Question
Tim is a 32-year-old, married father of two children, age 8 and 5 years. Tim is a software program developer who works freelance for large
Tim is a 32-year-old, married father of two children, age 8 and 5 years. Tim is a software program developer who works freelance for large institutions. He owns and operates his own software development company and is a subcontractor who basically works alone. Time married his high school sweetheart after he finished college; they bought a home and started their family. Currently, he is estranged from the outside, his life looked like the "typical American dream." About a year ago, Tim had developed a software program for universities and met with the leadership of a university that was interested in buying his program. The deal would have been a breakthrough for Tim because the university had several branches and affiliates that would also use the software and it would have opened up the possibility of other deals with other universities. However, the university was not interested after his presentation at the meeting, and the deal fell through. After this incident, Tim's symptoms surfaced. Tim began demonstrating paranoid symptomology. He became and continues to be suspicious of others and believes people are "out to get him." He believes the university is trying to steal his software. He states that the university has bugged his home, his phone and computer. He believes the university is trying to destroy his business and his credibility and has bribed his family members and friends into trying to make him "look crazy." He reports that the university is sending him encrypted messages through the closed captioning on the TV and is trying to take pictures and videos of him through his phone and computer. He refused to share what the messages were, sating, "I will be killed if I tell you." Tim denies hearing voices or seeing things that other people do not see. His affect is appropriate. He reports that he enjoys playing with his children and that he coaches his 8-year-old son's little league team. After Tim signed an authorization for release of information, Tim's mother reported he had difficulty interacting with others for most of his life. His career choice was a good one for him because he could work independently. After Tim became suspicious, he refused to work on a computer, and he closed down his business. He is not having difficulty securing gainful employment and has not worked in several months. His home is in foreclosure. Although he reports that his wife, friends, and family have repeatedly assured him they are not trying to sabotage his business, Tim states that because of his suspiciousness, his wife eventually became exasperated and moved out, taking the children with her. At that point in time, Tim's symptoms became worse. He states that he began stalking her because he wanted to see her and the children. After one incident when Tim unexpectedly showed up at her house to see the children, his estranged wife became fearful and demanded that he immediately seek treatment or she would contact the police. Arrangements were made for him to be admitted into an inpatient psychiatric hospital. Upon release from the hospital, he moved in with his mother. He still holds onto the delusions but is able to manage his symptoms and function better, although not at his previous baseline. He reports feeling sad because he lost his business, his wife and children, and his friends. Although he holds firm to his delusions, he states he is hopeful that he can rebuild his relationship with his children and secure employment. Instructions: Provide a current diagnosis or diagnoses for Tim following this evaluation. You must provide an appropriate DSM 5 diagnosis(es), document any relevant health conditions (codes necessary for that are at the end of the cases) and identify contextual and psychosocial factors (using, Z-codes) that require clinical attention. You also need to include a rationale for the diagnosis(es) you choose over other diagnoses. (Note that there may be multiple diagnoses in one or more of the cases. Be sure to put the primary/principal one first.)
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