Lost Interest
Barbara Reiss was a 51-year-old white woman who was brought to the emergency room by her husband with the chief complaint "I feel like killing myself."
Ms. Reiss had begun to "lose interest in life" about 4 months earlier. During that time, she reported depression every day for most of the day. Symptoms had been worsening for months. She had lost 9 pounds (current weight = 105 pounds) without dieting because she did not feel like eating. She had trouble falling asleep almost every night and woke at 3:00 a.m. several mornings per week (she normally woke at 6:30 a.m.). She had diminished energy, concentration, and ability to do her administrative job at a dog food processing plant. She was convinced that she had made a mistake that would lead to the deaths of thousands of dogs. She expected that she would soon be arrested, and would rather kill herself than go to prison.
Her primary care physician had recognized the patient's depressed mood 1 week earlier and had prescribed sertraline and referred her for a psychiatric evaluation.
Ms. Reiss denied previous psychiatric history. One sister suffered from depression. Ms. Reiss denied any history of hypomania or mania. She typically drank a glass of wine with dinner and had started drinking a second glass before bed in hopes of getting a night's sleep. She had been married to her husband for 20 years, and they had three school-age children. She had been employed with her current company for 13 years. She denied illicit drug use.
The physical examination performed by the primary care physician 1 week earlier was noncontributory. All laboratory testing was normal, including complete blood count, electrolytes, blood urea nitrogen, creatinine, calcium, glucose, thyroid function tests, folate, and vitamin B12.
On mental status examination, Ms. Reiss was cooperative and exhibited psychomotor agitation. She answered most problems with short answers, often simply saying "yes" or "no." Speech was of a normal rate and tone, without tangentiality or circumstantiality. She denied having hallucinations or unusual thoughts. She described the mistakes she believed she had made at work and insisted that she would soon be arrested for the deaths of dogs, but she insisted this was all true and not "a delusion." Recent and remote memory were grossly intactA. Discussion of Diagnosis- You should make your own diagnosis based on the facts provided in the story. You must include why you choose that diagnosis, what their symptoms are that lead to that diagnosis, what specific symptoms fit which specific criteria (notice the word specific... you should be very detailed on this part), and what other possible diagnoses are and why you rejected those. Remember, some of the case studies may have multiple diagnoses! Please note: you should address all the criteria for your chosen disorder and discuss exs and symptoms fitting each criteria. Check the DSM for the full criteria. Your text only includes the main criteria for disorders, and often does not include ALL the criteria. If you are diagnosing the patient with more than one disorder, you need to do this for all the disorders. Also be sure that you discuss multiple other possible diagnoses which are NOT what they have. You should be able to rule out several other disorders in the course of your diagnosis. This section should include in-text citations.
B. DSM 5 coding and full name, including specifiers and subtypes. This is including the appropriate coding for the full disorder and the complete name of the disorder. If you did not discuss the specifiers in the previous section, be sure you do it here. You need to describe why/how they fit that subtype or specifier. **You can find most of the codes in the appendices of your textbook.
C. References- You will be required to have an APA style reference page, as well as in-text citations indicating where you got your information from. You should include all sources used to diagnosis the client (including the DSM if used, except the case study itself), and any other sources you used.