DSM 5 Social Work Discussion Question

CASE OF DAVID

INTAKE DATE: March 2020 DEMOGRAPHIC DATA: This is a recurrent hospitalization for this 48 year old, white married, employed male who lives with his wife and one child in San Francisco, CA. He works as a computer programmer. CHIEF COMPLAINT: “I’m depressed and thinking I do not want to live anymore”. HISTORY OF PRESENT ILLNESS: David states he has been feeling progressively more depressed for several months feeling hopeless, wishing that he were dead. When his therapist, whom he has been seeing since January 2020 urged inpatient hospitalization, patient initially was not agreeing but ultimately within a week agreed to the hospitalization. David was unable to list external stressors as the reason for his depression. He says that he first became depressed three years ago and made his first and only suicide attempt swallowing a bottle of Xanax in October 2016. At that time, he was hospitalized for two days on a medical unit. After discharge, he returned to a psychiatrist and therapist for continued outpatient treatment for his depression. He had been treated with Nardil and Xanax at that time. He stopped seeing the psychiatrist and therapist in the summer of 2018 when he was feeling better. David slowly began to get anxious and depressed during the fall. His wife noted that his condition changed to depression around November 2019. In January of 2020, he began to see his current therapist as his internist prescribed Prozac for him. PAST PSYCHIATRIC HISTORY: David reports that he was in psychotherapy as noted in History of Present Illness. SUBSTANCE USE HISTORY: It should be noted that David has a history of substance use as follows. He first began to use diet pills at age 15 on and off for approximately four years to lose weight. At age 17½. he began to drink beer; however, since he got sick when he was 18, he hasn’t drank beer since. At age 20 to 33, he drank socially only. At the age of 33. his daughter was born — he smoked his first joint and continued smoking marijuana on weekends until he was 36 when his marijuana usage increased to a daily basis. At age 40. he tried amphetamines a few times, mixing alcohol (two to three drinks) with the drugs. At age 43 to 45, he utilized

Oxycontin until November of 2015 while he continued smoking marijuana. He stopped using Oxycontin because he fell asleep driving a car. Marijuana smoking continued up until a few days prior to admission. FAMILY HISTORY: Patient is married 25 years. His wife is 45 years old. He has a 15 year old daughter. In 2010, his mother died from Alzheimer’s disease and his father died the following year from a heart attack. There is no psychiatric illness in the family. MEDICAL HISTORY: The patient has had diabetes since age 22. He has hay fever. David has been smoking a pack of cigarettes per day since 17 years old. PAST DEVELOPMENT AND SOCIAL HISTORY: David was born in Los Angeles, CA and went to public schools. He reports being a behavioral problem in elementary school. His mother was frequently called in for disciplinary reasons. Patient appeared annoyed when describing his mother being called in to school for ridiculous matters - the fighting was like initiation in his neighborhood. He graduated from high school in 1990 and tried college for several months. However, he dropped out. He describes himself as a spoiled child while he was growing up. David states he is good at deceiving people. He started working in the computer industry soon after he left college and has been working steadily up to this point. David has a “side business” of selling computer printers that he takes from his company. He is pleased he learned from early on how to make extra money by selling some of the printers on the side. David notes that he started selling pills to his friends and coworkers to make extra money also. His wife does not know this but enjoys the benefits of the money he brings home. Patient has no legal complications. MENTAL STATUS EXAMINATION: Upon admission, the patient was noted to be a well-built, casually but neatly groomed male who appeared his stated age. He was anxious with mildly pressured speech which was fluent, coherent and could be interrupted. There was no evidence of psychosis or form of thought disorder. There was no looseness of association, flight of ideas, or ides of reference. There was no evidence of paranoid ideation or delusions. His affect was full range. He described decreased appetite and intermittent sleep problems. He expressed suicidal ideation but denied feeling acutely suicidal or homicidal. Regarding cognition, he was alert and oriented to time, place, and person. Long and short memory is intact.