To begin, while the presenter of the grand rounds seemingly endeavored to evaluate the patient within the ethical guidelines set forth by the APA’s (2010) ethical code of conduct, he (the presenter) fell short when he failed to maintain ethical practices in terms of gathering collateral. The presenter had clear permission via a signed release of information form to garner insight/data from the patient’s friends; however, the patient did not sign a release of information form to obtain information from his mother. Nevertheless, the psychologist (presenter) proceeded to gather info by hiring a private detective to acquire the patient’s mothers contact information so that he could speak with her about the patient’s life and treatment. According to the American Psychological Association’s code of conduct, this is a violation of a standard 4.05 in that the patient did NOT provide consent to the psychologist to disclose his confidential info (APA, 2010). This was a serious breech in confidentiality and the patient’s rights to privacy.
Relevant information from the patient’s history, which will be utilized to inform my conceptualization of the patient’s problems and diagnosis include: The patient is an only child. He grew up in a low-income, conservative, and extremely religious environment. His father was absent frequently throughout the patient’s childhood, which left him in the care of his “strict, short-tempered” mother who was predisposed to enraged outbursts over inconsequential matters. The patient’s mother worked in the patient’s school during junior high, where she reportedly checked-up on him frequently. Bob, the patient, left home at 18 to study psychology at University in San Diego. He lived in the dorms, made friends rather easily, and joined a fraternity his within his first few years at the University. While he kept in contact with his parents, the patient severed contact with his mother at her suggestion of moving to San Diego to be close to him. The patient graduated with a 3.2 GPA and began working for the county as a psychiatric tech, wherein he remained for a total of 14 years. The patient reportedly undergoes routine physicals and denies any illicit substance use. The patient does report drinking on occasion with friends from his fraternity; however, there is no indication that his drinking habits extend beyond this. Additionally, the patient revealed his father died one year ago.
The patient does not present with any substantial psychiatric problems. His primary concerns deal with career choice and general life direction. While the patient does illustrate some observed anxiety, he has been largely friendly, open, and cooperative; however, he does become hesitant and guarded when talking about childhood experiences and his family. Thus, evaluating this patient through a psychoanalytic lens would seem most beneficial. The whole basis/point of psychoanalysis is to help patients release repressed experiences and emotions (McLeod, 2007), and therefore bringing the unconscious into consciousness in an overall effort to produce a cathartic experience to promote healing. For this patient, it appears that his problems may derive from unresolved issues that took place during development and also potentially from repressed traumatic experiences with his mother.
In this case, the patient’s information largely conflicts and diverges with the collateral information. According to the patient’s friends, the patient’s personality took a sudden downhill turn about three years prior. Where the patient was once friendly, outgoing, and sociable, he is now closed off, reclusive, and suspicious. He has also reportedly lost a significant amount of weight in only a few short months and has become highly unreliable in terms of showing up for work and/ or returning his friends’ phone calls. This is not how the patient portrays himself when attending his sessions with the psychologist. Thus, through the employment of the DSM-5 manual, my diagnosis is unspecified anxiety disorder; however, my differential diagnosis would be substance use disorders, mood disorders, anxiety disorders, and possibly adjustment disorder. I chose this manual due to its comprehensiveness and its ability to acknowledge possible differential diagnoses, which can aid in preventing misdiagnosis and/or over-diagnosis. While I do believe that the patient has an unspecifiable anxiety disorder, I also believe that there might be substance use even though the patient denied any such use.
While there really aren’t any treatments for unspecified anxiety disorder, most patients with anxiety are treated with a combination of cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) (Boyle, 2014). However, with there not being much insight and research into treating unspecified anxiety disorders, each of these approaches to treatment can be viewed as non-evidence based interventions as well. Nevertheless, therapy would seem like the best way to help this patient deal with his symptoms/issues.
Questions for my colleagues:
· Given the information above, how does Bob’s childhood experiences play into the issues he is having now?
· Is Bob’s seeming anxiety and lack of life direction a product of losing his father?
· How can I use the newly acquired collateral to make a definitive diagnosis?
References:
Morrison, J. (2014). DSM-5 made easy: The clinician’s guide to diagnosis. New York, NY: The Guilford Press.
McLeod, S. A. (2007). Psychoanalysis. Retrieved from www.simplypsychology.org/psychoanalysis.html
Boyle, A. M. (2014). Unspecified Anxiety Disorder Diagnosis Significantly Decreases Treatment for Veterans. Retrieved from http://www.usmedicine.com/agencies/department-of-veterans-affairs/unspecified-anxiety-disorder-diagnosis-significantly-decreases-treatment-for-veterans/
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