IDENTIFYING/DEMOGRAPHIC DATA: Lucia is a 53-years-old Hispanic female. She has two adult sons, aged 27 and 24, who both live with her. She works full time as an executive secretary. Lucia has a live in boyfriend, Tomaz. They have been together 8 years. CHIEF COMPLAINT/PRESENTING PROBLEM: "I am in constant physical pain every day and can hardly walk and move. Even at night when I am in bed I am always in pain." Lucia reports that even in the few moments the pain eases it is difficult for her to get sleep. HISTORY OF PRESENT ILLNESS: Lucia has been suffering from physical pain for the past 18 months. She has been to many doctors for help. Lucia has been very concerned about her illness and wants to understand the causes of this pain. There has never been an accurate diagnosis. She has been given medication and steroids with no relief of her physical pain. Most recently, she had a full evaluation at the Mayo Clinical which had inconclusive results. One doctor at the Mayo clinic suggested she seek individual counseling, hoping this will help her physically as well. Lucia's reports her anxiety is so high now with all the stress she is under. PAST PSYCHIATRIC HISTORY: Lucia denies any past psychiatric history for herself. The only significant family history is her older brother's diagnosis of Intellectual Disability. SUBSTANCE USE HISTORY: Lucia reports drinking socially and very minimally. There is no evidence of substance use disorders in her family. PAST MEDICAL HISTORY: Lucia has been ailing over the past 18 months with unidentified pain. There were no previous significant medical issues in her past. FAMILY MEDICAL AND PSYCHIATRIC HISTORY: Lucia is the third child of four from her parents union. She has an older sister, a brother, and a younger sister. Her brother was diagnosed with intellectual disability from a young age. The family's focus has always been on taking care of her older brother.

• The diagnosis should appear on one line in the following order. Note: Do not include the plus sign in your diagnosis. Instead, write the indicated items next to each other.

Code + Name + Specifier (appears on its own first line) Z code (appears on its own line next with its name written next to the code)

Then, in 1-2 pages, respond to the following:

• Explain how you support the diagnosis by specifically identifying the criteria from the case study.
  • Describe in detail how the client's symptoms match up with the specific diagnostic criteria for the disorder (or all the disorders) that you finally selected for the client. You do not need to repeat the diagnostic code in the explanation.
• Identify the differential diagnosis you considered.
• Explain why you excluded this diagnosis/diagnoses.
• Explain the specific factors of culture that are or may be relevant to the case and the diagnosis, which may include the cultural concepts of distress.
• Explain why you chose the Z codes you have for this client.
  • Remember: When using Z codes, stay focused on the psychosocial and environmental impact on the client within the last 12 months.