Discussion: Applying Differential Diagnosis To Neurodevelopmental Disorders

Social work clinicians keep a wide focus on several potential syndromes, analyzing patterns of symptoms, risks, and environmental factors. Narrowing down from that wider focus happens naturally as they match the individual symptoms, behaviors, and risk factors against criteria A–E and other baseline information in the DSM-5.

Over time, as you continue your social work education, this process will become more automatic and integrated. In this Discussion, you practice differential diagnosis by examining a case that falls on the neurodevelopmental spectrum.

To prepare:

  1. Read the case provided by your instructor for this week’s Discussion and identify relevant symptoms and factors. You may want to make a simple list of the symptoms and facts of the case to help you focus on patterns.
  2. Read the Morrison (2014) selection. Focus on Figure 1.1, “The Roadmap for Diagnosis,” to guide your decision making.
  3. Identify four clinical diagnoses relevant to the client that you will consider as part of narrowing down your choices. Be prepared to explain in a concise statement why you ruled three of them out.
  4. Confirm whether any codes have changed by checking this website: American Psychiatric Association. (2017, October 1). Changes to ICD-10-CM codes for DSM-5 diagnoses. Washington, DC: Author. Retrieved from https://www.psychiatry.org/psychiatrists/practice/dsm/updates-to-dsm-5/coding-updates

Post a 300- to 500-word response in which you address the following:

  1. Provide a full DSM-5 diagnosis of the client. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, and the Z codes (other conditions that may be a focus of clinical attention). Keep in mind a diagnosis covers the most recent 12 months.
  2. Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis.
  3. Identify which four diagnoses you initially considered in the case of the client, using the DSM-5 diagnostic criteria to explain why you selected these four items. In one or two sentences each, explain why three of these diagnoses were excluded.
  4. Explain any obvious eliminations that could be made from within the neurodevelopmental spectrum.
  5. Describe in detail how the client’s symptoms match up with the specific diagnostic criteria for the primary disorder that you finally selected for him. Note two other relevant DSM-5 criteria for that illness from the sections on “diagnostic features” and “development and course” that fit this case.

 

CASE OF BRIANNA

 

Intake Date: October 2019

 

IDENTIFYING/DEMOGRAPHIC DATA: Brianna is a 16-year-old Caucasian female who resides in California with her parents and 2 siblings. Brianna comes from an upper middle-class family. She attends private high school.

 

CHIEF COMPLAINT/PRESENTING PROBLEM: Brianna stated she is “ugly”, and others have been laughing at her since she was 13 years old. Now the pain of her “ugliness” is affecting her friendships and her ability to enjoy the end of her high school years. She becomes so anxious about this issue she feels nervous all the time.

 

HISTORY OF PRESENT ILLNESS: Brianna noticed from her early teens that her nose looked fat and her eyes seemed far apart. She begged her parents to let her get surgery on her face, but they refused, indicating that she was too young. Now that Brianna is 16, she is asking her parents once again to get surgery, but they are still refusing since Brianna is a very attractive young woman. Brianna has always been a good student and socially active. When she was younger, she was more confident but as the teenage years progressed, she became less confident. This was due to her feelings of being ugly and thinking others see her as ugly.

 

Brianna is finding herself staying away from high school activities. Her grades have started to decline since she no longer can concentrate on schoolwork. She finds herself thinking about her defects all the time. She sits in her room and does not attempt to do any activity. Often she finds herself pacing in her room with tingling throughout her body.

 

PAST PSYCHIATRIC HISTORY: Brianna denies any past involvement with counseling. Brianna began to pick at blemishes and hairs on her face about 1 ½ years ago. She believes they just stand out and that is what people are looking at.

 

SUBSTANCE USE HISTORY: Brianna reports drinking a bit at a few parties. She denies any illicit drug use. She reports not drinking a lot and only did that to make it through the parties she attended at the time

 

PAST MEDICAL HISTORY: Brianna’s parents have taken her to several plastic surgeons and medical doctors to ease her worries about the blemishes on her face, her nose, and eyes. Brianna refuses to acknowledge the doctors opinions.

CURRENT FAMILY ISSUES AND DYNAMICS: Brianna’s sisters are always making fun of Brianna because she frequently checks herself in the mirror and other reflective surfaces. The family is constantly reassuring Brianna that her looks are fine to no avail.

 

MENTAL STATUS EXAM: Brianna looks her stated age of 16. She is well dressed, with long blonde hair and presents very well physically. Brianna describes her mood as depressed. Her eating habits and weight have changed from earlier years, and she has gained some weight. Brianna does report passive suicide ideation, just thinking she wants to die since the stress of her looks has become overwhelming.

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