This experience is to expose you to a variety of cases, diagnoses, and treatment options as well as the contemporary research that surrounds those cases. This is also to offer a view from others acting as a “treatment team” offering thoughts on treatment options and suggestions for care in this case conceptualization exercise. In your review of a case make sure your presentation includes: Use of technology/terminology, Content and knowledge and relevance of topics addressed according to the research, confidence, professionalism, and address areas not already covered by a peer. Professionalism in team meetings includes timeliness, positive critique and review of the case and in summary ask 4 compelling questions about the case adding substantive feedback to your peer.
Sample:
Thank you for writing your case study on Joan Crawford. I have intrigued by her for a long time and had considered her as my subject for my own case study. It was a pleasure to read your case study and read the information that you provided. I believe that you did a very well case study and easy to understand. I believe that her diagnosis was spot on and fit the symptoms that she exhibited.
Here are some questions and comments that I have regarding your case study:
- You mentioned in your case study that Ms. Crawford’s father abandoned her and her family before her birth and died at a young age. She thought her stepfather was her biological father until her brother provided information on the truth. Do you believe that the combination of her father’s abandonment and early death along with her mother’s withholding the correct information regarding her biological father may have played a small role in her current behavior? I also would like to know why her stepfather left her mother in 1916 and the source of tension in his relationship with Ms. Crawford’s mother.
- You noted in your case study that Ms. Crawford was married three time with all of the marriages lasting five years. Do you believe that the lack of real father figure in her life and confusion of the real identity of her biological father may have played a role in the length of her marriages?
- You noted in the case study that Ms. Crawford feels a sense of “emptiness” in her life. I believe that this might be an area where additional information would help answer why she feels this way.
- As for impulse control, you note that Ms. Crawford “is compulsive and when she is angry she will lose control and ‘hit her daughter.’” I get a sense that she may have a little bit of anger management or regulation issues. Have you thought about some behavior therapy to work on those issues?
- You note that Ms. Crawford suffers from migraine headaches. How often does she get these type of headaches and how long would the episodes last? Who is treating her for the migraines and is she taking any prescription or over the counter medication to treat them?
- Under abuse history, you note that Ms. Crawford reported that she was sexually abused by her stepfather at age 10. On the other hand, under the parent history, you mentioned that you did not recall any parental history of abuse. Do you know if there was anything else going on between her stepfather? Do you know if her mother was aware of the sexual abuse by her stepfather? How was she sexually abused? Do you know if she was raped or another form of sexual abuse? I believe some additional information would help provide a clearer picture.
- You mention in your case study that she has been drinking excessively since she was in her early 20’s and drinks to “calm her nerves.” Do you have additional information about how often she’s drinking and whether she mixes prescription medication with the alcohol? Does she have any patterns of when she starts to drink excessively or whether a particular behavior brings it on?
- I do not see anything or I missed it, but I do not see anything about what type of theory you would be using to treat Ms. Crawford. What theory will be your focus as you treat her?
I believe that the treatment plan that you have for Ms. Crawford would be beneficial for her. I look forward to reading how her progress goes as you treat her.
Patient: Character Henry Evans from the movie “The Good Son”
Age: 12
BIOPSYCHOSOCIAL ASSESSMENT INTAKE
DATE(S) OF ASSESSMENT: September 21, 2021
DATE REPORT WRITTEN: September 21, 2021
NAME: Henry Evans
DOB: April 8, 2009 AGE: 12
GENDER: male
MARITAL STATUS: single
OCCUPATION: none
NATIONALITY/ETHNICITY: Caucasian
RACE: White
RESIDENCE/LIVING CIRCUMSTANCES: Resides with his mother and father (Susan and Wallace Evans), and sister (Connie Evans). One brother is deceased. His cousin, Mark Evans comes to live with the family after Mark’s mother passing.
