Running head: DIAGNOSTIC SKILLS 1

Diagnostic Skill Application I

NAME:

Institution:
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Diagnostic Skill Application I

Introduction

In this paper, an evaluation will be conducted on the two presented scenarios to identify

the main issues that are being faced by the clients. Majorly, the analysis will be performed from

the perspective of the client based not only on the symptoms that they exhibit but also on the

information they provide regarding their conditions and situations. In addition to these, some of

the other elements that will be taken into consideration include the cultural aspects to help in the

analysis of the symptoms and viewpoints of the clients. This is in addition to the provided

information to determine the appropriate disorders to be considered for each of the cases. This

will be alongside the proper diagnosis for each case through the provision of a rational outline

that will be used for the selection of that particular diagnosis.

Presenting Concerns: Case of Jenny

Jenny is 29-year-old woman who is bisexual and presents with several symptoms that can

be linked to a psychiatric disorder are presented in the case Jenny. They include fatigue, lack of

motivation, energy, sleep and appetite according to the American Psychiatric Association (2013).

Besides, these she has another major symptom of concern that is hopeless. Lamis et al., (2014)

mention it as a critical sign of presented depressive symptoms that lead to suicide. Another one

of her concerning symptoms would be hopelessness. They indicate that most psychological

illnesses develop from the inability of the brain to operate within the intended limits (Nolen-

Hoeksema & Marroquín, 2017). According to research, some of the factors that cause depression

include neurological or biological, environmental and social.

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Most of the brain functions such as rewards, memories and emotions are controlled by serotonin

and dopamine. The experience of chemical imbalance in the brain in terms of the hormones and

neurotransmitters causes a disruption in the communication between the nerves and neurons (Lu

et al., 2016). Therefore, it results in a psychiatric disorder like depression, which is associated

with the reduced levels of dopamine, serotonin and norepinephrine (Zhao et al., 2017). Besides

these, there are also indications that genetics contributes to the development of major depressive

disorders or MDDs. Mainly there is a connection between immediate family members who

include parents, siblings, and children as they have a greater chance of developing MDD as

contended by American Psychiatric Association (2013).

Countless people are affected by depression in the current times. It is therefore one of the

psychiatric conditions that are well known as it increases with certain circumstances such as the

loss of job, developed health issues, a broken relationship and other factors that are likely to

affect brain functions. It is revealed that people in depressed situations are no longer able to

engage in certain simple activities and tasks by WHO country office India (2017). It is for this

reason that as a mental disorder, depression tends to cause changes in daily patterns like feeding,

feelings, thoughts and sleep thus creating thoughts of hurting one self.

Differential Diagnosis: Case of Jenny

Examination of symptoms expressed by Jane reveals the presence of a depressive

disorder that should be appropriate matched with the symptoms. Therefore, it requires thorough

consideration of the persistent depressive disorder and MDD. Jenny has symptoms that relate to

depressive disorders. However, she does not meet the criteria as they have not lasted for at least

two years as indicated by American Psychiatric Association (2013). She mentions that she has
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experienced them for a few months in the video. Many of the symptoms fit under those listed in

the MDD, which requires that the patient should exhibit at least five symptoms from the list

within a period of fourteen days.

Through the use of the decision tree on depressed mood, it was possible to go through the

process of selecting a proper diagnosis for a major depressive disorder. From this, there was the

elimination of other medical conditions and the abuse of substances. Subsequently, it leads to the

ability to connect the presented symptoms to a mood disorder as in the case of Jenny. This forms

the basis for diagnosis according to First, American Psychiatric Association, & American

Psychiatric Publishing (2014). It is also possible for clinicians to make use of the differential

diagnosis through the use of tables that list the diagnostic criteria for the major depressive

disorder. It also stresses on the importance of creating the right differentiation from the Bipolar

disorders I and II (First et al., 2014). Confirmation of the accuracy of the diagnosis is done

through the use of current and updated DSM-5 since it provides the require definitiveness. It has

specific diagnostic codes with a list of the diagnostic criteria to be reviewed to ensure that the

right diagnosis is made.

Symptom Checklists: Case of Jenny

The best checklist for the assessment of Jenny’s symptoms would be the Symptom

Checklist-90-Revised or SCL-90-R (Derogatis, 1977). It is based on self-reporting and helps in

the identification of psychopathology. It contains several distress levels included within nine

subscales in terms of disorders. These include depression, phobic anxiety, and obsessive-

compulsive and paranoid ideation among others. It contains 90 items within the 5-point scale

rating and can be completed in 15 minutes. It is good, reliable and valid. It also has the great
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advantage that comes with the ability to take using 26 languages hence the opportunity for

people from different backgrounds.

