CNDV 5327 Lamar University Wk 1 Bob ADHD Case Study

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CNDV 5327

Lamar University


Question Description

Can you help me understand this Psychology question?

  • Bob is a 42-year-old Caucasian male who presented for assessment and treatment for nervousness, anxiety, frustration, irritability, anger outbursts, and insomnia. Bob was somewhat disheveled in the initial assessment.Bob married his wife at the age of 19. They divorced after 4 years because he had an affair. He has been married to his current wife, Anna, for 16 years and they have two children, James 14, and Teresa 12. The children are active in school extracurricular activities and both make better than average grades. James was diagnosed with ADHD and takes medication for that. Bob and Anna have recently had conflicts in their marriage and argue frequently.  Bob’s mother and father are alive at the ages of 62 and 66, respectively, and he is the second of three children from his family of origin. Bob gets along well with his mother, older brother, and younger sister, but has a distant relationship with his father. His mother and father divorced when he was 10 and he lived with his mother until he graduated from high school. He later found out his father had affairs while married to his mother. He briefly attended collage where he met his first wife but dropped out to go to work so they could marry. He and Anna met several years later through a mutual friend, dated for about six months and married.He reported no remarkable family history of psychiatric difficulties, alcohol or substance abuse, but said his cousin twice attempted suicide. He did not know much about his father’s family. Bob reported no inpatient or outpatient mental health admissions or treatment with the exception of the two visits to a counselor. He was diagnosed with Generalized Anxiety Disorder by a counselor. He saw the counselor twice but did not return for additional psychotherapy. He was prescribed Xanax 1 mg as needed, with a monthly quantity of 30, for anxiety by his PCP. He reported no other current medical conditions. In the first assessment, he was given the Beck Anxiety Inventory and scored 21, placing him in the moderate anxiety category. He did not report any other symptoms at that time and said he was confused as to why his physician said he would not prescribe a higher dosage of Xanax. He addressed his anxiety and irritability in session and was educated on mindfulness techniques, controlled breathing, and guided imagery to help reduce his anxiety and irritability. He was educated and encouraged to use the components of the anger wheel of choice to initiate anger management cognitive awareness. He returned for therapy one week later, reported he had implemented the interventions with only slightly noticeable improvement. He was re-educated on the techniques and encouraged to continue with them. He reported no anger outbursts but said his wife had “been nagging me to come here.” During that session he was quiet and reserved with a low energy level. He was prompted several times for session continuity but reported no new problems or difficulties during the session. He was encouraged to continue implementing the interventions and given additional education and material on anger management techniques.In the third session he was accompanied by his wife who came because she wanted to ensure complete communication. She reported domestic disharmony, said they have arguments frequently and have recently talked of divorce. His wife said he becomes angry and isolates himself after they argue. She also reported he cries often and tells her he cannot “stand the pressure at work.” They seldom have sex and, when they do, he frequently is unable to engage satisfactorily. She reported suspicions of infidelity in the first few years of their marriage but there had been no specific evidence other than her suspicions based on his behavior of being gone without explanation at times. He stopped that behavior years ago and she reported no current suspicions of infidelity.The client said little as his wife talked and he became more withdrawn. He volunteered little information in that session but said he will work with his wife to improve their marriage when she suggested that. She reported Bob’s mother struggled with depression when he was young and his cousin attempted suicide twice. She also said his mood changes, oftentimes abruptly, moving from anxiousness and irritability to withdrawal from the family and isolation accompanied by crying spells. The client made no comment to her assertions. When asked, he did not want to talk about his use of anxiety interventions and anger awareness communication and said he preferred to wait until the next session. Bob did not address his goal of reducing his anger and anxiety until his wife left the room. Bob then talked of his wife “nagging me to be happier and do more things around the house.” He reported anger outbursts and said he has difficulty remaining pleasant to her. He commented on the stresses at his job and said people there “do not understand me.” He reported instances of conflicts with others at his job but no major anger outbursts. He sometimes goes into the restroom to cry while at work. Directions: Please answer all the following questions and provide scholarly support. Your responses should be written in APA format. 
  • Questions
    • Given the diagnosis originally made by the first counselor, the prescription written by the PCP, and the information given and comments made by the client in the first session, analyze and discuss the rationale for the diagnosis and treatment plan from that assessment.  
    • What might account for the client’s mediocre response to the suggested interventions? What points of discussion might be incorporated into the next session? 
    • Describe the benefits and detriments of using the class of medications Xanax is in and potential for impact on the client. Provide an analysis of the pharmacodynamics and pharmacokinetics of the anxiolytic class of drugs. Include at least five pharmacodynamic and pharmacokinetic principles and a chart that summarizes the information. 
    • What ethical considerations should be included in the discussion with the client about medications? Describe the advisability of consultation with the original prescribing physician, topics for discussion and communication points. Describe concerns to be taken into consideration when speaking with the prescribing doctor about medications and related disease states.
    • Describe how you will integrate the information presented by his wife, Anna. Include additional therapy topics to be addressed in the next session, possible assessment instruments to use, diagnoses to consider, and potential medication changes.

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Explanation & Answer


Running head: CASE STUDY


Case Study
Student’s Name
Institutional Affiliation


Case Study (Bob)

Mental Disorders are amongst the most common medical conditions reported in health
centers and experienced in the community in general (World Health Organization, 2017). They
usually result from different causes, with the most common ones being genetics, neglect,
increased drug and substance abuse, and traumatic events, among others (World Health
Organization, 2017). Therefore, their treatment also usually varies depending on the diagnosis
that medical practitioner gives and the probable cause. This paper, therefore, discusses Bob’s
case study to address various factors regarding the disorders that he suffered, their possible
causes, and the diagnoses he received. First, the paper provides the rationale for the diagnosis
that Bob received before discussing the benefits of the medications given. Finally, the paper
explains the ethical considerations that were applicable for Bob’s case and the usefulness of the
information presented by his wife during the therapy sessions.
Rationale for Diagnosis and Treatment Plan
From the case study, the first counselor diagnosed Bob with ADHD condition which
typically stands for Attention Deficit Hyperactivity Disorder. People who suffer from this
condition usually experience differences in their brain development and, in turn, also their brain
activities are also affected (National Collaborating Centre for Mental Health, 2018). As a result,
the individuals start experiencing attention difficulties, high sense of hyperactivity, and
frequently suffer from impulsiveness. Additionally, the condition makes the victims to lose their
ability of being still, thus also affecting their self-control. These conditions explain why the first
counselor diagnosed Bob with ADHD. Bob had reported characteristics such as being overly



nervous, anxious, frustrated, irritated, and angry, all of which result from being impulsive and
Despite suffering the conditions mentioned above and receiving the described diagnosis,
the first counselor did not give Bob a specific treatment for ADHD. Instead, the counselor
provides a treatment plan that addressed the specific symptoms reported,...

Qbpgbe_ZvxrXney (19514)
Cornell University

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