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AddictionCaseStudyAnalysis.docxRunning Head: CASE STUDY ANALYSIS 1
CASE STUDY ANALYSIS 2
Addiction Case Study Analysis
Introduction
The report is based on the case study of Marci, who is a 22-year-old university student with problems of alcohol and drug addiction. She is living at home with her parents and has problems. She was recently detained. Based on the patient's physical, mental situation, medical and family history, the report presents the primary and secondary diagnostic impression. The report uses the DSM-5 method, which is the Diagnostic and Statistical Manual of Mental Disorders. The manual contains the diagnostic measures for various disorders, including Autism Spectrum Disorder, Gender Dysphoria, Attention-Deficit/Hyperactivity Disorder (ADHD), Substance Abuse Disorder, and others. The report will cover the diagnosis, prevalence, culture issues, comorbidity, and possible differential diagnosis.
Primary Diagnostic Impression
The primary diagnostic impression of a disorder is a brief statement that describes the problem or condition, its symptoms, and the reason for the medical disorder. On a broader level, it is the diagnosis that is the main disorder of the patient. Based on the description of the client, she is suffering from depression.
Depression – DSM-V
Most often, when the term "depression" is in use in a medical context, it refers to major depression (also called clinical or characterized depression). Major Depressive Disorder (MDD), Recurrent, Moderate F33.1 . In the case of Marci, it is moderate major depression. The criteria for a characterized depressive episode make up at least five symptoms among depressed mood, anhedonia, change in weight or appetite, disturbed sleep, restlessness or slowing down, fatigue, guilt, impaired concentration, and suicidal thoughts/acts.
A. Symptoms 1 and 2 are mandatory, and five or more criteria meet for ≥two weeks. A symptom can only be kept if it represents a change from the previous condition and cannot be attributed to another medical condition.
Depressed mood is present majority of the day, every day, reported subjectively (e.g., feeling of sadness, emptiness, hopelessness) or observations of those around him/her (e.g., fearful behavior). Marked reduction in interest or pleasure in all, activities majority of the day, every day (subjective reports or observations). Significant weight loss in the absence of diet, significant weight gain (e.g., ≥5% change in body mass in ≤1 month), or reduced or increased appetite every day (Friedman, 2012). Loss of sleep or oversleeping can also be one of the symptoms.
· Restlessness or psychomotor slowing down every day (visible to those around you, not a simple subjective feeling of impatience or slowing down).
· Fatigue or lack of energy daily.
· Feeling of unworthiness, excessive or inappropriate guilt (which can be delusional), almost every day (not just blaming yourself or feeling guilty for being sick).
· Reduced reflexive or concentration abilities daily indecision (subjective reports or observations).
B. “Symptomatology is responsible for clinically significant distress or deterioration in social, occupational, or another important functional area.
C. The episode is not attributable to the physiological effects of a substance or any other medical condition” (Fried et al., 2016).
Prevalence
The WHO (World Health Organization) estimates that depressive disorders represent the first factor of morbidity and disability worldwide ( press release of March 2017). Thus, more than three hundred million people in the world suffer from depression, an increase of more than 18% from 2005 to 2015. Depression is not a health disorder that should be taken lightly. It can lead to suicide. More than eight hundred thousand people commit suicide as a result of depression. According to the World Health Organization, depression is the second leading cause of disability. It ranks fourth among diseases in terms of financial cost per disease. Overall, the results show a prevalence of the depressive episode over one year of around 7%. The six-month prevalence is around 5%. Over the entire lifetime, this prevalence is 15%: during their lifetime, 15% of people have been, are, or will be depressed.
Epidemiological data suggest that depression has become more frequent since World War II, affecting younger and younger individuals. Most offer social explanations (increasingly stressful life), others advance genetic hypotheses (modification of the genome of contemporary populations). In reality, the question remains open. The only study (known as from Stirling County and conducted in the USA) conducted forty years apart (1952, 1970, and 1992) on the same population with the same diagnostic methods indicates a decrease in the prevalence of depression: 5, 3% in 1952, 5.3% in 1970 and 2.9% in 1992 (Shupp et al., 2020).
