Mrs. Smith is a
30-year-old married woman whose family brings her to the emergency
room due to what they call “odd behavior.” Mrs. Smith is the
youngest of 5 children. She was born prematurely, but despite being
low in weight, there were no other negative consequences from this.
She met all her developmental, cognitive, and social milestones on
time. It was reported that she did well in school academically, made
friends easily, and interacted in several extracurricular activities
to include yearbook and cheerleading. After graduating from high
school she began working in a bank, as her family did not have enough
money to send her to college. She was married 5 years ago and has 2
children, ages 1 year and 3 years. Mrs. Smith did not return to work
after the birth of her first child. One week prior to her family
bringing her to the emergency room Mrs. Smith went to her primary
care physician complaining of dizziness and trouble sleeping. She
also reported to him that she has been feeling “down in the dumps”
and that she was a failure as a mother and wife. Her doctor made her
an appointment with a therapist for the following week. Before she
could attend the appointment though, her family brought her to the
emergency room due to her “odd behavior.”
Four months prior, Mrs. Smith had left
her husband and moved in with her mother and father. Shortly after
she moved back home with her mother and father, her brother was in a
car accident and was seriously injured, and the man she had been
dating went to jail on a drug charge. About a month after she moved
home, her family began to notice a deterioration in her ability to
take care of herself, including making her own meals and bathing.
This culminates in the police finding her wandering about a mile from
her home. She is unable to tell them who she is or how she got there.
On that day she is brought to the hospital in a very agitated state
and reports to the hospital staff that voices are telling her to kill
herself and her husband. Mrs. Smith is hospitalized and treated and
discharged 3 days later to begin outpatient treatment. Three months
later she is brought to the hospital by her family. She reports at
this time that she has been experiencing anxiety, insomnia,
delusions, and auditory hallucinations during the past 3 weeks. On
further investigation, she reveals that the hallucinations and
delusions have been occurring for the past 3 months, but she was
worried she would get readmitted to the hospital, and so she did not
want to share this with her outpatient therapist. She describes that
she thinks others are out to get her and that she is getting messages
from the television. She reports that she can hear others talking
about her but when she looks no one is there.
Mrs. Smith’s mother also reports that
about 3 weeks ago her daughter started to go on frequent shopping
sprees. At first this made her mother happy, as she thought her
daughter was coming out of the “funk” she had been in. But her
mother reports that Mrs. Smith also had an overabundance of energy
and had difficulty sleeping in the evening, often pacing the floor.
About 3 days before this hospital admission, she became irritable and
was talking about how the teacher at the college she was attending
was “out to get her”. On returning home from school she reported
that she heard God talking to her and that voices were discussing
her, accompanied by the feeling that someone was touching her
although no one was there. She slept for only 1 or 2 hours on the
nights prior to being admitted to the hospital. Instead she would
sing loudly, dance, and recite Scripture.
During this second
admission, she is irritable and hyperactive, displays a flight of
ideas, and talks nonstop. She also believes she can heal others with
Case Study 2 is due by 11:59 p.m. (ET)
on Sunday of Module/Week 6.
Follow the example below as you complete your Case Study assignment.
You will have 3 major areas to your case study response: (1) key
issues, (2) diagnostic impressions, and (3) treatment
recommendations. This assignment does need an APA-formatted title
page, and you are required to cite the sources for the treatment
recommendations and include a reference page. It should be 3–4
pages for content. The case study assignment is an opportunity for
you to think through a clinical case, identify and prioritize key
issues involved, consider and clarify relevant diagnostic issues, and
formulate treatment recommendations that are most likely to be
helpful to the client.
List in order of importance the key issues you believe are involved
in the case study, as if you were the client’s counselor. Provide
a rationale for the order in which you prioritized issues. What are
the most important features to you, and why?
Link your rationale to what you believe outcomes of treatment
should be for this client. How will your order of priority
contribute to a successful outcome for the client?
Based on the information provided in the case study, use the
current version of the DSM to accurately diagnose the type(s)
of disorder(s) involved. Refer to specific diagnostic
criteria when presenting your impressions. What category could this
be in? What disorder in that category does this appear to be and
why? Provide rationale for diagnosis, giving consideration to
differential diagnostic considerations. In other words, what
disorders in this category or other closely related categories were
considered? Why could this not be any of those disorders?
Be sure to consider other disorders in addition to the main
disorder. Is there more than one diagnosis? Provide rationale for
diagnosing any additional disorders.
Recommendations (cite sources in this section)
List your recommendations (e.g., 1., 2., 3., etc.) so that you can
clearly delineate what you believe will be of most help to your
client. Consider recommendations that will be motivating to your
client and reflective of a collaborative approach.
Be sure to consider the biopsychosociospiritual aspects of the
case. Make sure your recommendations are relevant to the case, able
to be implemented by the client, and have some basis of support
from professional literature—include academic sources here (2–3).