of having heartburn, upset stomach, fatigue, and bowel changes.

Diagnostic Impressions

F41.1 Generalized Anxiety Disorder with Panic Attacks

K25 Stomach Ulcer

Rational for Diagnostic Impressions

Based on Ka-Sean’s reports and presenting symptomology, Ka-Sean meets the criteria for F41.1 Generalized Anxiety Disorder with a Panic Attacks. Consistent with the symptoms of Generalized Anxiety Disorder, Ka-Sean presents with excessive worry and anxiety occurring more days than not for at least the last couple of years about various aspects of her life, including work, school, and her relationship with her significant other (Criteria A.) She reports that she is unable to control her worry (Criteria B) and that her anxiety is associated with being easily fatigued (Criterion C2), difficulty concentrating and focusing on her mind going blank (Criterion C3), experiencing muscle tension (Criterion C5), and sleep disturbance with restlessness (Criterion C6.) Ka-Sean’s experiences with anxiety, worry, and physical symptoms has caused clinically significant impairment at work with her quitting her job, at school with her difficulty with completing assignments and working with others, and potentially her relationship (Criteria D.) She denies using alcohol or illicit substances or having a medical issue that could account for these symptoms (Criteria E.) Her symptoms do not meet the criteria for another mental disorder (Criteria F.)

Ka-Sean also meets the criteria for the Panic Attack specifier in that she experiences heart palpitations (Criterion 1), shortness of breath (Criterion 4), tightness in her chest (Criterion 6), and fear of losing control (Criterion, 12). She has a history of experiencing abdominal distress (Criterion 7), however, she has recently been diagnosed with a stomach ulcer.

Required Resources

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

· Section II, “Anxiety Disorders” 

· Section II, “Obsessive-Compulsive and Related Disorders” 

· Section II, “Trauma- and Stressor-Related 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 5, “Anxiety Disorders” 

· Chapter 6, “Obsessive-Compulsive and Related Disorders”