Culture/Gender Issues
Depression is more common in females as compared to males. While men commit suicide more than women. Few of the findings show such regularity in sociology. Male dominance during the first studies in the 19th century and can be observed in all countries. Initiated timidly by Durkheim, the tradition of analyzing gender differences in depression has nevertheless abandoned the explanation of this fundamental gap between men and women to focus on the antagonism of the interests of the two sexes in marriage. Despite a systematically gendered analysis in examining marital status, Durkheim dwells little on the reasons that would explain the gender differential of this "propensity to suicide due to depressive episodes" (Zhang, Zhang, & You, 2018).
The relative preservation of women would only be ensured by the joint presence of children and, therefore, by the integration. In cultures like that of Marci, she can face issues like discrimination and hate. By itself, the conjugal society harms the woman and worsens her tendency to suicide. The relative preservation of women would only be ensured by the joint presence of children and, therefore, by integrating "domestic society" more than through marriage.
Functional Consequences and Co-morbidity
Depression targets people regardless of their age, social status, socioeconomic level, usual vitality, or social network. However, most conditions or situations put certain people at greater risk than others, such as the person who has suffered from depression or experienced a traumatic event. The comorbidities included along with depression for Marci are anxiety, alcohol abuse, and others. There can be cases of mental disorders. Depressive disorders often accompany other mental health problems such as anxiety, eating disorders, or substance abuse (McIntyre, & Calabrese, 2019). Depression can also worsen health problems in older people, making a recovery more difficult, which can lead to deconditioning syndrome. Geriatricians maintain that a first depressive episode at an advanced age is sometimes the precursor sign of installing a neurocognitive impairment in the person. Major depressive disorder increases the risk of death in the elderly 2-3 times and remains the most worthy cause for suicide in this age group (Kawashima et al., 2020).
Possible Differential Diagnoses
The diagnosis of depression is based on the identification of symptoms, signs, and clinical criteria as proposed in the DSM V. To facilitate the differentiation between a depressive disorder and a simple change in mood, there must be clinically significant suffering or maladjustment in social, occupational, or other important categories of autonomic functioning for a significant period and regularly (Pan et al., 2018).
In this same context, in the presence of symptoms such as a feeling of worthlessness, suicidal ideation, psychomotor slowing down, and severe impairment of usual functioning, a major depressive episode in addition to the expected normal reaction to the loss experienced. Laboratory tests may accompany this clinical diagnostic process, but they intended to rule out other health problems that could produce depressive symptoms (e.g., hypothyroidism). Questionnaires whose metrological qualities that are evident are available to the doctor, supporting the diagnostic process (Taylor-Swanson et al., 2019).
Secondary Diagnostic Impressions
Substance use disorder -DSM- V
In the DSM-5, the list of criteria includes, for the first time, the withdrawal states. The recurrent legal problems resulting from substance abuse, were left off the list because of the great diversity of practices in the application of the law across the world. The eleven, DSM V diagnostic criteria of the American Psychiatric Association includes the following:
Compelling and irrepressible need to consume the substance or to gamble (craving), loss of control over the amount and time spent taking drugs or playing, a lot of time spent researching for substances or playing games, increased tolerance to the addictive product, presence of a withdrawal syndrome, i.e., all the symptoms caused by suddenly stopping consumption or gambling, inability to fulfill important obligations, use even when there is a physical risk, personal or social issues, persistent desire or effort to decrease doses or activity, reduced activities in favor of consumption or gambling and continued use despite physical or psychological damage (Gavin et al., 1989). In this case, Marci suffers from Cannabis use Disorder 304.30 (F12.20) from moderate cannabis use disorder there are two criteria that are present; it is weak addiction, while 4 out of 5 shows moderate addiction and six or more points to severe addiction (Mauri et al., 2017).
1. Hunger, or a powerful desire or compulsion to consume cannabis
2. Essential societal, professional, or leisure interests are given-up or diminished for the consummation of cannabis
3. Persistent cannabis consummation neglecting to perform important job responsibilities at place of employment, school, or at home.
4. A tremendous amount of time is devoted to actions needed to acquire cannabis, consummate cannabis, or recuperate from its outcomes.
