Review the following Case Study and Answer the questions that follow

DEMOGRAPHIC DATA: This is a voluntary intake for this 53 year old Jewish male. Sigmund has had several psychiatric hospitalizations in the past. Sigmund has been married for 29 years and has been separated from his wife for the past ten months. He has been living alone for the past five months. His wife and three daughters live two blocks from him. Sigmund has had difficulty in jobs and has not been at any job longer than three years. CHIEF COMPLAINT: "I miss my family and do not want to live without them". HISTORY OF ILLNESS: Sigmund reports first seeking psychiatric treatment when he was sixteen years old. He was prescribed anti-depressants, but does not remember what kind. Since they helped his mood he remained on anti-depressants for several years. In his late teens he began drinking. His use of alcohol continued into his early thirties. At thirty four years old he attempted suicide after his wife and children left him. He was hospitalized in a psychiatric unit for thirty days. At that time Sigmund was put on lithium, with continued successful results for several years, resulting in reconciliation. In December, two months earlier, Sigmund returned to his psychiatrist because he was becoming depressed again, feeling sad, fearful and suicidal. He was given Parnate. Soon after, both Sigmund and the psychiatrist did not think this was working very well and the psychiatrist added Ritalin to his medication regiment. During the next three months Sigmund felt on top of the world sometimes lasting for 10 days. He then would have angry outbursts. His wife asked him to leave the home. He then took an overdose of Klonopin. Sigmund was then prescribed ECT (shock treatment). Sigmund returned home after the shock treatment but reported that it was an inhumane experience and felt anger towards his wife believing she forced him to receive ECT to return home. Sigmund continued on anti-depressants and lithium. Mrs. Sigmund was getting continuously concerned about their financial state because Sigmund would constantly be buying big items that they could not afford. They would have arguments about this all the time. By the end of August he was asked to leave his home again because he used pills as a suicidal gesture. He began drinking again to cope with the separation. This use and behavior continued up to his current

presentation for intake. PSYCHOSOCIAL HISTORY: Sigmund reports growing up as tumultuous. His mother beat him and would lock him out of the house when she became angry. His mother separated from his father on several occasions and sometimes would throw Sigmund out of the house with the father. His mother made all the decisions and his father played a more passive role. Both parents would often have physical fights and Sigmund would try to break up the fighting from as early as he can remember. Sigmund is the only child from his parents union. He has an older brother from his mother's previous marriage. Sigmund does not have any contact with his brother. Sigmund was initially considered an underachiever in the early years of school. He had trouble being in fights with other kids because they use to make fun of his wrinkled clothes. Sigmund always wanted to be a doctor. He spent the following five years after college graduation taking courses but never completed his graduate studies. Sigmund has no legal history. He worked in the family business through high school and college. He became a project coordinator at his next job. He stayed there three years. MEDICAL HISTORY: Sigmund states he currently takes Synthroid for a thyroid problem and this helps him keep his weight down. FAMILY ISSUES AND DYNAMICS: Sigmund was first married at age twenty one years old. He reports not loving his first wife but liked the stability of her family and asked her to marry him. They spent one year together. He physically abused her from the beginning of their marriage. Mrs. Sigmund the first had an affair that ended the marriage. Mrs. Sigmund reports Sigmund had spoken to her several times about getting involved with other men for sexual pleasure with his knowledge and she states she just followed through with his wishes. They had no children. Six months after his first divorce Sigmund married again. He reports not loving his second wife but thought it was better to be married. The second Mrs. Sigmund had one child from a previous marriage who Sigmund adopted. They had two other children. The first ten years of their marriage Sigmund reports physically abusing his wife. He reports hitting the oldest child once. He stopped the physical abuse when Mrs. Sigmund asked for a divorce the first time. Sigmund reports he always wants

people around him. He believed his wife was becoming more distant from him over the past several years which he could not take. Their fighting increased, although he would not become physical with her now. MENTAL STATUS EXAM: Sigmund presents as a neatly dressed male who appears younger than his stated age. His hair is a bit disheveled. His nails are neatly groomed. Facial expressions are appropriate to thought content. Motor activity is appropriate. Thoughts are logical and organized. There is no evidence of hallucinations. Sigmund admits to a history of suicidal ideation, gestures and attempts. His mood is depressed. During the interview Sigmund talked fast. Sigmund is oriented to time, place and person. His intelligence appears above average.

Questions:

The diagnosis should appear on one line in the following order.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)

• 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.