ADDRESS: 1111 Streetway, Newport, Maine
PHONE: (207) 820-0005
SOCIAL SECURITY: 423-00-1234
INSURANCE/CASH PAY: Blue Cross Blue Shield
REFERRAL SOURCE: Dr. Alice
PRIMARY CARE MD: Dr. Dana Lyles
EDUCATIONAL HISTORY: Henry is currently in the sixth grade. He does well in school. There are no reports of failing or repeating a grade, learning disorder or behavior problems at school.
VOCATIONAL HISTORY & OCCUPATION: None
MILITARY SERVICE: None
BIOPSYCHOSOCIAL ASSESSMENT: Psychiatric History, Substance Abuse, Eating Disorders, Sexual, Trauma/Abuse, Hobbies, Spirituality, Observations
Cognitive impairments No
Psychotic Symptoms
Dissociative problems No
Irrational anxiety No
Unusual fears No
Repetitive thoughts or actions No
Paranoia No
Avoidance No
Increased arousal No
Hyper vigilance Yes
Flashbacks No
Mood problems/changes Yes
Sleeping problems No
Eating Problems No
Problems with Impulse control Yes
Physical complaints about illness or pain No
Adjustment problems—in the last 3 months have you been worried or upset about something that happened to you? Like a death, loss, separation from a job, friend, divorce, an accident, serious illness, or something like that? His uncle’s wife died. His sister almost drowned while they were ice skating. His cousin had to come and live with them.
Identify symptoms
Duration
Assess severity: None
Assess social interference None
Assess associated symptoms None
SUBSTANCE ABUSE HISTORY (Past/Present including dates): None
Date of onset of each symptom
How they describe themselves
Anything else that you think is important to know in order to understand one’s frame of
Psychiatric/Substance Abuse History
ALCOHOL: None
DRUGS: None
TOBACCO: Henry said he has smoked cigarettes before
VAPING: No
CAFFEINE (Energy drinks, soda, coffee, specialty drinks): None
OTHER SUBSTANCES: None
CROSS ADDICTIONS (Gaming, Gambling, Shopping…): None
AA/NA or other 12-step programs ever attended? (Dates, places, and description of what group meetings were like and why started and or stopped): N/A
Sponsor information:
ABUSE HISTORY
Was abuse ever reported with dates? no
As a note: What are the ethical and legal requirements for reporting abuse in your state?
SEXUAL No
PHYSICAL No
EMOTIONAL/VERBAL No
RAPE TRAUMA No
DOMESTIC VIOLENCE No
BULLYING No
CYBER ABUSE No
STALKING No
EATING DISORDERS
Anorexia Nervosa: Have you ever deliberately lost so much weight on a diet that people started to seriously worry about your health? No
Bulimia nervosa: Did you ever have a problem with binge eating, when you would eat so much food so fast that it made you feel sick? No
When you were doing this did you feel you’re eating binges were not really normal? N/A
Was the urge to binge sometimes so strong that you could not stop, even though you wanted to? N/A N/A
After you had binged, did you often feel depressed, ashamed, and disgusted with yourself?
Did you ever vomit after eating, use laxatives, or excessively exercise? No
Do you eat at night or times you are not aware of? No
Orthorexia (People who suffer from orthorexia develop an obsession with checking food contents labels)? No
Drunkorexia (Food intake restriction for the sake of alcohol consumption or binge drinking is an especially dangerous scenario). No
Pica syndrome – Eating or chewing on non-foods can be an obsessive-compulsive disorder caused by anxiety or lack of proper diet. No
Rumination is prevalent in children/adolescents with abuse hx or under major stress & can also be a part of anorexia. Rumination is when a person chews, swallows and then ‘spits up’ the food again only to continue chewing it. No
Fletcherizing is just the act of chewing food for a very extended period of time.
SEXUAL HISTORY (include dates of onset or change)
Sexual identification: heterosexual (says he likes girls.)
Sexual problems/complaints: No
Pornography: No
Bondage & Discipline / Domination & Submission / Sadism & Masochism (BDSM): No
HOBBIES/INTERESTS
He likes to experiment and make things. He likes to explore.
