Odd behavior

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 her thoughts.

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.

1. Key Issues
   1. 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?
   2. 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?

1. Diagnostic Impressions
   1. 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?
   2. 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.

1. Treatment Recommendations (cite sources in this section)
   1. 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.
   2. 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).