PSY 650 Week 6

Psychological Treatment Plan

It is recommended that students review the e-book The Complete Adult Psychotherapy Treatment Planner (Jongsma, Peterson, & Bruce, 2014) for additional assistance in completing this assignment.

Clinical and counseling psychologists utilize treatment plans to document a client’s progress toward short- and long-term goals. The content within psychological treatment plans varies depending on the clinical setting. The clinician’s theoretical orientation, evidenced-based practices, and the client’s needs are taken into account when developing and implementing a treatment plan. Typically, the client’s presenting problem(s), behaviorally defined symptom(s), goals, objectives, and interventions determined by the clinician are included within a treatment plan.

To understand the treatment planning process, students will assume the role of a clinical or counseling psychologist and develop a comprehensive treatment plan based on the same case study utilized for the Psychiatric Diagnosis assignment in PSY645. A minimum of five peer-reviewed resources must be used to support the recommendations made within the plan. The Psychological Treatment Plan must include the headings and content outlined below.

Behaviorally Defined Symptoms

  • Define the client’s presenting problem(s) and provide a diagnostic impression.
  • Identify how the problem(s) is/are evidenced in the client’s behavior.
  • List the client’s cognitive and behavioral symptoms.

Long-Term Goal

  • Generate a long-term treatment goal that represents the desired outcome for the client.
    • This goal should be broad and does not need to be measureable.

Short-Term Objectives

  • Generate a minimum of three short-term objectives for attaining the long-term goal.
    • Each objective should be stated in behaviorally measureable language. Subjective or vague objectives are not acceptable. For example, it should be stated that the objective will be accomplished by a specific date or that a specific symptom will be reduced by a certain percentage.

Interventions

  • Identify at least one intervention for achieving each of the short-term objectives.
  • Compare a minimum of three evidence-based theoretical orientations from which appropriate interventions can be selected for the client.
  • Explain the connection between the theoretical orientation and corresponding intervention selected.
  • Provide a rationale for the integration of multiple theoretical orientations within this treatment plan.
  • Identify two to three treatment modalities (e.g., individual, couple, family, group, etc.) that would be appropriate for use with the client.

It is a best practice to include outside providers (e.g., psychiatrists, medical doctors, nutritionists, social workers, holistic practitioners, etc.) in the intervention planning process to build a support network that will assist the client in the achievement of treatment goals.

Evaluation

  • List the anticipated outcomes of each proposed treatment intervention based on scholarly literature.
    • Be sure to take into account the individual’s strengths, weaknesses, external stressors, and cultural factors (e.g., gender, age, disability, race, ethnicity, religion, sexual orientation, socioeconomic status, etc.) in the evaluation.
  • Provide an assessment of the efficacy of evidence-based intervention options.

Ethics

  • Analyze and describe potential ethical dilemmas that may arise while implementing this treatment plan.
  • Cite specific ethical principles and any applicable law(s) for resolving the ethical dilemma(s).

The Psychological Treatment Plan

  • Must be 8 to 10 double-spaced pages in length (not including title and references pages) and formatted according to APA style as outlined in the Ashford Writing Center (Links to an external site.)Links to an external site..
  • Must include a separate title page with the following:
    • Title of paper
    • Student’s name
    • Course name and number
    • Instructor’s name
    • Date submitted
  • Must use at least five peer-reviewed sources in addition to the course text.
  • Must document all sources in APA style as outlined in the Ashford Writing Center.
  • Must include a separate references page that is formatted according to APA style as outlined in the Ashford Writing Center.

Attention Students: The Masters of Arts in Psychology program is utilizing the Pathbrite portfolio tool as a repository for student scholarly work in the form of signature assignments completed within the program. After receiving feedback for this Psychological Treatment Plan, please implement any changes recommended by the instructor, go to Pathbrite (Links to an external site.)Links to an external site.,  and upload the revised Psychological Treatment Plan to the portfolio. (Use the Pathbrite Quick-Start Guide Preview the document to create an account if you do not already have one.) The upload of signature assignments will take place after completing each course. Be certain to upload revised signature assignments throughout the program as the portfolio and its contents will be used in other courses and may be used by individual students as a professional resource tool. See the Pathbrite (Links to an external site.)Links to an external site.  website for information and further instructions on using this portfolio tool.