Systemic Assessments: Case of Jenny

The best assessment device to be applied in the case of Jenny and her mother would be

The McMaster Family Assessment Device. This model was created by Epstein, Baldwin, and

Bishop (1983). It basically considers the family structure and set up. Besides this, there is the

consideration regarding how family members interact to the point that healthy or unhealthy

movements are developed (Hamilton & Carr, 2016). It is based on six categories that are founded

on dysfunctional cycles within the family. They may include the ability to solve problems,

communicate, and engage in proper role functions among others. In essence, families that solve

problems functionally rise more effectively than those that do not. On the other hand,

communication helps family members to pass information properly while role functioning

defines the ability by members to take responsibility. Therefore, it can help Jenny and her mother

to identify the unhealthy patterns in their relationship and the psychobiological factors that affect

Jenny.

DSM and ICD Diagnosis: Case of Jenny

296.33 is the most recent DSM and ICD diagnosis that is mist appropriate for Jenny’s case.

(F33.2) involves severe and recurrent episodes of major depressive disorder (American

Psychiatric Association, 2013). The other tool that should be applied is the V62.89 (Z60.0)

Phase of Life Problem since it is appropriate for individuals with difficulties in adjusting their

current situations. They include having children, ending relationships and leaving children at
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home (American Psychiatric Association, 2013). It is applicable to Jenny who moves back home

after breaking up with her boyfriend. These are both significant and require major adjustments.

Medication Referral/Consultation: Case of Jenny

Severe MDD cases are mostly treated with anti-depressants by physicians (Wong,

Abrahamowicz, Buckeridge, & Tamblyn, 2018). This reveals the need for proper to avoid over

or under medication as indicated by Cohen, Tanis, Ardalan, Yaseen, & Galynker, 2016).

Physicians usually prescribe anti-depressants. Thus, there is a need to refer Jenny to a physician

or psychiatrist to get this medication. Anti-depressants are effective in the way that they reduce

the symptoms of lack of sleep, motivation, appetite and happiness (Nolen-Hoeksema, 2017).

Those most commonly used act on the inhibitors that enhance reuptake of serotonin and

norepinephrine (Nolen-Hoeksema, 2017).

Presenting Concerns: Case of Marisol

Marisol displays several symptoms that include panic anytime she wants to go out with

her friends or perform work-related duties. Her thoughts are interfered with during such

moments in which she gets anxious and excited. She does not like seeing people hence the

tendency to avoid or quickly leave large gatherings. Because of fear, she can no longer advance

her work like the decline of a promotion because she could not communicate with others. She

always worries about people’s responses and reaction to her. She also does not date or travel.

Individuals with Social Anxiety disorder (SAD) experience a decline in occupation,

quality of life, well-being, and socioeconomic status levels. Typically, they have difficulty

dating, stay unmarried, get divorced or decide not to have children (American Psychiatric
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Association, 2013). Personality can be inherited since some of these genes are inherited (Nolen-

Hoeksema, 2017). Thus, a whole immediate family that includes children, parents and siblings

are likely to be affected by SAD (American Psychiatric Association, 2013). It may also result

from the exposure to traumatic incidences during early developmental stages (Nolen-Hoeksema,

2017).

Differential Diagnosis: Case of Marisol

The evaluation of the symptoms exhibited by Marisol reveal the presence of an anxiety

disorder. They are indicated by SAD, Generalized Anxiety Disorder (GAD) or Panic disorder. It

is clear that she lacked signs of fatigue, muscle tension, trouble with sleep and irritability as

listed in the American Psychiatric Association (2013). The patient must have at least four of the

listed symptoms to be diagnosed with panic disorder. Marisol appears to have sweating, an

increase in the heart rate and trembling or shaking among those listed. Therefore, her symptoms

are more related to SAD. This was confirmed after comparing the assumptions with those on the

decision tree.

The decision box describes SAD, as the surrounding instances of anxiety that create a

feeling of scrutiny from others without other issues of generalization (American Psychiatric

Association, 2014). In this diagnostic criterion there is the aspect of worry during situations

where people are likely to be scrutinized by others such as meeting new people, holding

conversations, being inspected, and looks from people while eating or drinking, presentations

and doing tasks in front of others (American Psychiatric Association, 2013). Social settings

create fear in individuals with SAD making them desist from such functions instead of suffering

from extreme fear and anxiety.

