Assignment task: Submit your diagnosis for the client in the case. Follow the guidelines below.
The diagnosis should appear on one line in the following order.
Note: Do not include the plus sign in your diagnosis. Instead, write the indicated items next to each other.
Code + Name + Specifier (appears on its own first line)
Z code (appears on its own line next with its name written next to the code)
1. Explain how you support the diagnosis by specifically identifying the criteria from the case study.
2. Describe in detail how the client's symptoms match up with the specific diagnostic criteria for the disorder (or all the disorders) that you finally selected for the client. You do not need to repeat the diagnostic code in the explanation.
3. Identify the differential diagnosis you considered.
4. Explain why you excluded this diagnosis/diagnoses.
5. Explain the specific factors of culture that are or may be relevant to the case and the diagnosis, which may include the cultural concepts of distress.
6. Explain why you chose the Z codes you have for this client.
Remember: When using Z codes, stay focused on the psychosocial and environmental impact on the client within the last 12 months.
CASE of JADA:
Intake Date: September 2021
IDENTIFYING/DEMOGRAPHIC DATA: Jada is a 32-year-old, divorced, heterosexual African American female. Jada works in a doctor's office as a receptionist and lives in a one-bedroom apartment. Jada has no children.
CHIEF COMPLAINT/PRESENTING PROBLEM: Jada came to the intake session with complaints of depression with passive suicidal thoughts, anxiousness, and trouble sleeping. Jada's primary concern was the added stress in helping her mother with her illness. Jada reports over this past month or so she often "isolates" which makes her feel alone. Jada description points to always feeling empty although she denies this when asked.
HISTORY OF PRESENT ILLNESS: Jada stated that one year ago she allowed one of her brother's friends to move in with her as a favor because he was homeless and had nowhere to go. She said she believed he was a sweet person who just has had a hard time in life, and she wanted to help him. She had been supporting him financially over the last month and was concerned because it appears that he has not made any effort to get a job. She feared she made a mistake allowing him into her home and has thrown him out several times. Jada then felt bad and allowed him back in each time. Jada said that she and this new roommate had sex one time when he first moved in. She said they both got very intoxicated, and she is not sure exactly what happened, but she blacked out and found him in her bed, undressed. She then told him she had herpes, and he responded that it had been a "mistake" and that he did not want to have sex with her again because he was afraid of getting infected. Jada became angry with him at this. Jada explained that her promiscuity through her twenties had resulted in this lifelong disease, and she expressed anger and resentment toward some men she had sex with. She said even though the herpes is controlled with medication she feels embarrassed. She said she feels used, slighted, and humiliated by the man now living in her home and wishes he would be different.
PAST PSYCHIATRIC HISTORY: Jada reports a history of threatening suicide since she was a teenager. She denies any suicide attempts. Jada reports being in and out of therapy for years with many different therapists. She always ends up "firing" them because they just do not understand.
SUBSTANCE USE HISTORY: Jada stated she was addicted to heroin and using daily years ago. Jada reports that she began using marijuana at 14 years old. As she entered high school she began experimenting with many different kinds of drugs. Her heroin use began when she was 21 years old. When she completed her prison sentence, she was paroled and mandated to attend a 1-year outpatient drug treatment program, which she successfully completed. Jada reported that she returned to using cocaine 2 years ago, stating that it helps her do her fast-paced job better and it keeps her energy up so she can help her mother early in the morning and late at night. She said no one in her family or at her job knows that she has been doing drugs. Jada believes the cocaine use is just an added stress reliever. Jada reports using shopping as "retail" therapy. She reports shopping has been a great relief from the time she was working full time.
LEGAL HISTORY: Jada has an arrest history and was incarcerated for 3 years for drug-related charges at 24 years old. She was charged with possession with intent to distribute.
PAST MEDICAL HISTORY: Jada takes numerous medications prescribed to her by her primary care doctor, including an antidepressant and pain medication.
FAMILY HISTORY INCLUDING MEDICAL AND PSYCHIATRIC: Jada is the oldest of four children (two brothers and one sister), all of whom are married and live in the same community. Jada reports never feeling as important as her siblings and has fought with them often over the years. She indicates she loves her family very much. She thinks her siblings are selfish and believes that is why she is the only one helping her mom now.
CURRENT FAMILY ISSUES AND DYNAMICS: Jada states she is close with all her siblings but sometimes gets so frustrated with them she "can't stand them". Jada is the primary caretaker of her mother, who was involved in a car accident 20 years ago and was left a quadriplegic. Jada goes to her home daily to help with her personal hygiene. Jada shared her feelings about being her mother's primary caretaker, stating, "I love my mom, but everyone expects me to care for her. It feels so unfair, but it's because I am not married and don't have any children, this is when I really hate my siblings." Jada believes her family looks at her differently since she has a criminal history. She said her father does not help with the care of her mother and that all he does is "hang out" and drink. She reported feeling increasingly frustrated with this added responsibility and resentful that her father and siblings have relegated this job to her. She sometimes resents her mother for being in this situation. She was dysphoric as she shared this content and described being "stuck." She described her father as a "manipulative loser."
MENTAL STATUS EXAM: Jada presented as casually groomed, coherent, and goal directed. She appeared older than her state age. Jada denies any suicide attempts but does have suicidal ideation often. She denied homicidal ideation. Jada was agitated throughout the interview. Her motor activity was jittery. Her speech was soft and dragged out. Jada denies hallucinations and delusions.