Carefully review the Grading Rubric (Links to an external site.)Links to an external site. for the criteria that will be used to evaluate your assignment.

Waypoint Assignment Submission

The assignments in this course will be submitted to Waypoint.  Please refer to the instructions below to submit your assignment.

  1. Click on the Assignment Submission button below. The Waypoint “Student Dashboard” will open in a new browser window.
  2. Browse for your assignment.
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PSY 646b

Initial call transcript from the patient’s point of view

I am a husband of one child and have stayed in the marriage for the last 34 years. I have been working for a New Jersey Company for the last 32 years. My life completely changed when my brain stopped working properly. At the start, the problems seemed small, hardly noticeable. Life was good before, until my brain went downhill, taking the whole family down with it. I have been a dedicated father who loves his family. I realized things have started to change when I forgot about my anniversary. My wife was furious that that day and I hardly noticed her anger and reaction until she reminded me about the anniversary. Forgetting even very little things made me visit the psychiatrist. Also, I could the plates on the floor after eating, spilling the food all over me, and unable to drive when am heading to work. I needed to visit the psychotherapy to know why the brain has been not functioning properly.

What would the patient say?

The patient would not maintain a smooth conversation

The patients keep on saying he is not sick

The patient’s mood would change when he continues to speak

What tone of voice might he or she use?

Using a positive and friendly tone

A low/calm tone (pitch)

A tone that conveys respect and dignity

How fast would the patient speak?

The patient would speak in a slow-paced tone

The patient misspells words, for example instead of decision he says revision

Poor choice of language

The patient is often repeating some words

Would the message be understandable?

The message is not understandable

It is circumstantial because the speech has non-linear thought pattern

How would listening to this voicemail make you feel?

The patients made me feel like am experiencing dementia myself

I feel overwhelmed and irritated by frequent repeat of questions.

I fail to maintain balance of words

I feel uncomfortable because I don’t know how to handle the patient’s condition

Reference

Gorenstein, Ethan E. Case Studies in Abnormal Psychology, 2nd Edition. Worth Publishers, 20140627. VitalBook file.

 

Running head: DIFFERENTIAL DIAGNOSIS 1

 

DIFFERENTIAL DIAGNOSIS 2

 

 

 

 

 

 

 

Differential Diagnosis

PSY 645 Psychology

Ashford University

October 21st, 2018

 

 

 

 

 

 

 

Differential Diagnosis

Introduction

Differential diagnosis is defined as the method which is used to systematically identify a disorder, condition, or a syndrome which result into different signs and symptoms. This method of diagnosis has been used extensively in the diagnosis and determination of mental disorders (Barbui & Cipriani, 2008). As suggested by Emil Kraepelin, the method is more systematic and effective than the old-fashioned method gestalt diagnosis (impression diagnosis).

The term differential is derived from “difference”, which speaks to the practice used in the process of diagnosis where a list is made of all possible diagnoses (Wilson, 2007). It is then followed by removing diagnosis from the list by elimination till two or one diagnosis are left, where further diagnosis is done to arrive at the most and highly possible diagnosis (Barbui & Cipriani, 2008). Certain cases may end up leaving not particular diagnosis, which is an indication that the physician may have made an error or that the possible or true diagnosis is not known by the medication process being used (Guzofski, 2007). When removing diagnoses from the list, several tests and observations are made showing different results as pertains the diagnosis being undertaken.

In undertaking differential diagnosis, different conditions or circumstances, known as the presenting problems or the chief complaints, are assessed and examined in regard to the underlying factors causing the problems, the concurrent phenomenon which are observed appropriate perspectives of the discipline, as well as according to different theoretical frames or paradigms, which are then compared to the known types of pathology (Guzofski, 2007). In the process of differential diagnosis, a physician is able to do the following:

· Understand more clearly the circumstance

· Assess the most probable prognosis

· Remove all the imminent conditions which could be life-threatening

· Plan for the treatment of the arising condition

· Enable the patient and the family to understand and integrate the condition in their lives.

In the event that the diagnosed condition has not improved, the process of diagnosis is reassessed in order to arrive at the correct diagnosis (Wilson, 2007).

