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Primary and secondary diagnoses

The main condition that resulted to Smith’s admission to care is alcohol and substance use. Some of the direct symptoms that were observed in the patient, which point to alcohol and substance abuse include: feeling of anxieties and being jumpy, shaking hands, serious depression, being irritable, feeling of tiredness, nausea and vomiting, as well as lack of appetite (Gitlow, 2006). Furthermore, the patient has reddish eyes and sometimes gets irritated by people around her. All these symptoms point to alcohol and substance use (Freud, 2013). Apart from the above primary conditions, there are several secondary issues observed in the patient. For example, the patient manifests dysthymic disorder. This is because Smith expresses feelings of committing suicide, and has low self-esteem.

There are many occasions where Smith has attempted to commit suicide. In fact, at some point Smith went to seek advice on how she can concentrate on her work. This is because the disorder is characterized by neglect of responsibilities. In addition to the above observations, Smith also experiences sleep and appetite disturbances, low self-worth, and general body fatigue. In her life as a child, she has been in an abusive family, where her mother would hurl insults at her and beat her up (Freud, 2013). This has psychologically affected her, thereby contributing to dysthymic disorder. Her father would also take alcohol and come back home abusive and arrogant. Her disorder makes the people around her nor comfortable to hang around with her because she sometimes gets violent and can start physically exchanging attacking them (Ikkos, 2000).

The reasons for selecting the primary and secondary diagnoses

Smith’s conditions point to the diagnoses selected above. This is because she has had a long history of alcohol and substance abuse, coupled with depression that borders dysthymic disorder. Her background points to years of distress and quest for a better life. She was admitted to a rehabilitation center for overuse of alcohol and drugs (Ikkos, 2000). What motivated her to resort to taking alcohol and drugs is that she longed to escape the troubles she faced in life, seeking one job after another. For example, her emotional problems have been interfering with her ability to focus on her work and secure her job. This is because she had problems maintaining a single job, as she would be fired from one job to another (Freud, 2013). The whole problem began during her childhood. She was born in a family of three kids after an uncomplicated pregnancy and deliveries. Her younger sister depended on her after school. This means that she had to work harder to fend for them. Such pressures, accompanied by prolonged physical and emotional attacks by parents, caused depression, thereby resulting in a state in which she had to rely on alcohol to ease her emotional feelings (Ikkos, 2000).

Differential Diagnoses

The conditions that Smith is facing can be confused with major depression. However, there are various characteristics of the complication that makes it different from major depression. Smith manifests symptoms such as attempted suicide, where she has on some occasions tried to take her life away (Freud, 2013). In addition, she feels excessively irritated to the extent that she can harm the people around her by hurling insults and physically attacking them. Furthermore, Smith lacks appetite, and sometimes feels like she does not want to eat. This makes her weak and lean in nature. The conditions that she is facing have resulted in poor concentration at work and in the company of other people, as well as feeling of hopelessness and low self-esteem. These conditions point to dysthymic disorder, which is different from major depression in many ways. First, dysthymic disorder can make the victims harm the people around her, while major depression does not go to this extent. Secondly, dysthymic disorder may result in feeling of committing suicide. Major depression does not have feelings of suicide. Therefore, the differences are clearer, suggesting that the above patient is not suffering from dysthymic disorder (MMHE, 2015).

The reasons for selecting the differential diagnosis

The differential diagnosis has been selected since its share several features with the above patient’s symptoms. The patient was exhibiting some characteristics related to the diagnostics, although not all of them. For instance, Smith is sometimes feels extreme sadness, anger and irritability. In addition, the patient sometimes finds it difficult to sleep, coupled with loss of appetite. Loss of appetite results in a situation in which the patient becomes weak and hungry looking. Because of the above problems, the patient resorts to alcohol and substance abuse as an escape for consolation purposes (MMHE, 2015).

Why the actual diagnoses are better fit than the differential diagnosis

There are many ways in which the actual diagnoses are better fit than the differential diagnoses. The diagnoses accurately describe the conditions that the patient is going through, and can be used for interventions. For example, the differential diagnoses (alcohol and substance use plus dysthymic disorder), which are to some extent similar to the actual diagnosis (major depression), share some differences in the way they are manifested in the symptoms (Ikkos, 2000). For instance, the actual diagnostic is a condition which can last for more than five years, while the differential diagnosis is a condition that takes around two years at most. In this case, Smith has had prolonged disorder of alcohol and substance abuse coupled with dysthymic disorder since childhood. In addition, the actual condition is characterized by feeling of suicide, which is lacking in the differential diagnostics. This means that the actual diagnostic is more accurate and better.

Whether diagnosis from other conditions is warranted

The patient has been suffering from dysthimic disorder and alcohol and substance abuse for over a decade. This calls for diagnosis from other conditions. This is because, with time, the patient may have physical changes in their brain over time (Sadock & Sadock, 2011). Additionally, the problem may be genetically induced, owing to the fact that her m other also showed signs of depression and irritability, while her father used to be an alcohol addict.

References

Freud, S. (2013). Psychological evaluation (Pdf document). Maladaptive behavior and psychopathology.

Gitlow, S. (2006). Substance use disorders: A practical guide. Lippincott Williams & Wilkins.

Ikkos, G. (2000). Interpersonal Psychotherapy for Dysthymic Disorder by JC MarkowitzJ. C..

Published by the American Psychiatric Press, Washi. British Journal of Psychotherapy,

17(1), 125-127.

MMHE. (2015). Faces of abnormal psychology. MMHE. Retrieved from:

http://www.mhhe.com/socscience/psychology/faces/

Sadock, B. J., & Sadock, V. A. (2011). Kaplan and Sadock's synopsis of psychiatry: Behavioral

sciences/clinical psychiatry. Lippincott Williams & Wilkins.