Diagnosis of client: ?? Major Depression (Major Depressive Disorder) BackgroundSignificant signs and/or symptoms associated with Major DepressionAccording to the DSM-5 is feeling hopeless or depressed most of the day, psychomotor agitation or retardation regularly, having excessive feelings of guilt or worthlessness. The person or patient haven’t encountered a manic or hypomanic state, symptoms have lasted for at least two consecutive weeks (Reynolds, and Kamphaus, 2013, p. 1)BackgroundIn this diagnosis, the client is a Caucasian female, and she’s been battling depression since she was 17 years old. She currently works as a drug abuse counselor. Throughout the years she has gone through multiple suicide attempts and even hospitalizations. She expressed than since small, around four years old she has experienced hatred and anger towards her teachers, friends and even family. When in high school she went through the horrible experience of the death of her boyfriend. She is not part of any extracurricular activities and says is not interested in a romantic relationship either. She doesn’t have what we call a social life, and she feels even though she frequently communicates with her family that they don’t understand her. She hides her emotional pains by fake smiling and going shopping to cope. She feels guilty for the shame this disorder brings to her family. Are there any predisposing factors?I would say one of the most significant factors was the coping with the tragic death of her boyfriend in high school even though mourning of a loved one doesn’t account for is a definite sign of MDD (McGraw-Hill, 2007). Also, another factor is the worrisome behaviors she’s had since she was in elementary school. But genetically speaking, I don’t think any factors predisposed the client. ObservationsDescribe any symptoms observed during diagnosis?One of the significant signs was her smile; it was too consistent as if she was hiding her real emotions, it’s like she put on a façade. She even said, “how she feels guilty for the shamefulness that has been brought upon her family for her disorder.” She is also doing suggestive behavior that correlates with psychomotor agitation. The client has been hospitalized with or without consent, and she has a long history of isolation and self-harm by even sleeping 22 hours out of the 24 of the day. Describe any symptoms or behaviors inconsistent with diagnosisIn most situations those who suffer from this are not functional, they don’t go anywhere or do anything, they just stay at home. Tara, on the other hand, is entirely functioning. She can keep her job, get up, get dressed; she even maintains her excellent hygiene. Nobody would know what she suffers from at work since she separates her feelings from what she deals with at work. Data relevant to the developing of the disorderMajor Depressive Disorder is closely similar to Dysthymic Disorder but is a bit more severe due to that Major depression has suicidal or homicidal thoughts and or tendencies. Dysthymic Disorder is very functional but does not have the ideas or trends for suicide or violent actions. Statistics show that 24% of females and 15% of males suffer from or will suffer from depression (McGraw-Hill, 2007).DiagnosisWhere there any medical conditions observed that might indicate the diagnosis?In the aspect of dealing with depression, there are no physical medical conditions that contribute to the diagnosis. Just like other mood disorders, it is a neurological factor that it can’t only be fixed surgically but also requires the potential use of antidepressants to help stabilize the neurotransmitters sent from the brain to the body. Where there any psychosocial or environmental are factors contributing to the diagnosis?To notice if there is any neurological condition just like in other symptoms it may require a CT scan to determine it. She does remains isolated other than with her family she does not have friends. The only things she does is to shop and go home to watch tv then go to bed. She does have experience the loss of a boyfriend in high school. What is the safety of the client overall? (Suicidal or homicidally)She is at high risk of committing suicide. Other than her history of attempting suicide and her hospitalizations, she expresses she would like to die, it’s just not right for everyone else and she just “shouldn’t.” I believe she is at high risk of exhibiting unsafe behaviors due to her history of anger and isolation with her long history of suicidal attempts. Are there any cross-cultural issues that affect the differential diagnosis?The closer it gets to dealing with the diagnosis, cultural psychology should not be seen as a psychiatric treatment of ethnicities (Alarcon, 2009, pg. 134, para. 2).TherapeuticWhat are the short-term goals?She should go out more than just shopping for clothes this way she could start developing a social network. She could also do like a log of her emotions kind of like a journal and maybe even visit a psychiatrist.What are the long-term goals?Very importantly she needs to express or communicate with a psychiatrist or her family about her feelings or any issues she faces while taking her medications. She should start family therapy so she can finally see how supportive her family is even though she can’t understand it right now. She can’t miss any of the bilateral or individual therapy sessions. Most appropriate strategy and why?The best strategy for her is to maintain her medications, and slowly trying to go out and meet new people to develop her social life. It is super talented that her