Patient description

The patient in this case study had memory loss which began as a mild condition. He later started forgetting major events like marriage anniversary as well being nit able to control himself in certain instances. He presented himself to a psychiatrist for diagnosis. The psychiatrist had to go through differential diagnosis in order to correctly arrive at the problem as presented by signs and symptoms (Barbui & Cipriani, 2008).

Steps in the DSM-5 Differential Diagnosis

Patients appear in hospitals with different circumstances or conditions which require proper diagnosis, but the path for the diagnosis is usually not a straight one from symptom to diagnosis (Guzofski, 2007). There are many disorders which could have the same symptoms as those of a person suffering from depression. For the clinician, his work is using different methods in order to figure-out the right disorder from the symptoms being presented by the patient. This is essential because it defines the kind of treatment to be used for the condition (Barbui & Cipriani, 2008). This is basically because patients do not understand what is ailing them in most cases and may describe many signs and symptoms which could be related or associated with other similar disorders.

A patient will not be able to say “I have depression, plan a treatment for me”. On the contrary patients come to the hospitals ti seek relieve from the symptoms or pain in their bodies (Guzofski, 2007). It is therefore the work of the clinician to determine the right disorder from the DSM chart. The diagnostic processes of these disorders are usually broken down to 6 steps (Guzofski, 2007). This makes it easier for the clinician because the success of the diagnostic depends on good collaboration between the patient sand the clinician. When the patient does not give the right information, or is not honest, the process of diagnosis may not give the right outcome. The collaboration between the clinician and patient usually depend in good faith (Guzofski, 2007). The following are the steps which are used in determining a particular disorder from the presenting symptoms:

Step 1: Ruling out Malingering and Factitious Disorder

In the process of diagnosing a problem, the malingering disorder will differ from the factitious disorder in the basis of the available motivation. Malingering achievement usually depend on goals which are clearly recognizable such as avoiding responsibilities or compensation through insurance, which is most cases is not a mental disorder (Guzofski, 2007). On the other hand, factitious disorder presents symptoms related sicknesses which are usually derived from psychological reasons.

Step2: ruling out substance etiology.

Clinicians should also consider the symptoms presented by the patients in relation to substance abuse. It is noted that many of the psychiatric problems could be associated with substance abuse. In making this determination, the clinician can ask questions to the patient regarding the past life, check the family line for possible substance abuse, look for any signs of substance abuse, or undertake laboratory tests which aim at screening for substance abuse (Guzofski, 2007). The side effects of any medication should also be considered.

If there is evidence of substance abuse, the clinician should consider the etiological relationship between psychiatric and substance disorders (Wilson, 2007). The psychiatric signs and symptoms may be resulting from direct effects of drug/substance abuse, or they could be through consequences as a result of primary psychiatric disorders as well as abuse of substances (Guzofski, 2007). The psychiatric symptoms could also be independent and completely comorbid. The fact that these psychiatric symptoms and substance use are completely independent does not mean they cannot influence each other.

Step3. Ruling out disorder due to a general medical condition

It is important that clinicians take direct examinations of the conditions which are commonly present because they could account for the emerging psychiatric symptoms such as mental problems which result from dysfunctional thyroid. In the case that the general medical condition has contributed to the psychiatric problem, it is prudent for the clinician to encounter various etiological relations (Guzofski, 2007). The psychiatric symptoms may have been caused by medication, in which case they will cause adverse effects of the general medical condition, or there may be a coincidence between the general medical condition and the psychiatric symptoms.

Additionally, the general medical condition may result into symptoms of mental health through direct effects of psychology, hence affecting the brain either through stroke or other related psychological mechanisms (Barbui & Cipriani, 2008). This is usually observed when patients have depressive symptoms as a result of cancer medication or diagnosis. In cases where depression is caused by other conditions such as cancer, the diagnosis on the patients will be characterized by depressive or adjustment disorder (Guzofski, 2007). When a clinician is looking for any clues which may determine the general medication factor, a complete assessment is done temporary on the relationship of the conditions such as whether the psychiatric problem was triggered by the presence of the general medication disorder, if there is variation between the psychiatric symptoms and the general medical condition, or the symptoms go down when the general medical condition resolves (Wilson, 2007).

