CASE STUDY-DIAGNOSTIC IMPRESSIONS 2
Case Study 2: Diagnostic Impressions
Primary Diagnostic Impression
The primary diagnosis from the case study narrative is substance use depressive
disorder, per ICD 10 CM with diagnosis code F19.94. A person must meet various criteria per
the DSM 5 criteria to be diagnosed with substance use depressive disorder.
Listing of Criterion
One of the criteria is that a person with substance use depressive disorder must have
clinical features and physical symptoms suggestive of the substance use, and the features
presented are capable of causing a disturbance in the physical and psychological performance of
the client (Diagnostic and statistical manual of mental disorders, 2016). In the case study, Marci
meets this criterion because she cannot concentrate on her studies, loses interest in the activities
she previously enjoyed, and has a problem interacting with her parents such that most of the
time, she has to lie to them whenever they question her behavior.
The second criterion for substance uses depressive disorder is the presence of proof that
the client's problems arose due to substance use. The problems should have started after the
person started using the specified substances. Besides, there should be no other conditions that
may cause the problem, such as a medical condition. In the case study, merci meets this criterion.
From the history of the patient, the client was well and had no disturbances in her life until she
started using alcohol and marijuana; that the symptoms such as reckless driving, having
problems interacting with parents, and feeling of inadequacy such that she wanted to drop out of
school's started hence a proof that the symptoms were caused by the use of substances such as
marijuana and alcohol.
CASE STUDY-DIAGNOSTIC IMPRESSIONS 3
The third criterion of the disorder is that the substance involved should have the ability to
elicit the symptoms presented by the client. In the case study narrative, the client used alcohol
and marijuana, substances that can cause anxiety, depression, mood disorders, and impaired
social interactions, as justified by the client. In conclusion, the client meets the diagnostic criteria
of substance use depressive disorder.
The tasks required to obtain alcohol, consume it or deal with its effects take up a lot of
time. Marci exhibits actions that point to alcohol abuse and excessive consumption. The case
study details Marci's frequent attendance at parties, her tendency to drink alone on school nights,
and how she frequently misses classes because she oversleeps after a night of drinking.
Alcohol consumption on a regular basis in potentially dangerous situations. In light of
recent pregnancy scares and a potential current pregnancy due to a missed period, Marci
expressed her worry. Despite being aware of the harm alcohol can do to a developing baby's
health, she has persisted in using it. According to the case narrative, Marci also reportedly
consumes alcohol alone in her room on school nights. If she falls and hits something
unintentionally, this could be particularly dangerous for her physical health.
Marci adopted the ongoing alcohol use due to failure to fulfill significant role and
obligations at school, home or work, Marci adopted the ongoing alcohol use. Due to her drinking
and missed classes the following day, Marci is having academic difficulties. The case narrative
also details her employment difficulties, stating that over the previous four years, she has been
fired or left four other jobs—three for excessive absenteeism and one for property destruction—
and explained that she has struggled with finding work.
Prevalence, Culture, Gender issues, Functional Consequences, and Comorbidities
CASE STUDY-DIAGNOSTIC IMPRESSIONS 4
In the United States of America, the prevalence of substance use depressive disorder is at
7.6%, affecting a larger percentage of the youths (McHugh & Weiss, 2019). Alcohol
consumption disorder is prevalent in the US population, as stated by the DSM-5 (American
Psychiatric Association, 2013). The male gender is more affected as compared to the female
gender. Most males use substances such as alcohol and marijuana at a higher rate than females;
hence they are more affected. Substance use depressive disorder has various functional
consequences. Some of the functional consequences of the disorder include impaired social
interactions, inadequate interactions skills, and low self-esteem, as shown by the client in the
case study. There are various comorbidities existing with substance use depressive disorder. The
common comorbidities include disorders such as major depression, anxiety disorder, and mood
disorders such as mania which can be fatal and increase the cost of treatment.
Multiple factors stemming from both heredity and environment contribute to the wide
variation seen among cultures in the prevalence of alcohol use disorder. Alcohol consumption
also differs by gender and race/ethnicity, which is highlighted by the additional cultural and
gender-related data. When it comes to alcohol use, men around the world are heavier drinkers
than women, and women in economically advanced nations are heavier drinkers than those in
less developed nations, according to this study (American Psychiatric Association, 2013). It's
also been found that men in the US have a higher likelihood to drink alcohol and report heavy
drinking than women.
A wide variety of practical repercussions might come along with alcohol use disorder.
The diagnostic criteria this disorder point out the many functioning domains at risk of being
compromised. The capacity to drive a car or operate heavy machinery safely, to do well in class
and on the job, to keep up positive relationships and open lines of communication, and to remain
CASE STUDY-DIAGNOSTIC IMPRESSIONS 5
in good health are all good examples. In addition to "elevated rates of homelessness,"
"accidents," "violence," and "suicide," the DSM-5 claims that "alcohol-related disorders lead to
absenteeism from work" and "poor employee productivity." Some of the additional health
repercussions include liver disease, lack of inhibition, depression and irritability, immune system
suppression, and an increased risk of heart disease. The DSM-5 recognizes disorders like bipolar
disorder, schizophrenia, and antisocial personality disorder as possible co-occurring conditions
with alcohol use disorder. Additionally, anxiety and depression may also be linked to
alcoholism; the transient effects of alcohol on depressed symptoms may explain the correlation
between depression and moderate to severe alcoholism (American Psychiatric Association,
2013).
