DualRole-Play Diagnostic Mastery Exercise
DualRole-Play Diagnostic Mastery Exercise
Conclusivediagnosis of mental health problems has been a major challenge in themedical sector, and to date, there are no scientifically provenavenues to help establish specific patient disorders. The fate of apatient lies on the keenness and accuracy of a psychiatric beforesettling on a particular disorder (Barkley, 2014). There arediagnostic schedules that help medical practitioners to compare theinformation obtained from their patients with the set standards.Nevertheless, diagnosis remains a major challenge, and more oftenthan not patients feel that they have been misdiagnosed (Hoge et al.2014). The truth about an individual’s mental status can never beconclusive in the absence of proper and straightforward tests toestablish the same. Research is underway to establish the bestavenues to mental disorders diagnosis (Barlow, 2014). Until such atime that there will be improvements, psychiatrists have theresponsibility to do their best in establishing solutions to theendless cases of mental disorders (Khoury et al. 2013). In an attemptto explore the dynamics revolving around diagnosis and treatment ofmental conditions, this paper explores a simulated interview and theapproach towards the most desirable diagnosis and treatmentrecommendations.
DualRole-Play Diagnostic Mastery Exercise Part I
Theinterviewee, Jessica, is cooperative and quite easy to talk to evenon very sensitive issues. The key reason behind the session was tohandle anger issues. The patient considers herself as an easilyirritated individual who loses control whenever things fall out ofproportion. From the interview, she outlines that her parents havecalled law enforcement personnel on her because she overreacted andalmost harmed the family members by a knife. Jessica is 16, and shefeels that everything she does is typical of any teenager of her age.However, from a psychologist’s point of view, there is more toJessica’s current course of action than mere anger managementskills. Her life at home and school are the determinants of hercharacter, and if the family had taken measures to mitigate the trendrather than despise her, she would be a better individual than she istoday. She showed a negative attitude towards everything and at somepoint indicated that she would perform better at school and getstraight A’s, but she would not do that because she did not care.She mentioned that she would perform better at basketball, but therewas no motivation from the coach for her to do so. The proceedingparagraphs will focus on the patient’s background to help indiagnosis as well as suggesting the best way forward for a solutionto a condition that may be detrimental to Jessica and the peoplearound her.
Lackof attention from the people around Jessica prove to be the mainsource of her anger and negative attitude towards everything. Duringthe interview session, she opens up because of the confidenceinstilled in her by the interviewer. She has a normal life likeanyone else. She explains why she gets angry and the only person sheis close to is her sister whom she believes understands her and nevercrosses her path. She has a mother, a brother, and a step dad thatshe feels do not care about her. Jessica’s father has not seen herin more than four years, and she gets no motivation whatsoever to besocial and normally interact with others. She does not have friendsbecause whenever she makes any new ones, they end up leaving becauseof fear that she is going to get upset at some time and compromiseeverything. Humans are emotional by nature, and it is normal for thepatient to have a negative attitude if no one cares about them orwhat goes on in their lives (Long & Tong, 2014). She is ready towork things out with her family and admits to the psychiatrist thatworking things out with her family would be a splendid foundation forhelping her to solve her issues. If Jessica’s parents would sparesome time to talk to her and motivate her and prove to her that shematters, maybe her anger problem will cease to be an issue. From thesessions, it is crystal clear that some of her actions are driven bythe attempt to seek attention and demand autonomy that comes with thevirtue of being human.
Jessicais an intelligent and vibrant young girl with the ability to be abetter citizen with a bright future. She is aware of everything thatgoes on around her and admits that she has issues bonding andcoexisting with her family members. There is nothing outrageous abouther life. She does everything that would be expected of a regularteenager. She goes to school and attends parties like anyone else.During the session, she embraces everything that the psychiatristrequires, and when engaged in intellectual sessions, she proves to bebrilliant. Her writing, reading, and cognitive skills are exemplary.She has a trace of the family tree and understands how issues havebeen unfolding within the nuclear and the extended family context.She indicates that her grandmother in Florida understands her and shementions that she is one of the people who never make her angry. Shedoes not do drugs, and everything that goes on in her life may beenvironmentally induced. The most encouraging part of the interviewwas that she knows how the society perceives her and she is ready towork out the problems and coexist peacefully with everyone. Accordingto her, she is not the problem and being upset is a part of her thatpeople should understand and learn to live with whatsoever. Herunderstanding of life in its entirety is an indication of highintellectual ability that presents a strong foundation for executionof any medication or restructuring strategies.