There other patterns in patients which may cause such symptoms such as age onset, which may also require check up from a clinician. For instance, the onset of manic issues in elderly patients could trigger psychiatric symptoms on the patient and could lead to memory loss or weight loss as a result of accompanying depression.

Step 4: determination of primary disorders

If the clinician has been careful in following up the problem presented, he should be able to pinpoint the possible primary disorder. This is because many of the problems which are presented in the DSM-5 show within the common daily symptoms (Guzofski, 2007). Considering the manual of DSM-5, it is possible follow up from the decision tree and arrives at the problem. The manual makes it easy to choose from the presented primary disorders (Guzofski, 2007). Additionally, using differential diagnosis can aid in getting the right diagnosis for the possible disorders. This is achieved through ensuring that all other likely possible disorders have been ruled out

Step 5: Differentiate adjustment disorder from residual other or unspecified categories.

Clinicians should think using different ways which could help them in deciding the right condition. In the case where patients have presented different thresholds of symptoms which may be severe to cause distress or impairment, the physicians should explore the adjustment disorder in relation to the use of other specified or unspecified disorders. Symptoms could be maladaptive in responding to the psychological stressors (Guzofski, 2007). In this case, adjustment disorders should be considered. If there are no adjustment disorders, the appropriate residual category is given. For example, a physical may use specified or unspecified in establishing the reason for not arriving at the criteria or choose not to give a reason in case there condition is unknown (Guzofski, 2007)

Step 6: Establishing boundary with no mental disorder

The final result from the clinician should be the evaluation of the possibility of the symptoms of the patient to cause any clinical distress which is significant or which can cause social or occupational impairment, among other many things. The determination in the hands of the clinician is to determine what can constitute clinical significance or whether the problem was picked in the process of giving primary care (Guzofski, 2007). Additionally, presented problem should constitute psychological or biological dysfunctions in the patient. In this case, the clinician should be able to differentiate the psychological distress may be caused by mourning a close family member because this may not qualify to be in the category of mental disorders.

Looking at the symptoms of the patient in the case study, he may be suffering from depression disorder because he loses from internal distresses which are not associated with substance abuse. It is important to note mental disorders are one of the hardest disorders to diagnose because they do not present symptoms such as swollen limb or sore throat (Guzofski, 2007). Another problem which encountered in these situations is in determining the presence of personality disorders. In this determination, there is possibility of other disorders to be present such as psychopathy, Asperger’s syndrome or bipolar disorder

 

Risk factors

Looking at the complaints of the patient, there are number of risk factors which could have contributed to the problem. In this case, age could be a factor. Research shows that the onset of manic episode could lead to problems of memory loss as well as other depression (Guzofski, 2007). This is because of the alteration of the hormone systems in the body triggering the change in the way the body has been conditioned to operate.

More importantly, the conditions are not easily recognizable and the patient may take a long time to realize that there are internal problems. The systems result into delayed coordination of the nerves in the brain (Jha & Prakash, 2016). Additionally, when the brain is unable to coordinate its functions well, the patient will not be able to remember important things due to memory loss. In other instances, the changes may result into anxiety or stress because the patient may become uncomfortable to what is happening to him, triggering depression and other related disorders (Guzofski, 2007).

Another factor which could result in depression is economic problems. A person who has been enjoying the good life brought about good income and the conditions change abruptly he may not be able adapt or adjust in a very short time (Guzofski, 2007). This triggers many thought in the brain, leading to constant stress due to inability to provide for the family, and as a result, the person develops psychiatric symptoms which could be escalated by age.

Evidence based and non-evidence based treatment options.

Evidence based treatment

The growing number of patients who are able to monitor their quality of life, health and functioning, as well as other important outcomes in life, they acquire a pool of information which they can use to handle their life’s outcome, as well as contribute to practical knowledge base. This works when the monitoring is reliable, friendly and systematic (O’Hare, 2014). The results of the monitoring can be useful in developing ways which can be used to handle other upcoming problems (O’Hare, 2014). Registers belonging to patients who have undergone similar treatment are useful in the development of new drugs as well as gathering information about certain mental conditions and their related signs and symptoms. The patients are then given treatment based on the symptoms such as describing the appropriate medication to deal with the cause of the depression (O’Hare, 2014). The patients may also undergo therapy in order to alleviate the problems, which should be followed until the desired outcome is achieved.

