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valoriel36
Using the case study below, answer the following questions in a…
Using the case study below, answer the following questions in a narrative form.
1. What would you diagnose the client with? Please provide justification and ensure you use proper specifiers if applicable.
2. Are there any differentials that you would consider? If so, what are they?
3. What would your treatment recommendations be? (is there a certain theory you’d use? Would you suggest individuals, families, couples, etc? Would you suggest medication and if so what would you think a prescriber would prescribe?).
Please ensure you explain why you chose the recommendations you did.
Maria Greco was a 23-year-old single woman who was referred for psychiatric evaluation by her cardiologist. In the prior 2 months, she had presented to the emergency room four times for acute complaints of palpitations, shortness of breath, sweats, trembling, and the fear that she was about to die. Each of these events had a rapid onset. The symptoms peaked within minutes, leaving her scared, exhausted, and fully convinced that she had just experienced a heart attack. Medical evaluations done right after these episodes yielded normal physical exam findings, vital signs, lab results, toxicology screens, and electrocardiograms.
The patient reported a total of five such attacks in the prior 3 months, with the panic occurring at work, at home, and while driving a car. She had developed a persistent fear of having other attacks, which led her to take many days off work and avoid exercise, driving, and coffee. Her sleep quality declined, as did her mood. She avoided social relationships. She did not accept the reassurance offered to her by friends and physicians, believing that the medical workups were negative because they were performed after the resolution of the symptoms. She continued to suspect that something was wrong with her heart and that without an accurate diagnosis, she was going to die. When she had a panic attack while asleep in the middle of the night, she finally agreed to see a psychiatrist.
Ms. Greco denied a history of previous psychiatric disorders except for a history of anxiety during childhood that had been diagnosed as a “school phobia.”
The patient’s mother had committed suicide by overdose 4 years earlier in the context of recurrent major depression. At the time of the evaluation, the patient was living with her father and two younger siblings. The patient had graduated from high school, was working as a telephone operator, and was not dating anyone. Her family and social histories were otherwise non-contributory.
On examination, the patient was an anxious-appearing, cooperative, coherent young woman. She denied depression but did appear worried and was preoccupied with the idea of having heart disease. She denied psychotic symptoms, confusion, and all suicidality. Her cognition was intact, insight was limited, and judgment was fair.
