Diagnosis (DX) Case Discussion Board Template
Introduction
to topic (e.g., diagnosis category for this week – schizophrenia, depression, etc.)
[http://academicguides.waldenu.edu/writingcenter/writingprocess/introductions]
Case summary
should include specific information about client symptoms and biopsychosocialspiritual cultural
contexts; should be no more than 2 paragraphs that consist of 4-5 sentences each. See Clinical Thinking
Skills document in Doc Sharing.
Diagnostic Impressions
Line 1: Give primary diagnosis (diagnoses). Be sure to use the ICD-10 code, name of the
disorder, and all of the specifiers.
Line 2: Give secondary diagnosis (if applicable)
Line 3: Give any additional considerations (Z codes). Select most pertinent one(s) to what’s
presented at time of assessment. No more than 3.
Line 4: Give rule out diagnosis (es). Select no more than 2.
Example 1 (list):
F32.0 Major Depressive Disorder, Single Episode, Mild, with Anxious Distress.
Z60.3 Acculturation difficulty
Rule out: Z65.8 Religious or spiritual problem
Rationale
Should include the aforementioned diagnostic impressions using the DSM5 as the foundation of your
evidence and include outside source information to support your impressions. If you opt to NOT include
a primary diagnosis OR rule out diagnosis, you still need to use the DSM5 as your evidence in
substantiating why you choose not to select anything potentially appropriate. Therefore, it not
acceptable for this training course to say “I don’t think anything’s needed for a rule out.” Thus, you
should have a separate paragraph for each line item listed.
Example 2 (single primary diagnosis with rationale)
“Client Joe presents with symptoms and behaviors that meet criteria for F32.0 Major Depressive
Disorder, Single Episode, Mild, with Anxious Distress. According to the Diagnostic Statistical Manual of
Mental Disorders, Fifth Edition (2013), individuals must meet “five or more” of the listed symptoms
within a “two-week period,” have a “change in functioning, and at least one symptom either depressed
mood or loss of interest” (p.160). Client Joe meets criteria A by his expressions of feeling sad, isolated,
confused, and alone for most of the day every day for about a month (A1), loss of appetite and 15 lbs
(A3), missing classes and temple or mosque for the past 2 weeks (B, A2), worry, guilt and tense (A7,8) …”
(list the specific information in whichever numbers in criteria A that Joe meets and match it with the
client’s symptoms as evidence of meeting those numbers’ criteria). Do this for all the remaining criteria
letters.
Rule out: I ruled out F43.10 Posttraumatic Stress Disorder because the symptoms don’t appear
to have occurred as a result of a specific event (A.1) and don’t appear to have any intrusive symptoms
(criteria B). A detailed clinical interview or assessment might reveal more information. However, he
does meet full criteria for 296.21 at this time. I would like to rule out Z65.8 Religious or spiritual
problem as a more meaningful contribution to symptoms. The client notes not attending Mosque and is
a second generation Muslim-American. This means that in additional to have a cultural shock
experience by attending school in the South, as a northerner, he may be presented with more Western
ideas about religion that’s challenging his own understanding of his faith; thus, presenting a crisis of
identity and faith. The symptoms might appear to be a mental health issue but actually be a crisis of
faith and for the devout could have such an impact as the symptoms described by the client. A spiritual
genogram or ecomap or the Spiritual Health Inventory (SHI) assessment, as well as a consultation
interview with his spiritual leader (or a local Imam) would give more insight and re-connect him to
support.
Example 3 (multiple – primary and secondary diagnoses)
“Client B meets the criteria for the following DSM-5 diagnoses:
F41.1 Generalized Anxiety Disorder (Primary)
F10.10 Alcohol Use Disorder (Secondary)…”
Follow the same pattern as example two when justifying your rationale but do so for BOTH. Like
example 2, you would include specific assessments to use to help make your determination (e.g., SUDS
alcohol assessment).
Rule out: I selected __ as a possible disorder to rule out because Joe described having ___
symptoms, but we don’t have enough information to determine if this meets the ___ criteria required
for ___ (the rule out disorder you listed). Potential assessments
Cultural aspects
Include information that may be pertinent to the diagnosis, assessment, and treatment of the case.
Using example 2, you could say “Joe is a second generation Muslim-American male from the north
attending a predominantly white college institution in the South…” Highlight aspects of gender, faith
tradition, geographical cultural differences, acculturation considerations, historical cultural experiences
as a marginalized group, intergenerational trauma, and so on as they relate to how you assess Joe and
offer treatment recommendations for him as an individual. Then, be sure to consider the research
related to those cultural aspects and the diagnosis (es) from the diagnostic issues and co-morbidity
sections of DSM-V and outside reading material.
Note: some weeks may not require this information; be sure to give attention to the discussion prompts
for each week.
Conclusion
(http://academicanswers.waldenu.edu/faq/72799)
References
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
Arlington, VA, American Psychiatric Association, 2013.
tion is
Ollowing case. In other
instances, it may require extremely careful and detailed
observation and analysis for the therapist to learn what is
maintaining the maladaptive behavior.
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Billy, a 6-year-old first grader, was brought to a psychological clinic
by his parents because his teacher had told them that his behavior
at school was inappropriate and no longer acceptable. Specifically,
he had a long pattern of disrupting the class, talking back to his
teacher, and being aggressive toward other children. It became
apparent in observing Billy and his parents during the initial interview
that both his mother and his father were uncritical and approving of
everything Billy dict After further assessment, a three-phase pro-
gram of therapy was undertaken: (1) Billy's parents were helped to
discriminate between disruptive behavior and appropriate behavior
on Billy's part (each type of behavior was defined and described in a
very detailed way for the parents so they would be consistent in
classifying each type of behavior). (2) They were instructed to ignore
Billy when he engaged in disruptive behavior while vocally showing
their approval of appropriate behavior. (3) Billy's teacher was also
instructed to ignore Billy, insofar as it was feasible, when he engaged
in disruptive behavior and to devote her attention at those times to
children who were behaving more appropriately.
Although Billy's disruptive behavior in class increased during
the first few days of this behavior therapy program, it diminished
markedly after his parents and teacher no longer reinforced it. As his
maladaptive behavior diminished, he was better accepted by his
classmates. This helped reinforce more appropriate behavior pat-
terns and changed Billy's negative attitude toward school.
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Billy's was a case in which unwanted hoh
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