week 5

Diagnosis of Anxiety Disorders and Obsessive-Compulsive and Related Disorders

After completing two practice diagnoses, take a moment to reflect on your progress and understanding of how to diagnose. Mastering the  process of diagnosis takes time and experience, just as with any skill.

Here are a few reminders:

· Have you started using tabs in the book for common sections you frequent? If not, consider doing so.

· Remember to include all the words that go with the diagnostic code.

· When you use a symptom to support a diagnosis, the same symptom cannot be used to support another diagnosis.

· Some specifiers can be used for many different diagnoses, such as with:

· Anxious distress

· Panic attacks

To Prepare

· Review the case study for this week. Note below

· 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.

Assignment

Submit your diagnosis for the client in the case. Follow the guidelines below.

· 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 #5: The Case of Aaliyah

· CASE of AALIYAH   

· INTAKE DATE: May xxxx 

· IDENTIFYING/DEMOGRAPHIC DATA:  Aaliyah is a 29-years-old, single, heterosexual, African American female. Aaliyah has lived with her boyfriend, Dion, for 4 years. She wants to get married, but her boyfriend does not believe he is ready yet since he is three years younger than her. Aaliyah is a Certified Public Accountant who loves her job. Dion is a manager for a gym franchise. 

· CHIEF COMPLAINT/PRESENTING PROBLEM: “My job is flexible and I can work from home often but lately my focus has been in other areas, and I just have trouble getting to work.” 

· HISTORY OF PRESENT ILLNESS: Aaliyah concerns herself about many things, which are not new to her, and she finds that scrubbing her home clean is her best therapy to ease her concerns . Aaliyah reports that germs have been a regular concern of hers since adolescence, when she learned in health classes about the risks of serious diseases including sexual transmittable disease. There are times when she looks at the house, and it triggers her and within minutes, she has intense discomfort feeling dizzy, sweating, feels nauseous, and trouble breathing. She is able to calm herself down in a few minutes. Aaliyah presented with meticulous grooming. She is challenged by her time management sometimes, when she finds herself scrubbing the house clean daily. A dirty house worries her in case she gets a visitor, and the house is not in order as she would like it. She sometimes has arguments with Dion to help more around the house. The amount of time it takes to scrub the house clean delays her daily schedule. 

· PAST PSYCHIATRIC HISTORY: Aaliyah has never been to therapy before and decided to attend now because her life seems to be spinning out of control.  She has always been organized and liked a clean home, for as long as she can remember. Dion is not invested in that. She remembers always keeping her room clean as a teen, which was very different from her friends. She remembers sometimes going to friend’s homes that had messy rooms and would get dizzy and nauseous at their homes when she saw that. There was a time when she was so concerned about getting dizzy and throwing up that she stopped visiting friends for months and would only meet them in public areas. 

· SUBSTANCE USE HISTORY: Aaliyah reports drinking socially. She tried marijuana in college several times but did not like it. She denies any other drug use.     

· PAST MEDICAL HISTORY: Aaliyah had the usual childhood illnesses but has not had any severe illnesses in adulthood. 

· FAMILY MEDICAL AND PSYCHIATRIC HISTORY: Aaliyah shared that when she was 2 years old her mother died from cancer. She denies any psychiatric history in the family although she does not know her mother’s family very well. 

· CURRENT FAMILY ISSUES AND DYNAMICS: Aaliyah shared that she was raised in the military; her father is an army officer. Aaliyah’s father remarried and she gets along well with her stepmother. She has two half-brothers from that union.  She has travelled all over the world, living on military bases mostly. She has a very close relationship with her father. She knows they were raised in the “military” fashion but believes it has benefited her over the years. 

· MENTAL STATUS EXAM: Aaliyah is oriented to time, place, and person. She is professionally dressed and looks at her stated age. She presents some anxiety in the interview. Motor activity is appropriate. Speech is clear. There is no evidence of delusions or hallucinations. Aaliyah intelligence appears above average.