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The Case of FARIDAH – There should be 1 F code and 1 Z code INTAKE…
The Case of FARIDAH – There should be 1 F code and 1 Z code
INTAKE DATE: May xxxx
IDENTIFYING/DEMOGRAPHIC DATA:
This is a voluntary admission for this 32 year old Black male. This is Faridah’s first psychiatric hospitalization. Faridah has been married for 13 years and has been separated from his wife for the past three months. He has currently been living with his sister. His family residence is in Nashville, TN where his wife, two daughters and son reside. Faridah graduated high school then attended a technical school for computers. In the past, Faridah worked for seven years at the front desk of a hotel. For the past three years Faridah has been employed at a local print shop. Religious affiliation is agnostic.
CHIEF COMPLAINT/PRESENTING PROBLEM:
“I need to learn to deal with my wife wanting a divorce.”
HISTORY OF PRESENT ILLNESS:
This admission was precipitated by Faridah’s increased depression with passive suicidal ideation in the past three months prior to admission. He identifies a major stressor of his wife and three children leaving him three months prior to admission. Faridah has had a past history of alcohol binges but only drinks periodically now when there is a need for coping mechanisms in times of stress. Faridah was starting vacation from work just prior to admission and recognized that if he did not come to the hospital he did not know what would happen. Faridah reports that in the past three months since separating from his wife, he has experienced sad mood, fearfulness, and passive suicidal ideation. He denies a specific suicidal plan. Wife reports that during these past three months prior to admission, Faridah made a verbal suicide threat.
Faridah reports he has been increasingly withdrawn/non-communicative. His motivation has decreased and he finds himself “sitting around and not interested in doing chores at home”. He reports decreased concentration at work and increased distractibility. Faridah has experienced increased irritability, decreased self-esteem, and feelings of guilt/self-blame. There is no change in appetite. Faridah states for many years he doesn’t sleep, having a past history of working double shifts when requested. Faridah reports his normal sleep pattern for many years has been generally three hours of unbroken sleep. He then feels tired and ends up sleeping more than his average pattern. Wife reports he has not been violent with her since they have been separated.
Faridah denies suicidal ideation at the present time while on the evaluation unit.
PAST PSYCHIATRIC HISTORY:
Faridah was seen on an outpatient basis by Dr. S, for a period of two months prior to admission. He was being seen for individual counseling because of the marital problems and depression. Dr. S recently referred Faridah for inpatient treatment.
SUBSTANCE USE HISTORY:
Faridah reports a history of some alcohol binges in the past. He began drinking beer 12 years ago. His pattern of drinking was to get drunk with his social group approximately twice per month. He denies a history of blackouts. He admits to the alcohol binges in the past. Since his marital breakup, Faridah reports using alcohol as a coping mechanism for stress (reporting that he will only drink on weekends now but doesn’t get drunk).
PAST MEDICAL HISTORY:
Faridah reports having been involved in a motor vehicle accident with loss of consciousness 16 years ago. He states he has no memory of the accident. Faridah had a past history of fractured toes with pins being inserted in the third and fourth digits in his right foot after an accident in which he crushed his foot playing sports. Faridah denies a past history of seizures.
Faridah smokes approximately two packs of cigarettes per day. Faridah is allergic to Codeine.
FAMILY MEDICAL AND PSYCHIATRIC HISTORY:
Father and grandfather have a history of cardiovascular disease.
Faridah reports that while growing up his parents maintained a satisfactory relationship. Father reportedly worked nights and slept during the day. Faridah did not have much contact with his father but now enjoys a close relationship with his father. He states he has always had his parents support.
During Faridah’s school years, he reports he was an underachiever in elementary school. He denies having had a history of discipline problems or hyperactivity. He states he did well in high school and earned grades of A’s and B’s. F played football in HS.
Faridah has been married for 13 years and has recently been separated for the past three months. F and his wife have three children including a daughter, age 12, a daughter, age 8, and a son age 7. Faridah states he feels very invested as a parent and feels close to his children.
Leisure time activities Faridah has enjoyed in the past include playing softball, skiing, reading, playing poker, and watching football. His wife has complained that he is doing less of that now. Faridah states he has several close friends.
CURRENT FAMILY ISSUES AND DYNAMICS:
Wife reports that Faridah’s difficulties began to get worse a few months ago when she decided to move out of the house due to Faridah’s increasing erratic behavior. She moved into her parents’ house and Faridah is living with his sister. Wife states that Faridah has been suffering from mood swings. At one point, after threats from his wife, Faridah told her that he had gone to a clinic for outpatient rehabilitation, but she did not believe him.