SPIRITUALITY
He attends church with his family on Sundays.
BEHAVIOR OBSERVATIONS
He was mild toned when talking. He was stoic when answering questions. He sat up in his chair. He appeared to have an awareness of what was going. He looked around a lot and did not give a lot of eye contact. He seemed to be a mature for his age. He did seem restless at some point during the assessment.
APPEARANCE
Appearance was neat. Clothes were clean, hair was neatly trimmed and he appears to be healthy.
INTERPERSONAL PRESENTATION
The client engaged with the counselor and was willing to answer questions.
FACIAL EXPRESSION: He maintained a serious, stoic look on his face.
POSTURE He sat upright in the chair. He had good posture for a young child.
MOTOR ACTIVITY Good motor activity. He was able to sit in chair, walk and move on his own ability.
SPEECH Very good speaking abilities. He was able to answer questions, ask questions and be verbally able to communicate.
MOOD/AFFECT Client states he is generally happy.
SLEEP PATTERNS Stated he sleeps well at night.
EATING He has normal eating habits.
ACTIVITIES OF DAILY LIVING He attends school, interact with his family after school, eat meals with family, do homework, play with his cousin in his tree house.
MOTIVATION Good motivation
ANXIETY/AGITATION/PANIC ATTACKS None reported
BEHAVIORAL CHANGES None reported by client.
IMPULSIVITY None
RACING THOUGHTS None
Mood/affect, Problem Solving, Memory, Concentration, MSE, Suicide Assessment, Legal/Ethical, Patient’s Concerns, Therapeutic Challenges
MOOD/AFFECT: Henry’s mood was relaxed. Affect was flat.
SLEEP PATTERNS: Henry reports that he has normal sleeping pattern.
EATING: None reported.
ACTIVITIES OF DAILY LIVING: Henry has normal daily activities that include attending school, interacting with family, having meals with family, play in shed that is like a tree house, doing homework.
MOTIVATION: Henry seems to be motivated when he is working on inventing new things his little shed located at his house. He attends schools regularly and maintains good grades. Henry loves the freedom his parents give him.
ANXIETY/AGITATION/PANIC ATTACKS: There were none reported.
BEHAVIORAL CHANGES: Henry’s cousin stated that his behavior has changed. He invents things to harm people and animals. The cousin observed him killing a dog and attempting to kill a cat. The client’s cousin reported him being aggressive with the dog. The client has increasingly become aggressive with his cousin and sister.
IMPULSIVITY: Henry has an impulsivity with harassing and harming animals.
RACING THOUGHTS: Henry has thoughts related to harming animals and family members. He seems to be fascinated with death.
PROBLEM-SOLVING: None reported.
SHORT & LONG-TERM MEMORY: Henry had good short and long term memory. He was able to recall events that happened in the past and recent occurrences. He also knew information such as personal information, family information and history, the death of his aunt and his cousin coming to live with them.
ATTENTION: Henry demonstrated good attention during the session.
CONCENTRATION: Good.
MENTAL STATUS EXAM: Henry was alert did not demonstrate any impairments related to orientation and or memory. He was fully aware of where he was and the purpose for being in the interview.
COMPREHENSION (3 STEP COMMAND): Henry was presented with a three step command. He was able to efficiently complete the following three step command: Walk the door, open the door and read the name on the door, close the door.
THOUGHT PROCESSES & CONTENT: Henry demonstrated a clear thought process. He was able to respond to questions about himself. His thoughts were organized and clear.
SUICIDAL/HOMICIDAL — SUICIDE ASSESSMENT SCALE: There was no reports from the client on having suicidal thoughts, or impulses, or thoughts of harming himself. It was noted that his cousin reported odd behaviors with his sister and he killed a neighbor’s dog. He has threatened to harm his cousin.
INSIGHT/JUDGEMENT: Henry has good insight but he lacks good judgment related to what is right and wrong.