Jessicais most likely suffering from Disruptive Mood Dysregulation Disorder(DMDD). The disorder is quite new in the mental arena. The disorderis characterized by spontaneous episodes of unwarranted actions(Sperry & Carlson, 2013). Individuals suffering from the disorderhave been reported to have major temper tantrums. The patient getspissed off at things that should be normal and brushed off by a smilefrom normal people. How does one explain extreme anger because of apresident’s speech that hijacks a show? The patient gets angry tothe point that she throws a knife at people she is purportedlysupposed to love and protect. She cannot make friends and keep thembecause sooner rather than later they are going to leave because ofher anger. Friends do not leave because of such fears unless there issomething outrageous about the condition. The whole point of havingpeople around is to help support an individual when they are at theirworst. Anger is part of humanity and friends always stay close andsolve issues whenever they arise. However, that is not the case withJessica, and whenever she gets angry, she may not be a threat toherself but is disastrous to people around her. Research has revealedthat DMDD is common in teenagers especially in circumstances wherethere is a minimal parental support to mitigate the problem (Baer,2015). The disorder is further escalated by the adolescence stagethat makes teenagers believe that they are right and everyone else iswrong and always antagonizing them. Research has revealed that DMDDpatients feel a sense of relief once they have released the tensionthat affects them despite the actions involved in theprocess(Seligman & Csikszentmihalyi, 2014). It does not end therewhen they engage in aggressive activities that may pose a threat toothers. If the patients hurt other people, they feel remorse andregret their actions.
Thereare multiple causes of DMDD which include genetic factors, physicalstructures, and to some extend the surrounding influence. Medicalpractitioners confirm that DMDD may be caused by abnormaldevelopments in brain segments which control arousal and inhibitionactivities. However, physical factors are not a major contributor toDMDD. Most patients that show the symptoms of the effect are as aresult of environmental factors (Harkness et al. 2014). Mostindividuals who tend to be angry and aggressive around the clockestablish the traits from their surroundings. Psychologists havehypothesized that most DMDD patients developed the traits from harshbackgrounds or families (Fujita & Su, 2015). These are people whonever appreciate peace, love, and kindness because they never got achance to be part of such virtues. The character, Jessica, is in herworld and despite being at a sensitive stage of her life, there isnobody who interacts with her and motivates her towards living anormal life. The environment, in this case, is the main contributorto Jessica’s anger. She outlines that Taylor gets all the attentionand her parents never care about her demands. Jessica loves hergrandmother because she is the only one who pays attention to herdemands. Despite living in Florida, Jessica seems to love hergrandmother than anyone else in the family. Environmental factors, inJessica’s case, outplays any other possible cause of DMDD from thecomprehensive assessment as depicted in the videos.
Thereare many defined signs and symptoms of DMDD. Behavioral symptomsinclude physical and verbal aggressiveness, angry outbursts, damagingproperty, and physical attack on people or objects among many others(American Psychiatric Association, 2013). Psychosocial symptomsinclude feelings of rage and uncontrolled irritability. Jessica oncegot mad and had the parents call the police to stabilize thesituation. She threw a knife at the cabinet. Nobody got hurt andmaybe she was just lucky. At school, she is at times summoned andconfined to the nurses or the principal’s office because of heranger problem. Effects of the disorder include impairedinterpersonal relationships, legal problems, low self-esteem, troubleat work, home, and school among many others (American PsychologicalAssociation, 2009). All the highlighted signs and symptoms point toJessica’s current state. She is irritated by issues that regularpeople would brush off and laugh about as if nothing ever happened.She feels that everybody is always out to piss her off and thatjeopardizes her relationship with other people. She has a problem atschool and home. People usually make mistakes, and that seems not tomake any sense to the patient in question. She feels that everybodyshould give in to her demands and that tend to keep people away fromher. She does not have friends despite the willingness to make newones, and that haunts her on regular occasions.
Treatmentfor Jessica’s condition is quite a challenge since there has neverbeen conclusive research on dealing with the disorder. However,psychiatrists have found counseling sessions to be quite effectivesince 97% of the cases result from environmentally induced actions(American Psychiatric Association, 2013). Cooperative patients, likeJessica, are quite easy and convenient to help because theyacknowledge the existence of a problem that requires immediateattention. Guidance and counseling help the patients to perceive theworld in a different way and embrace others without prejudice orextreme demands for total attention (Yam & Simms, 2014). Angermanagement skills and blending into the society should be thepriority in dealing with such patients. The best part of dealing withthe disorder is that it is not a permanent medical condition and thesolution lies with a practitioner’s ability to exploit theversatility of humanity. The patients need a reason to forego aparticular course that psychologists regard as primitive and take ona new line of life (Hopwood & Sellbom, 2013). However, people areresistant to change, and they need concrete reasons to change theirway of life from one course to another. Informing IED patients of thethreat they pose to others and themselves because of anger managementissues, and aggressive reactions may be a best starting point tosolving the bigger problem (Cicchetti, 2016). Above all, establishinga serein environment that will enable a patient to confide in apsychiatrist will greatly determine the outcome of the guidance andcounseling sessions.
