Assigment .Apa seven . All instructions attached.

The Five P’s of Case Formulation (Macneil et al., 2012) • Presenting problem – What is the client’s problem list? – What are DSM diagnoses? • Predisposing factors – Over the person’s lifetime, what factors contributed to the development of the problem? – Think biopsychosocial • Precipitants – Why now? – What are triggers or events that exacerbated the problem? • Perpetuating factors – What factors are likely to maintain the problem? – Are there issues that the problem will worsen, if not addressed • Protective/positive factors – What are client strengths that can be drawn upon? – Are there any social supports or community resources ?

Diagnostic criteria – Disorder-specific criteria set (Presenting Problem) – Subtypes and specifiers (Presenting Problem) • Explanatory text information – Diagnostic features (Presenting Problem) – Associated features (Presenting Problem) – Prevalence (Presenting Problem) – Development and course (Predisposing, Perpetuating and Protective Factors) – Risk and prognostic factors (Predisposing, Perpetuating Protective Factors) – Culture-related diagnostic issues (5 P’s) – Gender-related diagnostic issues (5 P’s) – Suicide risk (Presenting Problem) – Functional consequences (Perpetuating Factors) – Differential diagnosis (Presenting Problem) – Comorbidity (Presenting Problem and Perpetuating Factors)

Case of Helen Helen was fired from her job one month ag because she started making numerous mistakes and had trouble concentrating. About three months ago she started feeling "down“ after a break-up with a man she had been dating for a few months. She has trouble falling asleep and has noticed a significant decline in her appetite. She feels like a failure and believes that no one will want to hire her again. She has thoughts of committing suicide but admits, "I could never do it." The only thing that seems to help is when she participates in a bible-reading group every Tuesday night. She explains, "During that time I'm more like my old self and at least that night I can sleep." She also reports that her mood improves when she visits her friends. However, she reports such low energy throughout the day that she is unable to schedule a job interview. She had a similar episode about two years ago after she was laid off from her former job. She reports that it took four months before she began feeling "normal" again and positive about herself. Her history indicates that her mother had severe depression and was hospitalized on several occasions when Helen was young. She describes her as “negative” and often absent in her youth. However, Helen always did well in school and had an active social life. Her work history has been very consistent up to her lay off.

Diagnostic Work-Up • DSM-5 measures: – Level 1(positive for depression, sleep problems and avoiding certain events) – PHQ-9, Score = 20 (Severe) – WHODAS 2.0 • General Disability Score = 85 (2.36; Mild) • Subscale: Life activities = 14 (3.5; Moderate) • Subscale: Participation in Society = 28 ( 3.5; Moderate) • Differential diagnosis: What are the possibilities? • Diagnostic Impression: 296.33 Major Depressive Disorder, recurrent, severe severity V62.29 Other Problems related to employment

Case Formulation • Why is she so depressed? – Predisposing factors? – Precipitating factors? – Perpetuating factors? – Positive or protective factors? • How does the diagnosis and case formulation inform your treatment plan?

Guide to Case Formulation 1. State the problem or diagnostic impression. 2. State the precipitant 3. Describe critical predisposing factors 4. Include a statement about perpetuating or maintaining factors 5. Highlight protective and positive qualities

Write a Case Formulation Helen presents with......(1) which appears to be precipitated by.....(2). Factors that seem to have predisposed her to depression include....(3). The current problem is maintained by....(4). However, her protective and positive factors include....(5).

From Formulation to Treatment • How does the formulation inform the treatment plan? – Best practices for this disorder? – Which types of interventions will address the predisposing, precipitating and perpetuating factors? – How do you ensure that diversity factors are considered? – How do you tailor treatments so that they are more strength-based?