PERSONALITY FACTORS (REHABILITATION CASES):
Abstractedness: Imaginative
Apprehension: Confident
Dominance: Submissive
Emotional stability: Calm
Liveliness: Restrained
Openness to change: Flexible
Perfectionism: Controlled
Privateness: Discreet
Reasoning: Abstract versus concrete
Rule-consciousness: Non-conforming
Self-reliance: Self-sufficient
Sensitivity: Tough-minded
Social boldness: Shy
Tension: Relaxed
Vigilance: Suspicious
Warmth: Reserved
STRENGTHS AND WEAKNESSES: Henry is very smart. His cognitive level seems well above his age. He is well spoken, artistic and creative. Weaknesses include being manipulative and he is not truthful about his behaviors.
SUPPORT SYSTEMS: Henry has a support from his mother and father. Henry does not have any friends at school or in the neighborhood.
LEGAL/ETHICAL ISSUES: Legal/ethical implications of the case relate to the age of the child and the reported allegations from the cousin. Issues such as confidentiality and other standards were discussed with the client and his parents.
PROGNOSIS: Henry can make significant progress with intensive treatment. Henry has to be truthful about his behaviors and thoughts.
PATIENT CONCERN’S/GOALS: No concerns
DSM 5 IMPRESSIONS:
Conduct Disorder DSM-5 312.81 (F91.1), 312.82 (F91.2), and 312.89 (F91.9)
Conduct Disorder is a DSM-5 diagnosis typically assigned to individuals under age 18, who habitually violate the rights of others, and will not conform their behavior to the law or social norms appropriate for their age. Conduct Disorder may also be described as juvenile delinquency; behavior patterns which will bring a young person into contact with the juvenile justice system, or other disciplinary action from parents or administrative discipline from schools. It is well established that Conduct Disorder can be a premorbid condition for APD (Antisocial Personality Disorder) or habitual adult criminality, especially when CU (Callous-Unemotional) traits are present. According to the DSM-5, to diagnose Conduct Disorder, least four of the following have to be present
Aggressive behavior toward others and animals.
Frequent physical altercations with others.
Use of a weapon to harm others.
Deliberately physically cruel to other people.
Deliberately physically cruel to animals.
Involvement in confrontational economic order crime- e.g., mugging.
Has perpetrated a forcible sex act on another.
Property destruction by arson.
Property destruction by other means.
Has engaged in non-confrontational economic order crime- e.g., breaking and entering.
Has engaged in non-confrontational retail theft, e.g., shoplifting.
Disregarded parent’s curfew prior to age 13.
Has run away from home at least two times.
Has been truant before age 13.
THERAPEUTIC CHALLENGES: The challenges with therapy include Henry not being truthful about what is really going on with him. Henry can be manipulative. He may resist medication.
BEHAVIORAL DEFINITIONS:
INTEGRATION:
LONG-TERM MEASURABLE GOAL: Participate in therapy (3 days per week) and medication (daily); decrease thoughts of harming others and animals.
SHORT TERM MEASURABLE GOALS: Participate in therapy (3 days per week) and medication (daily); decrease thoughts of harming others and animals.
THERAPEUTIC INTERVENTIONS/RECOMMENDATIONS:
Intervention: Medication and in-patient individual therapy for three days a week for an hour.
Objectives for long term goal: Participate in therapy (3 days per week) and medication (daily); decrease thoughts of harming others and animals.
Intervention: Individual therapy duration for three days a week for an hour.
AFTERCARE: Will be assessed/determined following 3 months of in-patient treatment.
PRESENT DIAGNOSIS ACCORDING TO DSM 5
Henry presents symptoms and behaviors Conduct Disorder DSM-5 312.81 (F91.1), 312.82 (F91.2), and 312.89 (F91.9).