Wife describes Faridah as “extremely depressed” now and says Faridah states, “life is over…I wish I was dead…don’t send the kids over to visit because I don’t want them to find my dead body…everything I touch turns to garbage. Wife adds that Faridah suffers from poor self esteem, lack of sleep and an extremely boastful attitude. On the positive side he is a good father, compassionate, creative, and could be an outstanding person.
Wife reports Faridah always had a bad relationship with his mother. Faridah is close to his father who is reported to have an alcohol problem and was allegedly loud and intimidating.
Faridah is currently employed by his wife’s father. Faridah states he has financial problems now due to paying for counseling and child support.
MENTAL STATUS EXAM:
Faridah presents as a casually dressed male who appears his stated age of 32. Posture is relaxed. Facial expressions are appropriate to thought content. Motor activity is appropriate. Speech is clear and there are no speech impediments noted. Thoughts are logical and organized. There is no evidence of delusions or hallucinations, which Faridah denies. Faridah admits to a recent history of passive suicidal ideation without a plan, but denies suicidal or homicidal ideation at the present time. His wife has observed a history of notable mood swings. No manic-like symptoms are observed at the time of this examination.
On formal mental status examination, Faridah is found to be oriented to three spheres. Fund of knowledge is appropriate to educational level. Recent and remote memory appear intact. Faridah was able to calculate serial 7’s. In response to three wishes, Faridah replied “I wish that my marriage would work out and that my kids would be happy and that someone would give me a million dollars.”
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)
Explain how you support the diagnosis by specifically identifying the criteria from the case study.
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.
Identify the differential diagnosis you considered.
Explain why you excluded this diagnosis/diagnoses.
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.
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
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (DSM-5-TR) (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787Links to an external site.
Bipolar and Related Disorders
Read the introduction to this classification on page 139, and then focus on:
“Bipolar I Disorder” (pp. 139-150)
“Bipolar II Disorder” (pp. 150-159)
“Cyclothymia Disorder” (pp. 159-162)
“Other Specified Bipolar and Related Disorder” (pp. 168-175)
Depressive Disorders
Read the introduction to this classification on page 177, and then focus on:
“Disruptive Mood Dysregulation Disorder” (pp. 178-182)
“Major Depressive Disorder” (pp. 128-192)
“Persistent Depressive Disorder” (pp. 193-197)
“Premenstrual Dysphoric Disorder” (pp. 197-200)
American Psychiatric Association. (2022). DSM-5-TR online assessment measures.Links to an external site. https://www.psychiatry.org/psychiatrists/practice/dsm/educational-resources/assessment-measures
Document: Week 4 Case Study
Note: Your Instructor will post an Announcement this week with details for retrieving the case study
Example Case:
Below is the explanation for the Case of Arthur and an example of how to write out the information. For bullet 2, it is critical that you list the criteria from the DSM 5-TR and align the symptoms from the case. Please remember that you can single space so that you do not exceed two pages.
Bullet 1 – Case of Arthur
F84.0 Autism Spectrum Disorder, Level I “requiring support”
F95.1 Persistent Motor or Vocal Tic Disorder, with motor tics only
Z55.9 Academic or Educational Problem
Z65.8 Other Problem Related to Psychosocial Circumstances
Z72.810 Child or Adolescent Antisocial Behavior
Bullet 2 – Diagnosis Explanation:
F84.0 Autism Spectrum Disorder, Level I “requiring support”
A. (must have all three)
1) Deficits in social-emotional reciprocity…..
2) Deficits in nonverbal communicative behaviors used for social interaction, ranging……
Arthur has trouble with restlessness and will stumble over his words, pause excessively, and restart talking fairly rapidly and loudly
3) Deficits in developing, maintaining, and understanding relationships, ranging….
B. Restricted, repetitive patterns of behaviors, interests, or activities….two of the following…
1) Stereotyped or repetitive motor movements, use of objects or speech
Carrying around toy cars in his pockets, which he proudly displays and talks about in detail
2) Insistence of sameness………..
Hates any type of transition and will get upset and have temper tantrums if she does not prepare him for any changes in plans
3) Highly restricted, fixated interests…………
He talks more about this topic at other times at school.
4) Hyper- or hypo-reactivity to sensory input Not present
F95.1 Persistent Motor or Vocal Tic Disorder, with motor tics only
A, B, C, D, E – facial tics
Other conditions that may be a focus of clinical attention (Z codes)
Arthur is having challenges in school as well as with friends and he had to be watched for homicidal attempts which is why the antisocial behavior is noted
Z55.9 Academic or Educational Problem
Z65.8 Other Problem Related to Psychosocial Circumstances
Z72.810 Child or Adolescent Antisocial Behavior
Bullet 3 – list the diagnosis you considered and ruled out
Bullet 4 – Give the reason you ruled out the diagnoses in bullet 3
Bullet 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. (cite a reference)
Bullet 6 – Identify the Z codes and explain the reason you selected them