family remains by her side and be supportive by showing her they are not ashamed of her or her diagnosis. Also with bilateral therapy is essential for Tara to begin uncovering the causes for her condition.Least to moderate strategy and why?Decreasing her isolation and suicidal tendencies with strict medication is the least productive strategy. Medications may help reduce symptoms and increase stability, but they cannot alter the environment or the client’s anti-social behavior. Bilateral therapy helps find the leading causes to help them overcome obstacles but cannot change the fact of being isolated. It makes it hard for a person to continue making positive changes if they don’t get that positive reinforcement by family, co-workers, etc. Positive encouragement helps heal, negatives reduce the positive atmosphere and therefore the outcome. Diagnosis of client: Dysthymic Disorder / Persistent Depressive DisorderBackgroundSignificant signs and/or symptoms associated withDysthymic Disorder According to the American Psychological Association in the current Diagnostic and Statistical Manual of Mental Illnesses (DSM-5), the significant symptoms by persons that suffer from Dysthymic Disorder are lack of proper hygiene, depression for longer than two years, having a chronic low-leveled depression. Indifference to Major depression they do not want or need to harm themselves, difficulty maintaining employment (McGraw-Hill, 2007). BackgroundThe patient is a 32 y/o white male called Robert and who has been in a depressive state for around two decades. He was raised in poverty and still sticks with what he knows. Robert lives in a small apartment and its proud of working the system for money and benefits. He also works part-time and doesn’t interact much at work; he is anti-social at work. Are there any predisposing factors?He blames being bullied as a young child for lack of friends and hobbies for his personal or unsolved conflicts. The client was raised in Poverty and claims he has been depressed and having low self-esteem for as long as he can remember. Even though he has a part-time job, he lacks in employment that is substantial to help him have a healthier and more positive lifestyle. From being raised in poverty, he instead keeps what he knows instead of seeking more and to do better.ObservationsDescribe the observed symptoms that support diagnosisHe functions in society, but he is in that persistent depressive state due to his lack of will to change his situation. Dysthymic Disorder lasts about for two years or more plus, and one is non-self-harming and still functional. He might often have the urges to get up and clean but lacks the motivational aspect to keep going until he finishes to maintain a decent home. His living condition is an image of his continuous state of depression.Behaviors and or symptoms inconsistent with PDD diagnosisHe said in his interview “I purposely make sure I keep my benefits and enjoy ripping off the system.” When he works, he remains isolated rather than engage with co-workers. Even though he can make conscious decisions to better himself and his situation he father stick to what he’s always known.Developmental aspects of Dysthymic Disorder or PDDOn average, there is no exact cause as to what the definite purpose of a person to develop PDD or Dysthymic Disorder is according to McGraw-Hill (2007). However, it may have to do with neurochemical disturbances. Dysthymic Disorder is a learned behavior as well. It is much recommended that one seeks a full medical evaluation to be able to determine a reason for their mood change better DiagnosisIn the case of Robert, it is concluded that he suffers from PDD based on the significance of the persistent problems. Refunding to improve the situation he is apparently able to change, being what he knows from his childhood and because he can be functional and not harm himself, he lacks the major aspect of Major depression. Observation of evidence of general medical conditions by the clientIt is clear that the client suffers from PDD but hasn’t been diagnosed with medical which can increase the development or increase of dysthymic disorder. Where there any psychosocial or environmental are factors contributing to the diagnosis?Robert has lived in fear of being bullied as a child causing him to develop anti-social behaviors. The state is controllable, but he refuses to step-out and overcomes it. What is the overall level of safety and or concern for the client? (suicidal/homicidal)Overall the client is moderately safe. Because PDD and Major Depression are nearly identical, remaining isolated and refusing to get help can have some adverse effects on him. He may become suicidal at one point or if pressured to change it can lead him to harm others. TreatmentWe must remember that this disorder can last for years and even decades. The psychologist should help adapt and overcome instead or just pushing in a manner that can result in an adverse outcome or set back of any progress that’s been made already.Short-term goalsFirst of all, he should go through a full medical checkup that way any possibilities of any other medical conditions affecting his disorder can be ruled out or noted. He could also see a psychiatrist that can give him mood stabilizers or anti-depressants. Another thing that would be good for him is to be part of cognitive therapy to help him change his views on life and maybe help him want to get out of that shell he is in. Long-term goalsThe long-term goals with CBT are to change how outlook in life, this will be accomplished by helping the patient