RAPPORT
A good rapport has been established with Henry. He feels comfortable with talking with me and sharing information about himself. An environment has been established with Henry where he can be opened to talk about what he is feeling and his experiences. He has presented behaviors of not fully disclosing what he has done. He seems to know how to be manipulative. He shares information that will refute what has been presented about his past behaviors. It seems he does not what to be totally honest out of fear of being judged.
MOTIVATION
Henry seems to be motivated when he is working on inventing new things his little shed located at his house. He attends schools regularly and maintains good grades. Henry loves the freedom his parents give him.
RULE OUT DIAGNOSIS LIST
ADHD : Early age of onset when compared to conduct disorder
ODD: Milder form of conduct disorder, rights not violated
ASPD: Diagnosed after age 18
Adjustment reaction: Symptoms subside when stress is ended
Mood Disorder: Presence of persistent low mood and other core features
DIAGNOSTIC CRITERIA—Duration of symptoms, severity of symptoms
Conduct Disorder is a DSM-5 diagnosis typically assigned to individuals under age 18, who habitually violate the rights of others, and will not conform their behavior to the law or social norms appropriate for their age. Conduct Disorder may also be described as juvenile delinquency; behavior patterns which will bring a young person into contact with the juvenile justice system, or other disciplinary action from parents or administrative discipline from schools. It is well established that Conduct Disorder can be a premorbid condition for Antisocial Personality Disorder or habitual adult criminality, especially when Callous-Unemotional traits are present. According to the DSM-5, to diagnose Conduct Disorder, least four of the following have to be present:
• Aggressive behavior toward others and animals.
• Frequent physical altercations with others.
• Use of a weapon to harm others.
• Deliberately physically cruel to other people.
• Deliberately physically cruel to animals.
• Involvement in confrontational economic order crime- e.g., mugging.
• Has perpetrated a forcible sex act on another.
• Property destruction by arson.
• Property destruction by other means.
• Has engaged in non-confrontational economic order crime- e.g., breaking and entering.
• Has engaged in non-confrontational retail theft, e.g., shoplifting.
• Disregarded parent’s curfew prior to age 13.
• Has run away from home at least two times.
• Has been truant before age 13.
Duration: The behaviors and symptoms have been exhibited by Henry within the last 12 months.
Severity: Has previously exhibited behaviors such as aggressive behavior toward others and animals. frequent physical altercations with others; use of a weapon to harm others; deliberately physically cruel to other people; deliberately physically cruel to animals; lying, stealing, staying out at night
Personality Disorders: Henry shows no indication or evidence of a personality disorder.
Psychosocial & Environmental Problems: Henry’s family recently experienced the death of one of his sisters. Henry’s mother is experiencing grief and sadness. The family also experienced the death of the wife of Henry’s uncle. The cousin came to live with them following that death.
ALTERNATIVE DIAGNOSIS: Alternative diagnoses and basis for rule out are as following (Sagar, Patra, & Patil, 2019):
ADHD : Early age of onset when compared to conduct disorder
ODD: Milder form of conduct disorder, rights not violated
ASPD: Diagnosed after age 18
Adjustment reaction: Symptoms subside when stress is ended
Mood Disorder: Presence of persistent low mood and other core features
SUMMARY
Henry presents symptoms and behaviors Conduct Disorder DSM-5 312.81 (F91.1), 312.82 (F91.2), and 312.89 (F91.9). Has previously exhibited behaviors such as aggressive behavior toward others and animals. frequent physical altercations with others; use of a weapon to harm others; deliberately physically cruel to other people; deliberately physically cruel to animals; lying, stealing, staying out at night.
Psychiatric History: None reported
Course of Personality Disorders: None reported
Treatment History: No record oof pr reports of treatment history
Social History: Henry has not demonstrated any social problems in school or with his family prior to the observing of the behaviors in the past year. He attended school and seemingly got along well with his parents and siblings. His cousin came to live with them following the death of his mother. The behaviors were observed by his cousin and reported to his parents. Henry seemed to be a loner. He does not have any friends. He likes to go off by himself and play in the surrounding areas of his home. He has a shed that he frequently visits and stores things that he has stolen. He also creates weapons to use on animals.
