Assignment
Case Vignette
Winston was an 85-year-old white male who was taken to the psychiatric emergency room (ER) by paramedics after they had been called to his residence by neighbors when they identified an odd smell. Apparently, his 87-year-old sister had passed away a few days earlier after a long illness. Winston had not reported her death due to becoming very disorganized as his sister's health worsened. He was worried that his landlord would use the apartment's condition as a reason for evicting him. He had tried to clean up, but his attempts consisted of mainly moving things from one place to another. He stated that he was about to call for assistance when the police and paramedics arrived.
In the ER, Winston recognized that his actions were odd and that he should have called for assistance sooner. At times, he became tearful when discussing his sister's death. Other times, he would seem aloof, and speak about the events in a calm, factual way. He also wanted to clarify that his apartment had been messy but that a lot of it was his large collection of articles on a topic he had been researching for many decades.
A licensed electrician, locksmith, and plumber, Winston had worked until age 65. He described his sister who had passed as having been "a little strange." She had been married once, briefly, and had never worked. Outside of her brief marriage, she and Winston had lived in the family's two-bedroom apartment their entire lives. Neither of them had ever seen a psychiatrist.
When questioned, Winston stated that he had never had a romantic or sexual relationship and had never had many friends or social contacts outside of his family. He stated that he had been poor and Polish and had to work all the time. He enjoyed his intellectual interests and had taken night classes at times. He was upset when he realized his sister was dying, but he stated he felt "numb" versus depressed. He denied any history of manic or psychotic symptoms. After an hour with the psychiatric trainee, Winston confided that he hoped the medical school might be interested in some of his papers after his death. He stated he believed that some of the technologies he wrote about were on the verge of making a breakthrough with bioluminescent and genetics that might allow the skin of animals and then humans to glow in subtle colors that would allow humans to recognize emotions more directly.
On examination, Winston was a thin, elderly man who was dressed neatly in khakis and a button-down shirt. He was meticulous and much preferred to discuss his interests rather than himself. He made appropriate eye contact and had a polite, pleasant demeanor. His speech was coherent and goal-directed. His mood was "fine," and his affect was appropriate though perhaps unusually cheerful given the circumstances. He denied all symptoms of psychosis, depression, and mania. Aside from his comments about his articles, he said nothing that sounded delusional. He was cognitively intact, and his insight and judgment were considered generally good, although historically impaired in regard to his delay in calling the police about his sister.
Task
A. What is the principal diagnosis or reason for the visit that you would assign to this client? What criteria does this client meet for the diagnosis? - Cite/support in APA format (minimum of 1-2 paragraphs)
B. What is the Prevailing Pattern? How prevalent is this disorder? Are there any risk factors to consider such as age, gender, culture, ethnicity, socioeconomic status, etc. that would apply or be important to consider for this client? - Cite/support in APA format (minimum of 1-2 paragraphs) -
C. What is the Differential Assessment? How are you able to differentiate this disorder from another for this client? Are there any factors of comorbidity to consider? - Cite/support in APA format (minimum of 1-2 paragraphs)
D. What is the Assessment Summary? Clearly identify why you feel this client meets the criteria? - Cite/support in APA format (minimum of 2-3 paragraphs) - points
E. What is the DSM-5 diagnosis/F-Codes/ICD-11/Specifiers for this client?