extend his social network and make friendships and be even involved in extracurricular activities. It will help him move from what he’s known and been through during childhood to a better life.Which strategy is most appropriate and why?With the use of Cognitive Behavioral Therapy, the client may overcome anxiety and develop ways to cope and therefore become more social. With this process, the patient will be able to change his views on life as well as improve social networks, etc.Which strategy is moderately appropriate and why?It would be advised that moderately having the client go through a full medical evaluation, help better in ruling out any other potential medical conditions influencing the disorder. Even though Medications like mood stabilizers and anti-depressants work on a neurological level, they do not help in situations that can be controlled through the development of coping skills and support networks. Diagnosis of client: Bipolar DisorderBackgroundSignificant signs and/or symptoms associated with BipolardisorderAccording to the DSM-5, Bipolar Disorder symptoms consist of mania, hypomania, and depression. Mania leads to increased energy amounts, poor judgment, restlessness, and even hypersexual activities. Hypomania, on the other hand, does not typically affect a persons’ day to day living. The state of depression affects the patient’s ability to act and lack social interaction cognitively. BackgroundHe is currently unemployed even though he has a college degree and has previously worked as a prison social worker. Bernie is a 38-year-old, African-American male, who grew up in New Jersey in a middle-class neighborhood. Are there any predisposing factors?The main factors for Bipolar disorder are life-changing events and genetic factors. One of the main factors might be the fact that his immediate family has a history of Bipolar disorder. Also, he noted that he went through several great breakups while in college getting him into a deep state of depression. He has a substance abuse problem of alcoholism, ObservationsDescribe any symptoms observed during diagnosis (behaviors or statements made by client)Even though during the evaluation he didn’t show any significant signs or behaviors, he mentioned that he has willingly continued to go to support groups, and can determine when his cycles are coming up. He expressed that he usually has a calm period of 1-3 weeks in between mania and depression. It needs to be noted that while in college following a break up he became out of control finishing up involuntarily committed to a psychiatric facility. During the interview process, he seems calm. Describe any symptoms or behaviors inconsistent with the Bipolar diagnosisIt can be noted that he does not exhibit practices which are incompatible with Bipolar disorder. Developmental factors of Bipolar DisorderMainly BD happens in the result of genetics, but it can also be caused by significant life-changing situations. Even though having good and bad conditions is life is healthy, it is known that BD is a reaction to the neurological transmitter connection if it’s broken. DiagnosisWhere there any medical conditions observed that might indicate the development of the diagnosis?He appeared healthy overall and did not show signs of medical issues. Where there any environmental or psychosocial are factors contributing to the Bipolar diagnosis?Within his immediate family members, there is a history of the Bipolar disorder. Throughout his college years, he experienced very intense breakups with girlfriends which lead him to buried depressions. He had years of up and downs and went from being an All-Star in high school to just a regular student in college, while also having issues of substance abuse in college. What is the overall safety concern for the client? (suicidal or homicidal)Even though the client is not on medical insurance or medication and yet though he has a reasonably healthy lifestyle he still poses a threat to himself and others around him. HE admitted that through being depressive, he tends to drink heavily and to create dangerous scenarios. These situations may result in both suicide attempts or violent acts by driving intoxicated etc. What if any, cross-cultural issues affect the differential diagnosis?In many cultures, they do not look at his behaviors as being mentally ill but as natural reactions to hardships in life. Gladly on average each time more psychiatrists are exposed to people from all walks of life and different ethnic or cultural backgrounds. By understanding cultural differences, it can reduce unnecessary treatments and better understand and treat the disorder.TherapeuticShort-term goal interventionEven though the client has a productive and healthy lifestyle, he should get back on health insurance. Having insurance will help that he can attend CBT and individualized therapy to help monitor and be aware of any symptoms of a manic or hypomanic state. Long-term goal interventionThe client should maintain medications and therapies that can help in reducing and controlling the manic or hypomanic states. One of the long-term goals is to get and keep stable employment and be insured to be able to get the treatment he needs.Most appropriate strategy and why?I feel the best strategy is to get help to get employment and attend CBT and individual therapy as well. He should keep a healthy livid and get back on his treatment. Moderately appropriate strategy and why?The best reasonable plan in this situation is to continue the monitoring of manic and hypomanic states and continue the support groups.