List all presenting symptoms Using DSM 5 criteria, determine the most likely diagnosis, based on symptom cluster(s)
Question:
- List all presenting symptoms
- Using DSM 5 criteria, determine the most likely diagnosis, based on symptom cluster(s) and reported history. Make sure to list the presenting symptom next to the symptom/symptom criterion that it matches from the DSM-5-TR.
- List 2 other possible diagnoses, based on symptom presentation, and for each:
- Describe how the client's presenting symptoms might support the diagnosis
- Explain why this is not the most likely diagnosis
- Based on your assessment, what is the likely course of the client's illness?
- Discuss relevant cultural and/or special considerations that may be relevant in regard to guiding intervention with this client.
- Use at least 5 peer-reviewed sources, total, to support items 2 to 5 above (one or more sources for each item).
Presenting symptoms:
Charlene keeps calling out for Tenny and searching the house for him
Denied the corpse was her child at the funeral and attempted to remove him from the coffin
Has not slept or eaten much since incident
Seems to have confusion over time/location
Agitated and worried over Tenny
Humming a lullaby
Appears to be avoiding broaching the subject of what happened or is unable to handle the thought of the incident, dissociation possibly
Seems to think her children are with her at the hospital
Diagnosis: I went back and forth on PTSD and ASD and finally had to google to see what the difference was. The difference is that ASD happens immediately after an event while PTSD occurs a month after the event. Since Charlene's son died only 9 days prior, I believe this is ASD (Acute Stress Disorder). I won't put all the DSM criteria in this message since ya'll have included it already.
And this is the article for the client.
Identifying Information Name: Charlene Johnson Age: 28 years old Ethnicity: African American Marital Status: Divorced Occupation: Grocery store cashier Children: Charlie, age 6; Tenny, age 3 (recently deceased) Background Information The client is a 28-year-old, divorced AfricanAmerican female brought into the emergency room at Cliffside General Hospital for evaluation by her live-in boyfriend, Greg. Greg reported that 9 days ago Charlene witnessed their 3-year-old son's death. He stated that Charlene had just gotten off work on a Wednesday night and was walking to her car when her exhusband drove through the grocery store parking lot at a high rate of speed and flung Tenny, her son, out of the driver's side window. Tenny hit a light pole in the parking lot, which fractured his skull. Charlene was about 20 feet from the speeding car when she saw her son fly out of the window. She screamed frantically as she ran toward her son, and when she saw the traumatic injuries to his head, she fainted in the parking lot. Emergency Medical Services personnel attempted to revive Tenny, but he was pronounced dead at the scene and taken by ambulance to the hospital. The police arrested Charlene's ex-husband approximately 4 hours later, and he is being held without bail in the county jail facility on charges of firstdegree murder. Greg stated that Charlene has been "out of her mind" ever since the tragic incident occurred. He told the triage nurse that Charlene keeps calling for Tenny and searching the house and the neighborhood for him. During the child's funeral, she alternately shouted that the corpse was not her child and attempted to remove the corpse from the coffin. He also stated that she hasn't slept or eaten much since the tragedy occurred. According to Greg, Charlene has no history of mental problems and, in fact, has always seemed well adjusted and happy. He stated that they were planning on getting married around the holidays. The emergency room personnel found no gross medical problems in their examination of Charlene. They then called you from the psychiatric unit for a screening interview. The emergency room physician briefly relayed the information to you and directed you to an examination room. Interview with Charlene When you walk into the room, Greg is sitting with Charlene and holding her hand. She appears very disheveled and scared. You explain to Charlene that you are a counselor and want to help her feel better. You start by asking Charlene if she knows what day of the week it is. "I think it's Saturday, but I don't really know. I'm worried about Tenny," Charlene tells you. She looks over to Greg, who 'has moved to another chair to allow you to sit beside Charlene. "I know you've been very upset about Tenny," you suggest, "but, right now, I'm concerned about how you are feeling. Do you know where you are, right now?" you ask. "I guess I'm at the doctor's office," Charlene says after a long pause. "Do you think I'm sick? I rea!Iy have to get home and find Tenny." "Charlene, you're at the emergency room at the hospital," you tell her. "Greg brought you here because he's very concerned that you've been so upset about your son." Charlene doesn't respond and seems to be having a hard time comprehending what you're saying. She begins humming what sounds like a child's lullaby. "How are you feeling right now, Charlene?" you query. Charlene doesn't resporid directly to your question. Suddenly, she jumps up and starts putting on her sweater. "I've got to get home now; come on, Greg, we got to find Tenny. He's lost, and we've got to find him." She appears very agitated and worried. Greg looks sadly at you and tells you that Charlene has been this way ever since Tenny died. "I don't know what to do. She doesn't seem to hear me when I tell her Tenny died," Greg says. "It's like Case 3.3 63 she just went over the edge when Tenny was killed." You gently persuade Charlene to sit down again. "Charlene, can we talk about what happened to Tenny?" you ask. Charlene stares at the door and finally nods her head. "Okay, I guess," she says. "Charlene, you are at the emergency room because you've been through a very difficult time lately concerning your son, Tenny. Can you t~ll me about what happened?" you ask gently. After a long delay, Charlene begins humming again. She looks at you blankly and finally says that she's not feeling very well and needs to lie down. "I'm very, very tired. I think I better get the children and go on home now. Greg, can you take me home now?" It is apparent to you that Charlene is not ready or able to discuss the tragic death of her son. After helping Charlene lie down on the bed, you ask Greg to talk with you for a few minutes in your office. A nursing assistant stays with Charlene, and you take Greg to your office. 3.3-1 What diagnoses are you considering at this time? 3.3-2 What kind of additional information would you like to have about Charlene? 1:You ask Greg if Charlene has shown any acknowl . dgment of Tenny's death. He says that she has een in a "state" ever since she saw Tenny die in .e parking lot. "She hasn't talked about it at all. seems like she doesn't believe it really happened. hasn't cried about it and keeps trying to find in the house or outside. She'll stand at the door ;ng for him to come home, and I can't persuade hat he's gone. It's like she's blanked out the incident." s she talked about 'seeing' Tenny?" you ask. as she talked about seeing things.that aren't " . c;ni't think so," Greg says, "but she seems to mg things that aren't real. Like she'll tell she just heard Tenny come in the door, or Tenny calling her outside." "Okay, and she hasn't been sleeping or eating very well?" you ask. "Right," Greg tells you, "she's hardly eaten a bite since the funeral, and she's up pacing the floor in the living room at all hours of the night singing that lullaby. It's really scary to watch her, and she gets really irritated with me if I try to get her to calm down." "Has she said anything about hurting herself?" you ask. "No, I don't think so," Greg states. "She seems too 'out of it' to think about anything like that." "I need to talk to the doctor, Greg, and Charlene may need to spend the night here so we can help her feel better. Does that make sense to you?" "Yes, I just want her back to her old self," Greg says. "This has been a nightmare of a week, I can tell iisorders you that. We need to get her some help so we don't lose her, too. Her other son needs her right now." "Where is Charlie staying right now?" you ask. "With Charlene's mother, but he wants to com,e home. I just don't think it's good for him to see Charlene in this state. I've just told her mother she's got to wait until Charlene is doing better before she lets Charlie come home." 3.3-3 What ' strengths are there in this situation? 3.3-4 What is your initial diagnosis? "Well, we're going to do everything we can to help her feel better soon. I'm going to talk to the doctor and see where we go from here," you tell Greg. You take Greg back to Charlene's room and then talk to the doctor about your assessment of Charlene and her situation.