Medical History: No reports of any serious medical problems.
Family History: There is no reported history of mental health issues with the family. Henry’s family recently experienced the death of one of his sisters. Henry’s mother is experiencing grief and sadness. The family also experienced the death of the wife of Henry’s uncle. The cousin came to live with them following that death. His family is very supportive of him.
Patient Prognosis: Henry can make significant progress with intensive treatment and medication. Henry has to be truthful about his behaviors and thoughts.
Clients Strengths: Henry is very smart. His cognitive level seems well above his age. He is well spoken, artistic and creative.
Clients Weaknesses: Weaknesses include being manipulative and he is not truthful about his behaviors.
Therapeutic Orientation
Based on the current research, I will be using for Cognitive Behavioral Therapy. I have diagnosed Henry with Conduct Disorder DSM-5 312.81 (F91.1), 312.82 (F91.2), and 312.89 (F91.9). This approach has been researched and found to be effective when working with children who have been diagnosed with conduct disorder. It focuses on the social cognition and improving the problem-solving skill in the social context in children and adolescents with conduct disorder. The therapist plays an active role, modeling the skills being taught, role-playing social situation with the child, prompting the use of skills being taught, and delivering feedback and praise for developing the skills. Can be used with other approaches and in multiple settings for possible generalization (Sagar, Patra & Patil, 2019).
Treatment Plan and Intervention
I have diagnosed my client, Henry with the following: Henry presents symptoms and behaviors Conduct Disorder DSM-5 312.81 (F91.1), 312.82 (F91.2), and 312.89 (F91.9). I find that my client could benefit from a residential inpatient setting/ group home that offers the following:
• treatment for the whole person
• individual psychotherapy
• medication management.
Client Need Group home establishment for Individual Cognitive Behavioral Therapy & Group Therapy for 12-months
Goal #1 By first week in November, Henry will have attended his individual therapy sessions.
Objective #1 Register for admission to residential group home located in Jackson, MS.
Objective #2 Attend one individual psychotherapy session by 1st week in November
Intervention #1 Behavior Therapy
Intervention #2 Cognitive Behavioral Therapy
Client Need Medication Management
Goal #2 Henry needs to establish medication maintenance by the first week at group home.
Objective #1 Henry needs to meet with the psychiatrist daily for the first 3 weeks to discuss symptoms and concerns.
Objective #2 After the first 3 weeks, Henry will need to see psychiatrist on a weekly basis to discuss maintenance and medication changes if any is needed.
Intervention #1 Begin the medication regimen of Ritalin and Dexedrine
Intervention #2 Psychiatric follow up daily.
Client Need Social skills training and educational
Goal #3 Henry will need to establish social skills and within the first 3 weeks of arriving to the group home.
Objective #1 Henry will need to meet with a therapist where he can be introduced to educational or school learning opportunities and develop skills necessary for attending school
Objective #2 Henry will need to attend social skills classes daily.
Intervention #1 Social Skills Training
Intervention #2 Cognitive behavioral therapy
Upon the completion of 12 month program, Henry will be assessed and released for services and referred to an outpatient psychiatrist office for the continuing of medication regimen and weekly follow ups. There will need to be family therapy scheduled for Henry and his parents. Henry will also benefit from a person-centered approach that focuses on group therapy, individual psychotherapy. Henry will remain on constant monitoring throughout his outreach treatment.
Legal implications include the court-mandated therapy in which Henry will have to complete in order to omit time in juvenile detention facility. Client confidentiality will be maintained as it relates to the treatment team and the juvenile court system.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596 (Links to an external site.)
Sagar, R., Patra, B. N., & Patil, V. (2019). Clinical Practice Guidelines for the management of conduct disorder. Indian Journal of Psychiatry, 61(Suppl 2), 270–276. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_539_18
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