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Symptom Checklists: Case of Marisol

The best evaluation tool to use on Marisol would be the Beck Anxiety inventory or BAI

Beck et al, 1988). It is an inventory based on self-reports that are used to weigh severe anxiety. It

has 21 elements that define anxiety and its distinctive symptoms (Beck, Epstein, Brown, & Steer,

1988). It functions on a scale with four points. 0 of these are not at all but 3 are very severe. It is

recommended due to its high reliability, validity and internal consistency. Equally good for a

clinician in assessment of Marisol is the SCL-90-R checklist since it is possible to gauge the

extent of severity of the displayed symptoms as listed in the DSM-5 diagnostic criteria. It also

reviews the nine main symptoms that summarize the severity levels.

Systemic Assessments: Case of Marisol

For Marisol the best evaluation tool would be The Family Assessment Measure Version

III (FAM III). It offers measures of self-reports that outline family structure by indicate the

stronger and weaker areas (Hamilton & Carr, 2016). It is, therefore, appropriate as she comes

from a highly close knit family since it helps in its analysis from a systematic perspective. From

this, the overall score of the family functionality can be assessed.

It also rates the family members from a social view regarding how well they receive

criticisms. For instance, it can be useful in making Marisol’s family members aware of her fear

during gatherings and social events. FAM III offers a general score and seven other subscales on

behavior to measure elements like accomplishment of tasks, involvements, norms and values that

will enable a clinician identify the normal and abnormal aspects in (Hamilton & Carr, 2016).

DSM and ICD Diagnosis: Case of Marisol

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300.23 F40.10 is the most applicable present tool for DSM and ICD diagnosis for

Marisol as it is related to the social environment, social anxiety disorder and unspecified

problems in V62.9 (Z60.9). They are suitable since the fear of judgement that increases stress in

Marisol results from social settings. They are related to scrutiny in gatherings. Other symptoms

of these conditions include withdrawal and not being open about these issues. They will also be

comfortable in work environments with minimal social contact (American Psychiatric

Association, 2013).

Medication Referral/Consultation: Case of Marisol

Anxiety is treated using antianxiety drugs such as benzodiazepines. They can reduce the

symptoms without causing significant disruption in their functionalities (American Psychiatric

Association, 2013). It is important to refer Marisol to a physician for this medication to help

lower her social anxiety levels.

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References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders

(5th ed.). Washington, DC.

American Psychiatric Association (2014). Differential diagnosis by the trees. In DSM-5

Handbook of Differential Diagnosis (pp. 17-156). Arlington, VA: Author.

Beck, A. T., Epstein, N., Brown, G., & Steer, R. (1988). Beck Anxiety Inventory. Psyctests,

Cohen, L. J., Tanis, T., Ardalan, F., Yaseen, Z., & Galynker, I. (2016). Maladaptive interpersonal

schemas as sensitive and specific markers of borderline personality disorder among

psychiatric inpatients. Psychiatry Research, 242, 395-403.

Derogatis, L. R. (1977). Symptom Checklist-90–Revised. Psyctests,

Elliott, R., Fox, C. M., Beltyukova, S. A., Stone, G. E., Gunderson, J., & Zhang, X. (2006).

Deconstructing therapy outcome measurement with rasch analysis of a measure of

general clinical distress: The Symptom Checklist-90-Revised. Psychological

Assessment, 18(4), 359-372.

First, M. B. (2014). DSM-5 handbook of differential diagnosis (First ed.). Washington, DC:

American Psychiatric Publishing, a division of American Psychiatric Association.

Hamilton, E., & Carr, A. (2016). Systematic Review of Self-Report Family Assessment

Measures. Family Process, 55(1), 16-30.

Lamis, D. A., Saito, M., Osman, A., Klibert, J., Malone, P. S., & Langhinrichsen-Rohling, J.

(2014). Hopelessness and suicide proneness in U.S. and Japanese college students:
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Depressive symptoms as a potential mediator. Journal of Cross-Cultural

Psychology, 45(5), 805-820.

Message from WHO country office, India. (2017). Journal of the Indian Academy of Applied

Psychology, 43(1), 167.

Nolen-Hoeksema, S. (2017). Abnormal psychology (7th ed.). New York, NY: McGraw-Hill.

Prevatt, F., Dehili, V., Taylor, N., & Marshall, D. (2015). Anxiety Symptom

Checklist. Psyctests.

Wong, J., Abrahamowicz, M., Buckeridge, D. L., & Tamblyn, R. (2018). Derivation and

validation of a multivariable model to predict when primary care physicians prescribe

antidepressants for indications other than depression. Clinical Epidemiology, 10, 457-

474.

Zhao, T. T., Shin, K. S., Park, H. J., Yi, B. R., Lee, K. E., & Lee, M. K. (2017). Effects of (-)-

sesamin on chronic stress-induced anxiety disorders in mice.Neurochemical

Research, 42(4), 1123-1129.
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