Please review the following two case studies and answer the questions (see below) for each case study. In order to support the diagnosis or diagnoses, list the DSM-5 criteria and the patient's symptoms which reflect the diagnostic criteria. Provide rationales for your answers. In the example below, the DSM-5 criteria were listed along with the patient's presenting symptoms which reflected the criteria. Use this example to assist you with the two case examples. Refer to the rubric for further details and points. Case Study EXAMPLE: A 30-year-old female patient reported sadness and feelings of hopelessness for the past several months. She has thoughts about killing herself but denied having a specific plan or intention for self-harm or harm to others. She no longer hung out with friends because it "just wasn't fun anymore." She was concerned about her job because she was not sleeping and drowsy during the day which affected her ability to concentrate and remember tasks. Her recent job performance rating was poor which was distressful to her as her past ratings had been good to outstanding. She rarely exercised and had gained 20 pounds in the past several months. "I used to run several miles daily." She was tired and "out of steam", finding it difficult to get up in the morning and start the day. Five or more of the following symptoms present during the same 2-week period and represent a change in functioning. At least one of the symptoms is either a depressed mood or loss of interest or pleasure The patient is experiencing 8/9 DSM-5 diagnostic criteria for Major Depressive Disorder. Depressed mood most of the day, nearly every day, per subjective report or observation made by others-patient reports feelings of sadness, hopelessness for the past several months. Markedly diminished interest or pleasure in activities nearly every day-patient no longer enjoys socializing with friends, rarely exercises, previously ran several miles a day Significant weight loss/gain-weight gain of 20 pounds over the past several months Insomnia/hypersomnia-not sleeping at night Psychomotor agitation/retardation-difficult to get up and start the day Fatigue/loss of energy-tired, "out of steam" Feelings of worthlessness, excessive guilt-negative Diminished ability to think/concentrate-unable to think and concentrate at work Recurrent thoughts of death, suicidal ideation, suicide attempt or plan-thoughts of killing herself, no plan or intention of self-harm or harm to others The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of function-The patient's symptoms are impacting her job performance negatively. Recent job performance rating was poor. Previous ratings-good to outstanding. Case Study A A 25-year-old female presents to your office. She is accompanied by her fiancé. She is animated, talkative, and difficult to redirect. She is easily distracted, gets up frequently, paces, and makes calls on her cell phone. She describes her thoughts as "speeding like a race car." Her fiancé reports that she has not slept for the past two weeks. She works fulltime as a stockbroker. During the past two weeks, the patient returns home after work and continues to call clients and work throughout the night. She has been involved in arguments at work with her supervisor over the loss of numerous clients related to her current behavior. Her fiancé reports several similar "hyper" episodes in the past. Her fiancé also reports that she has previous episodes of depression during which she has no energy or interest in anything, sleeps all the time, and misses work because she cannot think or concentrate. She feels worthless and useless during these episodes. The client has recently maxed out several of her credit cards, accruing a debt of $60,000. The client reports that she is going to be awarded broker of the year by Wall Street and will be selected as person of the year by Time magazine. Her fiancé reports that these statements are not accurate, she is not receiving an award nor being selected as person of the year. She insists on leaving, stating that she is being monitored by others who want to prevent her from receiving these awards. She denies having suicidal or homicidal thoughts, plans or intentions. The patient has a history of iron deficiency anemia and asthma. She has never been hospitalized but was prescribed a medication by a psychiatrist for depression. She felt better but stopped the medication after a few months. What are the differential diagnoses? Rationales. What are the patient's diagnoses? List DSM-5 diagnostic criteria and the patient's symptoms that reflect the diagnostic criteria to support the diagnosis(es). What level of care is appropriate for the patient? Provide rationale. What screening tools are appropriate to use to assist with diagnosis? What diagnostic labs would you order? Provide rationales. What are the red flags in this patient's presentation? What treatments would be appropriate to include psychopharmacology and psychotherapy for the patient? Provide rationales. Case Study B The patient is a 19-year-old female who presents with the following symptoms which have been present for "years." She was raised by her mother who was neglectful, physically, and verbally abusive. The patient's mother would disappear for days leaving the patient to care for her younger sister. The patient's mother used alcohol and had numerous boyfriends, many of whom were abusive. The patient and her sister were molested by several of the boyfriends. The patient generally avoids talking about her childhood abuse but has reported previous incidents of molestation and abuse during which she feared that she and her sister were going to be killed. She finds it difficult to remember but when she does recall events, she becomes distressed and angry. She has nightmares about her childhood abuse. She thinks she is a bad person and feels guilty because she did not protect her sister. She sometimes thinks that it would be better if she were dead but denies a suicidal plan or an intention of suicide. She feels on "high alert". She would like to be able to sleep through the night but awakens frequently. She gets frustrated easily and directs her frustration and anger toward her co-workers. She is currently on probation at work related to her angry outbursts. She denies substance use. She has no previous hospitalizations or psychiatric treatment. The patient has a history of gastroesophageal reflux disease. What are the differential diagnoses? Rationales. What are the patient's diagnoses? List DSM-5 diagnostic criteria and the patient's symptoms that reflect the diagnostic criteria to support the diagnosis(es). What level of care is appropriate for the patient? Provide rationale. What screening tools are appropriate to use to assist with diagnosis? What diagnostic labs would you order? Provide rationales. What are the red flags in this patient's presentation? What treatments would be appropriate to include psychopharmacology and psychotherapy for the patient? Provide rationales.

ANSWER. PAPER DETAILS
Academic Level	College
Subject Area	Nursing
Paper Type	Essay
Number of Pages	2 Page(s)/550 words
Sources	5
Format	None
Spacing	Double Spacing

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