Diagnosis of Schizophrenia Spectrum and Other Psychotic Disorders
Assignment: Diagnosis of Schizophrenia Spectrum and Other Psychotic Disorders
This week, you have focused on key symptoms related to schizophrenia spectrum and other psychotic disorders. Now, in this Assignment, you practice diagnosing in this area.
This is your fifth practice in diagnosing mental disorders. When reviewing the case study, remember that social workers keep a wide focus on several potential syndromes, analyzing patterns of symptoms, risks, and environmental factors. Narrowing down from that wider focus happens naturally as you match the individual symptoms, behaviors, and risk factors against criteria and other information in the DSM-5-TR.
Here are a few tips or reminders:
Catatonia is a specifier, although it does have a code. It even appears on a line of its own and may look like a code. However, it cannot be used as a diagnosis on its own.
Remember to include all of the words that go with the diagnostic code.
Note: Remember that symptoms can occur in many disorders. As a result, all disorders in the DSM-5-TR covered up until this point may factor into your diagnosis (for example, as a possible additional disorder you diagnose).
To Prepare
Review the case study for this week.
Start by familiarizing yourself with the disorders from the DSM-5-TR found in the Learning Resources this Week.
Look within the noted sections for symptoms, behaviors, or other features the client presents within the case study.
If some of the symptoms in the case study cause you to suspect an additional disorder, then research any of the previous disorders covered so far in the course.
This mirrors real social work practice where you follow the symptoms.
Review the correct format for how to write the diagnosis noted below. Be sure to use this format.
Remember: When using Z codes, stay focused on the psychosocial and environmental impact on the client within the last 12 months.
By Day 7
Submit your diagnosis for the client in the case. Follow the guidelines below.
REMEMBER : Assignment: Diagnosis of Schizophrenia Spectrum and Other Psychotic Disorders – Week 7 – Case of SY – 1 F code and 3 Z code
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.
Week 7 – Case of SY – 1 F code and 3 Z codes
Intake Date October xxxx
PRESENTING PROBLEM
Patient presented in the ER having been brought in by her mother and a friend. SY indicated that she was having one of her “anxiety attacks—it’s like a seizure, “I go into another world, I can hear people talking but I can’t talk back.”
PSYCHOLOGICAL DATA
SY is a 24-year old single Hispanic woman. She has lived in a group home for the mentally ill for the past 2 years. Her mother lives in a nearby town. Her father left the family when she was 3 years old. SY has no siblings. SY claims to be mentally retarded. She indicated that “I have always been in special education classes.”
MEDICAL HISTORY
An examination by a neurologist revealed mild cognitive impairment, difficulty with balance and a slight gait ataxia. A CT scan showed a mild enlargement of the lateral cerebral ventricles. No specific neurologic disorder was diagnosed (information derived from the ER chart).
SUBSTANCE ABUSE HISTORY
SY denies consumption of alcohol or illicit drugs. She denies ever using chemicals that were not prescribed to her.
PSYCHIATRIC HISTORY
SY has been hospitalized 8 times at a State Hospital during the past 5 years. SY was unsure of her diagnosis. Dr. Miller, from the psychiatric hospital, prescribed Zyprexa for SY and she continues to be medication compliant. She is unable to indicate her dosage. SY denied being under any current psychiatric care.
MENTAL STATUS
SY presented as a casually dressed, unwashed woman with an extremely disagreeable body odor. She lay on her bed in restraints during the interview. She had a fluctuating mood and an anxious expression on her face. Motor activity appeared agitated. Mood was anxious alternating with hostility and depression. Speech was pressured at times and inappropriately loud. Her affect was inappropriate and at times blunted.
SY’s thought processes were at times incoherent and at times displayed a marked loosening of associations. She also displayed bizarre delusions and reported verbal hallucinations.
“I see Jesus, God and the Devil. I see my mother, who committed suicide. It’s like having her alive again. I see little balloons out there, like two beach balls. At the group home I felt possessed. I felt that a demon was trying to come into my body. I felt that tricks were being played on me in my room. The devil went up inside of me and raped me. My mother was standing there watching me. God said I was a slut, that I married the devil. I thought I was pregnant. I am going to have the devil’s baby.”
SY was disoriented in three spheres (time, place, and person). Concentration was markedly impaired. Digit span was unobtainable. She was unable to calculate serial 7’s. Recent and remote memory was not discernible. SY was unable to abstract similarities and proverbs. Ordinary social and personal judgment was inappropriate. SY’s three wishes were that “my balloons stay floating, that the devil leaves me, that Jesus hates my mother.”
When asked about wishes for 5 years from now SY’s refused to express any.
SUICIDAL ASSESSMENT: Unable to ascertain.
HOMICIDAL ASSESSMENT: Unable to ascertain.
SUMMARY NOTES
SY was incoherent during most of the interview. She was able to indicate some history that was inconsistent with history taken from her mother. For example, SY indicated that she was adopted when she was 2 years old. Her mother claimed that SY is her biological child. SY’s mother said that she was not mentally retarded and indicated that SY first became ill when she was 16. Mother indicated that SY has become progressively isolated from friends and family since 16, and during the past 5 years has been unable to work or tend adequately to her personal needs. Mother indicated that SY had been picked up several times by the police for “talking in public” and each time she was sent to the State Hospital. Mother denied that SY is suicidal or homicidal. Mother indicated that SY’s father was an alcoholic and that they were divorced 4 years ago. SY has had no contact with her father since the divorce.
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