8/17/2019 Case Vignette Assignment 5

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Case Vignette Assignment 5 (10 points)

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Roger 

“I feel like I should be able to handle this better than I am. ther !eo!le ex!erience this and don"t fall a!art. I"m #ust weak.$ Roger has

 been ex!eriencing significant distress for the !ast five months since his divorce, which was messy, !ainful, and was something he had ho!ed toavoid. Since then he has consistently been feeling sad and down most of the time, but also fre%uently worries about what will ha!!en to him, how

he will make it, and what does this say about him that he was not able to save his marriage. &e has been finding it harder to concentrate at work,

and he is fatigued due to not slee!ing as well as usual. &e finds himself not engaging in his hobbies and outlets as much since the divorce. “I"ve

never ex!erienced anything like this before. f course everyone gets down or worries from time to time, but I #ust can"t seem to shake this.$

Roger has never received behavioral health services before this interaction and has not ex!erienced !ast difficulties with such emotional distress

and his functioning like this.

'. (ased u!on this vignette identify the likely diagnosis)diagnoses, including any a!!licable rule out *R)+ diagnoses *if any+. ist I- code

number, diagnosis, and any a!!licable s!ecifiers

iagnosis/ 012.32 4d#ustment isorder with mixed anxiety and de!ressed mood

3. &ow would you su!!ort or #ustify your diagnosis5 What details su!!ort what criteria5 6x!lain

these in narrative form, meaning that each answer needs to be at least a paragraph or more  *one

to two sentences will not suffice+ with attention to writing using complete sentences, a!!ro!riate

grammar *s!elling, !unctuation+ and clear organization and expression of content.

I would #ustify my diagnosis because the sym!toms started after the divorce and has

continued for the last 7 months. &e has been feeling sad and down as well as ex!eriencing worry

about what will ha!!en to him. &e has been finding it harder to concentrate at work, not

slee!ing well nor engaging in hobbies since the divorce that he used to.

2. What conditions would you look to rule out5

I would look to rule out anxiety or de!ression disorders

1. What are three !ieces of information you would like to know that would hel! you to either

 better su!!ort the diagnosis or to better understand this individual5

'. What lead to the divorce5

3. What was “messy and !ainful$ about the divorce5

2. &ow have you handled any !revious break u!s5

8/17/2019 Case Vignette Assignment 5

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-asey

“I"m haunted by ghosts.$ -asey is an 689. ver the years he has come across scenes that would !ut any horror movie to shame. “I"ve seen

 !eo!le cut wide o!en, limbs cut off, blood, and so much blood, everywhere. I have !icked body !arts u! off the road. 4ll the screams, the

des!erate look in !eo!le"s eyes when they think, or know, they will die. :eo!le have coded on the way to the hos!ital and des!ite working on

them *i.e. !erforming -:R+ we couldn"t bring them back.$ In res!onding to emergencies -asey has also been ex!osed to fire, an ex!losion that

left him with burns, he has witnessed !eo!le being shot and has been shot at when the ambulance arrived %uicker than !olice units. -asey is on

short;term disability from his work because he has increasingly found it near im!ossible over the !ast four months to focus on the #ob and

 !erform ade%uately. When not at work he has very vivid, unwanted images of these !ast accidents come to mind. &e finds himself re!laying thedisasters and how emergency services res!onded. &e now avoids conversations about “all that he has seen$, tries not to think about it, and when

he hears sirens or the scanner go off he feels anxious, tense and has trouble breathing. &e often feels wired, ready to go and seems to be looking

for danger. &e has become more verbally aggressive and stand;offish, and at times he drives very fast and aggressive in traffic to “get a kick$. &e

is drinking much more than he ever has because he says it hel!s him not to feel as much and to get rid of or at least turn down the volume of those

memories. &is relationshi!s have been significantly im!acted as he now isolates more, feels estranged from others and detached from his life and

a sense of future. “What"s the !oint< it"s all ho!eless.$ &e also finds himself struggling with guilt over not being able to save certain individuals<

“I should have been able to do more. :erha!s if I had they would not be dead.$ :rior to -asey going on short;term disability from work he was

having !roblems on the #ob because seemingly from “out of nowhere$ he would begin to feel warm, numb and tingly, his chest would hurt and

feel tight, he would not seem to be able to catch his breath, he would feel sick and fear he was going cra=y. “I"m an 689, I know these are !anic

attacks, but you can"t have !anic attacks and do the ty!e of work I do.$ 0ollowing the onset of attacks u! to and including !resent time he has

continued to ex!erience anxiety between attacks about having future ones, that if he does he will have one at work and someone will die or he

will lose his #ob, and he has been avoiding getting himself worked u! so as not to “throw me into another attack.$

'. (ased u!on this vignette identify the likely diagnosis)diagnoses, including any a!!licable rule out *R)+ diagnoses *if any+. ist I- code

number, diagnosis, and any a!!licable s!ecifiers

iagnosis/ 012.'> :osttraumatic Stress isorder, 01'.> :anic isorder, Rule ut Substance

4buse isorder 

3. &ow would you su!!ort or #ustify your diagnosis5 What details su!!ort what criteria5 6x!lain

these in narrative form, meaning that each answer needs to be at least a paragraph or more  *one

to two sentences will not suffice+ with attention to writing using complete sentences, a!!ro!riate

grammar *s!elling, !unctuation+ and clear organization and expression of content.

I would #ustify my diagnosis because the client has directly ex!erienced re!eated

traumatic events though his #ob. &e has recurrent, involuntary and intrusive distressing memories

of the traumatic events he went to as an 689. &e avoids discussing “all he has seen$. &e has been ex!eriencing these sym!toms for 1 months. 9he client struggles with guilt over not saving

certain !eo!le. &e has feelings of ho!elessness. &e has become more aggressive and stand;offish

with others. &e is driving recklessly to “get a kick$. &e is constantly searching for danger. &e is

having trouble doing his #ob and isolating from others. &e is drinking to excess to “turn down the

volume$ on his memories. &e is ex!ressing signs of !anic attacks and has anxiety about future

attacks es!ecially if he might have one while working as an 689 *that someone will die or he

may lose his #ob+.

2. What conditions would you look to rule out5

I would want to rule out other anxiety disorders and substance abuse disorders.1. What are three !ieces of information you would like to know that would hel! you to either

 better su!!ort the diagnosis or to better understand this individual5

'. I would want to know how much he is drinking5

3. Is he using any other substances to “turn down the volume of the memories$5

2. What else has he done to co!e with the anxiety and intrusive memories5