Differential Diagnosis
Substance use depressive disorder has to be differentiated from other conditions
presenting with similar symptoms. The significant disorders in which a differential diagnosis can
be made include depression caused by the presence of another medical condition. Other
differential diagnoses include primary depressive disorder, which is not related to substance use,
and substance intoxication or withdrawal, which presents with similar symptoms as Substance-
induced depressive disorder. It is good to examine the patient and rule out if any other medical
conditions may be causing the disorder apart from the use of substances.
Secondary Diagnosis Impression
One secondary diagnosis for the client is Alcohol Use Disorder with an ICD 10 code of
F10.9. The client in the case study narrative has various characteristic symptoms that make them
qualify for the secondary diagnosis of alcohol use disorder as per the DSM 5 Classifications. The
criteria of alcohol use disorder include an urge to consume alcohol, several failed attempts to
CASE STUDY-DIAGNOSTIC IMPRESSIONS 6
stop alcohol, a craving for alcohol, and recurrent use of alcohol that affects the person's normal
function and reduces social interaction due to alcohol use (Diagnostic and statistical manual of
mental disorders, 2016). A person has the disorder if they have two of the symptoms. Merci has
tried to stop using alcohol but failed, and she always has a strong urge to take alcohol, even in
custody. The symptoms presented by merci, therefore, make her meet the criterion for alcohol
use disorder as per the DSM 5 classification.
Prevalence, Culture, Gender issues, Functional Consequences, and Comorbidities
In the united states of America, the prevalence of Alcohol use disorder is higher in males
than in females. For example, in every 12 men, one has AUD, while in every twenty-five
females, one has AUD. Concerning this gender, males are more affected than females. A person's
culture plays a significant role in the development of AUD. For example, a family that uses
alcohol has a higher probability of its children consuming alcohol and other drugs such as
marijuana. In the case study, we see that merci parents are both consumers of alcohol, which
may have played a critical role in making merci an alcoholic because she cannot control the urge
to take alcohol and other substances such as marijuana. Alcohol use disorder has various
functional consequences, including impaired judgment and ineffective reasoning. For instance,
merci has impaired reasoning such that she cannot see the importance of studying, so she focuses
on her studies. Besides, alcohol affects the social interaction of children and parents, as seen in
the case of merci, whereby she avoids her parents due to fear that they may question her
behavior. The comorbidities existing with alcohol use disorder include major depression
disorder, anxiety disorder, and mood-related disorders such as episodes of hyper mania and
hypomania.
CASE STUDY-DIAGNOSTIC IMPRESSIONS 7
According to the CDC, smoking causes the deaths of more than 480,000 people in the
United States each year. Alcohol and substance abuse disorders, bipolar disorder, depression,
personality disorders, anxiety, and attention deficit hyperactivity disorder are the most frequent
types of mental comorbidities. If they don't kick the habit, smokers have a 50 percent chance of
passing away from tobacco-related illnesses at an earlier age. The inhalation of secondhand
smoke, often known as passive smoking, has been shown to "raise the risk of heart disease and
cancer by 30%." (American Psychiatric Association, 2013).
Listing of criterions
First, in spite of repeated hopes and failed attempts, cigarette usage persists. Marci says she tried
to quit smoking a year ago and was successful for six months but that she is now addicted again
and does not want to give up the habit. Secondly, Marci has smoked cigarettes regularly since
she was 16 years old and currently smokes a pack a day. She has no plans to give it up or reduce
her intake. Moreover, habitual smoking while in physically dangerous situations: Marci had been
worried about not having her period lately. Smoking during pregnancy is dangerous for both the
mother and the developing child. Lastly, smoking regularly when in potentially dangerous
situations: Marci says she's worried about the absence of her menstruation because she was
smoking while she doubted being pregnant, which is dangerous for the mother and the unborn
child.
Differential Diagnosis
Some mental and psychological disorders present the same way as alcohol use disorder.
To come up with a definitive diagnosis, an individual must conduct a differential diagnosis to
rule out other related conditions. One differential diagnosis is ruling out major depression
because it also presents almost similar to alcohol use disorder. Major depression disorder is
CASE STUDY-DIAGNOSTIC IMPRESSIONS 8
caused by other factors such as stressful events and financial loss and should be there even
before a person consumes alcohol. Alcohol intensifies depression.
On the other hand, alcohol use disorder develops after a person has started using alcohol
over a given period, such that their activities of daily living have been affected. In this case,
major depression is ruled out because merci initially had no episodes of depression. Still, the
conditions started after she was introduced to using drugs hence the primary diagnosis of
substance use depressive disorder and a secondary diagnosis of alcohol use disorder as per the
DSM 5 classification of mental illness.
The DSM-5 does not offer a possible differential diagnosis for tobacco use disorder.
According to American Psychiatric Association, (2013), a person is said to have a tobacco use
disorder if they are dependent on nicotine, which is found in tobacco, according to the DSM-5.
Nicotine is a psychoactive substance that affects the mind and is a highly addictive stimulant of
the central nervous system; its addictive properties include drug-reinforced behavior, obsessive
use, relapse after abstinence, tolerance, and physical andGphysical dependence. Marci exhibits
dependent symptoms and actions that are related to the things mentioned above.
CASE STUDY-DIAGNOSTIC IMPRESSIONS 9
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(5th ed.). Washington, DC: Author
Centers for Disease Control and Prevention. (2020). Burden of Cigarette Use in the U.S.
https://www.cdc.gov/tobacco/campaign/tips/resources/data/cigarette-smoking-in-united-
states.html
Diagnostic and statistical manual of mental disorders. DSM Library. (2016). Retrieved
September 24, 2022, from
https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787
McHugh, R. K., & Weiss, R. D. (2019). Alcohol use disorder and depressive disorders.GAlcohol
research: current reviews,G40(1).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6799954/
Powered by TCPDF (www.tcpdf.org)