Prevalence
Regardless of the country or historical period studied for which data are available, women consume alcohol in smaller quantities and less frequently than men. Thus, each major quantitative study observed that heavy drinking behavior and alcohol-related disorders are male. With respect to other PPS, in the United States, according to the 2002 National Survey on Drug Use and Health (NSDUH), in the population aged twelve and over, 6.4% of women per compared to 10.3% of men reported the use (in the previous month) of an illicit substance. In that same year, 11.3% of the Canadian population reported having used cannabis in the past twelve months (14.5% of men versus 8.2% of women). Heroin and cocaine use remained marginal, with less than 1% of the population reporting using it (Kisilu et al., 2021).
Culture/Gender Issue
There are differences in gender and cultural effects. Women are shamed due to the use of drugs and alcohol. Although the abuse is bad, women are looked down upon more in the matter as compared to men. In the eastern cultures, these issues are higher. The non-medical use of psychotropic drugs is remarkably similar: 2.6% for women and 2.7% for men. However, research shows that women using sedatives or tranquilizers are significantly more likely than men to become addicted to these substances. If gender appears to be one of the most important socio-cultural factors associated with health-related behaviors, it is also so with regard to the phenomenon of addictions. This factor, which can in many forms, to a form of vulnerability in public health, refers to more risky behaviors and less inclined to the prevention or care than that of women (Jones & McCance-Katz, 2019). The masculine gender, at this level, therefore, constitutes more of fragility than a force, which both should be taken into account in prevention programs, too often designed in a “unisex” manner, and in reception policies of socio-health structures, tending more to minimize, to put it in a way no doubt a little caricatured, the difficulties of men compared to those of women. If gender is by no means "the" explanatory factor for the emergence of an addiction, it can precipitate the entry and burden the exit. For this reason, it is advisable to better apprehend it at the preventive as well as the curative level (Greene, & Patton, 2020).
Functional Consequences and Co-morbidity
First, the co-morbidity between alcohol-related disorders and other drug use disorders is 41% in males and 47% in females. Next, it appears that problematic APS consumption among women linked to another mental health problem. A meta-analysis of longitudinal surveys from the United States, Canada, and Scotland (Hartka, Johnstone, Leino, Motoyoshi, Temple & Fillmore, 1991) concludes that elevated levels of depressive symptoms in women predict elevated levels of depressive symptoms. High alcohol consumption. According to this meta-analysis, alcohol consumption also predicts depressive symptoms, more in women than in men, thus testifying the two-way influence between depression and alcoholism. According to this report, thirty-five million people worldwide suffer from substance and drug use disorders.
Drug addiction is frequently associated with other mental health disorders. The co-morbidity of the disorders is higher in women than in men, although the prevalence of disorders associated with AS use is lower (Han et al., 2017). As we have seen the presence of alcohol and drug abuse problems in the family, deficient performance in school, different stressors, and difficulty integrating or exclusion from a group because of their race, ethnicity, or gender, Marci suffers from these disorders. People differ in behavioral sequences of alcohol and drug consumption over the course of life, related to life experiences. There are gender-related differences in the patterns of use and the appearance of problems associated with binge drinking and the persistence of these behavioral patterns and abuse and dependence problems. Compared to men, women consulting for ASD-related disorders are more likely to present concurrent disorders such as anxiety disorders or mood disorders and less antisocial personality disorders. They have a family history of alcoholism, substance abuse, or other mental health issues (Greene, & Patton, 2020).
Possible Differential Diagnoses
In case there is suspicion that alcohol and drug use may be the cause of problems in your life, try answering the following questions (CAGE questionnaire):
· Have you ever tried to cut down on alcohol or drugs?
· Have you ever got angry because someone has commented about your alcohol and drug use, or have such comments annoyed you?
· Have you ever felt guilty about using alcohol or drugs? \ Have you ever had alcohol or drugs when you wake up in the morning? (Grant et al., 2020).
Epidemiological studies tend to show a higher prevalence of substance use disorders in men than in women. Thus, the NESARC study shows that the lifetime prevalence of substance-related disorders (all substances combined) is 13.8% for men against 7.1% for women (Conway, Compton, Stinson & Grant, 2006). Regarding current disorders, abuse and alcohol dependence are 2 to 5 times higher in men than in women.
References
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