Non-evidence based treatment.

Psychiatrists who deal with patients having mental problems focus on helping the patients with the right interventions which have been proven to be beneficial to them. there are many levels of treatments which can be used in treating mental health such as meta-analyses based on observable data, randomized, double-blind trials, controls, among many others (Jha & Prakash, 2016). Treatment decisions for people with mental problems may be more difficult when using evidence based treatments.

Psychiatrists are able to help patients because they have information on the possible outcomes than physicians who treat patients who handle patients with multiple medical conditions. Psychiatrists are able to use different interventions in order to help patients overcome the disorders (Jha & Prakash, 2016). The options presented to the patient by the psychiatrist in order to help the patient with the mental problems may include the patient taking charge of his life in order to monitor anything that may cause stress to the patient. It would also involve the patient being able to monitor the changes that are in his life and dealing with them early enough before they cause any psychiatric symptoms (Guzofski, 2007).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Annotated Bibliography

Geddes, J., Reynolds, S., Streiner, D., Szatmari, P., & Haynes, B. (2009). Evidence-based practice in mental health. Evidence-Based Mental Health, 1(1), 4-5. doi:10.1136/ebmh.1.1.4

This book describes the procedures which can be used by clinicians in keeping up-to-date with the appropriate clinical research for the treatment of mental health. It summarizes research which has been done in the area of mental health by giving the best ways if deal with patient with psychiatric problems and answering different kind of questions regarding mental health.

Jansson, L., & Nordgaard, J. (2016). Mental State Examination: Signs. The Psychiatric Interview for Differential Diagnosis, 53-90. doi:10.1007/978-3-319-33249-9_5

This is a research book which gives different approaches of examining the causes of mental health in order to arrive at proper diagnosis of the problems through differential diagnosis. It stipulates ways in which psychiatrist may ask relevant questions in order to get the required information

Rozzini, R., & Trabucchi, M. (2017). Mental health: Epidemiology, pathophysiology, diagnosis, and management. Oxford Medicine Online. doi:10.1093/med/9780198701590.003.0134

This is a detailed study of mental health in terms of the causes, signs and symptoms, the best method of diagnosis, and the most appropriate treatment for patients in order to alleviate the problems. It gives step to step methods of recognizing the problems

Schwartz, R., Lent, J., & Geihsler, J. (2011). Gender and Diagnosis of Mental Disorders: Implications for Mental Health Counseling. Journal of Mental Health Counseling, 33(4), 347-358. doi:10.17744/mehc.33.4.914g2n123u771316

This article deals with mental health as observed in different genders, as well as what psychiatrist should consider in counseling the patients. It outlines the ways in which counselors should deal with mentally sick people

Wykes, T., & Callard, F. (2010). Diagnosis, diagnosis, diagnosis: Towards DSM-5. Journal of Mental Health, 19(4), 301-304. doi:10.3109/09638237.2010.494189

This article describes the diagnosis processes which are used by psychiatrists in ensuring proper diagnosis of mental disorders using the DSM -5 manual. It places major concern on the best way to utilize the manual when trying to get the solution to mental problems.

 

 

 

 

 

 

 

 

 

 

 

References

Barbui, C., & Cipriani, A. (2008). Cognitive improvements with antipsychotics: Real or practice effect? Evidence-Based Mental Health, 11(2), 42-42. doi:10.1136/ebmh.11.2.42

Guzofski, S. (2007). Differential Diagnosis Made Easier: Principles and Techniques for Mental Health Clinicians. Psychiatric Services, 58(4), 572-572. doi:10.1176/appi.ps.58.4.572

Jha, S., & Prakash, O. (2016). Differential diagnosis for cognitive decline in elderly. Journal of Geriatric Mental Health, 3(1), 21. doi:10.4103/2348-9995.181911

O’Hare, P. (2014). Evidence-Based Practice. Approved Mental Health Practice, 171-186. doi:10.1007/978-1-137-00014-9_12

Wilson G. T. (2007). Treatment manuals in clinical practice. Behave Res Ther;35:205–10

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