DualRole-Play Diagnostic Mastery Exercise Part II
July 24, 2016 Client Vivienne Wood
Age: 22 DOB:
Relationship Status: Not married, or currently in arelationship. Delusion of being married to Matthew McConaughey
Referral Contact: Police brought into the hospital due to awell-being call from a roommate.
Mental Status Examination
Interview with parents
Review of ER medical records
Presenting Problem: Vivienne discusses her intention to takeTylenol PM to be “reunited with her (fictional) children to savethe world.” Vivienne is sad nothing makes her happy.
Stressors: Broke up with the boyfriend about one year ago,quit soccer team, quit school.
Substance Abuse: Blood test at ER-negative for any substancesor toxins.
Social: Vivienne is a 22-year-old Caucasian young woman.Vivienne is one of three children. She has an older brother that ismarried with two children and an older sister that is engaged to bemarried. Vivienne’s parents are still married and the biologicalparents of Vivienne and her two siblings. Vivienne’s parents livefour hours away. Her father and brother are lawyers and her motherand sister are journalists. Vivienne attends church. Viviennecurrently lives with Sarah, a former teammate from the college soccerteam. Sarah and Vivienne have lived together for the last two years.Vivienne played on the soccer team in high school and college until ayear ago when she quit the team. Vivienne had a lot of friends whilegrowing up.
Relationship History: Vivienne reports being married toMatthew McConaughey and having two children, both girls, ages 2 and4. Vivienne broke up with her boyfriend Alex Smith last year. Alexand Vivienne met in class. He played on the college football team.
Spirituality: Vivienne attends church.
Employment: Vivienne does not work.
Health: There are not any health concerns being treated.Vivienne has not been eating. She is concerned that her husband ispoisoning her food. She can only drink bottled water. She issleeping only a few hours at a time. Vivienne saw a counselor in thefall at the suggestion of her teammates when she quit the soccerteam. She was too tired and sad to keep playing soccer. She iscurrently sad.
Vivienne requires many sessions because her landing to a counselingsession was invoked by an attempt to kill herself. She wanted to takepills before her roommate intervened and called the police to rescueher. She is a threat to herself and should not be left alone becauseat some point she may break and cause great harm to herself. She hashallucinations and claims to be hearing voices during her counselingsession.
From the assessment, Vivienne is most likely suffering from abipolar type of schizoaffective disorder. The diagnosis is from thecombination of schizophrenia symptoms depicted by the patient. Shehas incidents of hallucinations and delusions. Depression and maniaare also evident from her assessment. If untreated, the disorder maylead to major problems at work, school, or even around friends.
Mental Status Examination: Vivienne was wearing a nice dressand was groomed. She had a flat affect. Experienced auditoryhallucinations and held conversations with the two “friends”talking to her in her head. Vivienne also saw her daughter in thecorner of the room.
The ability of a client to confide in the interviewer and open upwithout any limits is the first step to solving any mental disorder(Maercker et al. 2013). Trust is difficult to earn, and it is theresponsibility of the concerned practitioners to ensure that theirpatients can open up and offer all the information required tosuggest a treatment that will solve the existing problem. Vivienne isquite cooperative, and she recognizes that she has a problem.Acceptance is the first stage in dealing with mental issues (Travis,2014). The Vivienne interview took a positive path when she showed astrong will to cooperate and communicate her concerns towards gettinga remedy to her unending pains.
Confidentiality in the psychiatric context refers to the demand bythe outlined rules of professionalism to ensure that no informationbetween the practitioner and the patient leaves the room unless thereis a threat to the patient or a third party (Morey et al. 2013).Confidentiality helps the patients to share all the informationdespite the level of sensitivity because they are sure that suchinformation can never get out to unauthorised persons. The patientscan conveniently let all the load off their chest. The limitation toletting out information may be detrimental to the other concernedparties (Nesse, 2015). In Vivienne’s case,for instance, the conflict involving her husband will never beresolved unless she finds a way to get her to attend the sessions.She thinks her husband poisons her food and that makes her survive onwater. Confidentiality limits the ability to embrace an existingproblem and solve it from the roots as in Vivienne’s case.
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