Jason is a 28-year-old male who was brought to the emergency room after being found wandering downtown in the middle of the night. Police were called by concerned neighbours who saw Jason wandering downtown.

Upon examination at the emergency room, Jason was unaware of where he was and smelled of alcohol and cigarettes. He denied any drug or alcohol use. Jason appeared to be out of touch with reality and was observed laughing to himself on occasion. He openly spoke to all medical staff and he did not report any mental health or physical health conditions.

Urine drug screen showed high levels of THC, cocaine, and a blood alcohol level of 0.20. Jason admitted to using only alcohol upon further prompting. Jason's mother was called as his emergency contact, and she reported that over the last year he had been using substances heavily and that this had been an increase from before. She reported that as a result, he had lost his job and was unemployed. Previously, Jason was working as a manager at a local grocery store. Over the last several years, he has been going out and not returning for days at a time, and upon return appeared to be disconnected from reality. Jason's mother would ask where he was and about drug use but would receive no answers from him. He would spend days in his room following these binges and would continue to consume alcohol and use cannabis. His mother reported that he sometimes plays loud music in his room and she wasn't sure if he was talking to himself or speaking to others on video games. Over the last several months, Jason also lost touch with many of his friends. Throughout childhood, Jason was a self-proclaimed loner. He did not have many friends growing up and did not want to participate in social activities. Up until the last year or so, Jason was doing better in social situations and had a small group of tight knit friends he would see a few times a week. Since his increase in substance use he has lost touch with these friends.

Jason's mother reported that his uncle had bipolar disorder and there is a family history of alcohol addiction. Jason's father died from cancer two years ago. His mother reports that Jason struggled significantly watching his father deteriorate over the course of several years from cancer treatments. He was on antidepressants over the last 2 years and to her knowledge he was still taking them as prescribed. There was no other reported family history of medical or mental health history.

Jason has no siblings and was a significant caregiver for his father as he went through chemotherapy and radiation. Jason's mother reported being very concerned for Jason and feels very guilty not having brought him to get help sooner.

CASE SUMMARY

Provide information and empirical evidence to assist in making diagnostic, etiological, and treatment decisions

• What symptoms is the patient currently exhibiting and what diagnostic symptom clusters do these belong to?
• What is the most accurate DSM V diagnosis for these symptoms? What led you to rule out other possible diagnoses?
• What information (if any) is still needed to strengthen the diagnosis? How will you obtain this information?
• What factors may have contributed to the onset/etiology of the disorder?
• What current factors might be maintaining the disorder?

TREATMENT PLAN

• What are your treatment recommendations and why?
• Given the diagnosis, what is the scientific evidence supporting this treatment recommendation?
• If there have been previous unsuccessful treatments, how will your plan differ?
• Are there factors that might stand in the way of treatment success? If so, how will you get around them?
• Are there other individuals (e.g. family members, outside health care professionals) who will have to be incorporated into the treatment plan?
• How will you judge the success or failure of your treatment approach?

CASE CONCEPTUALIZATION

• Based on the case details, provide a plausible, theory-based hypothesis for the etiology and maintenance of the symptoms ("case conceptualization"). What scientific evidence supports this hypothesis?
• How does this case conceptualization lead to your treatment plan?
• What future evidence would support or disprove your case conceptualization?