Review the 3 case studies provided (one for each DSM-V section…

Review the 3 case studies provided (one for each DSM-V section covered in the module). Determine the correct DSM-V diagnosis including any applicable specifiers. Provide a brief rationale for your specific diagnosis (see example below).
Here is an example of a case study and also an example of the DSM-V diagnosis and rationale for the diagnosis which includes the letters and numbers associated with the diagnosis in DSM-V.
Example Case Study:
“Carl Estel, a 74-year-old right-handed man, was brought for a neuropsychiatric evaluation after a multi-year decline marked by stiffness, forgetfulness, and apathy. His wife had been trying to get him in for an evaluation for years and had finally become desperate enough to enlist his brothers to bring him for the evaluation.
Mrs. Estel described her husband’s problems as starting when he retired at age 65. He had seemed “out of sorts” almost immediately, and she had wondered at the time whether he was getting depressed. He became uncharacteristically forgetful, misplacing items and neglecting to pay bills. He had trouble with appointments, medications, and calculations. He had declined to see a physician at her urging until he was involved in a traffic accident a few years prior to this evaluation. While evaluating him for minor injuries, a physician had said that the accident was caused by inattention and diminished depth perception, that Mr. Estel should stop driving, and that he might have early dementia.
Over the past year, things had gotten worse. Mr. Estel often could not recall the outcome of sporting events that he had just watched on television, although his memory improved with cues. He resisted activities such as travel and socializing that he had previously enjoyed. A former athlete, he quit taking walks around the neighborhood after several falls. He quit playing cards with neighbors because the rules had become confusing. He looked depressed and acted apathetic but generally said he was fine. His judgment and problem-solving skills were rated as poor. A retired plumbing contractor who had completed 4 years of college, Mr. Estel sometimes seemed unable to operate household appliances. All of these cognitive problems seemed to fluctuate, so that his wife reported that sometimes he was “almost like his old self,” whereas at other times it was “like living with a zombie, a depressed zombie.” She described his excessive daytime drowsiness and frequent staring spells. She also reported that she felt exhausted.
When asked specifically about sleep, Mrs. Estel reported that neither of them slept well. Mainly, she said, it was because of her husband “acting out his dreams.” He punched and screamed and would occasionally fall out of bed. She was bruised the morning after these episodes and decided it was safer to sleep on the couch. These episodes occurred several times per month. She recalled that these sleep episodes began just before he retired; she recalled wondering at the time whether he had posttraumatic stress disorder, but she did not think he had suffered any particular trauma. A few years earlier, a friend had offered a “sleeping pill” that had helped her own husband with dementia. Mr. Estel had responded to it with extreme rigidity and confusion, and his wife had nearly taken him to the emergency room in the middle of the night.
Mrs. Estel denied that her husband had ever had any psychiatric illness. When asked about psychotic symptoms, she said he often seemed to swat at invisible things in the air. This happened about twice a month.
Mr. Estel’s medical history was pertinent for hypercholesterolemia, cardiovascular disease with a stent, and possible transient ischemic attacks. His family history was positive for his mother having developed dementia in her mid-70s.
On examination, Mr. Estel was a stooped, stiff man who shuffled into the office. While listening to his wife present the history he often stared into space, seeming to pay no attention to the content of the conversation. His right hand was tremulous. He appeared depressed but when asked, he said he felt fine. His voice was so quiet that words were often unintelligible even when the interviewer leaned close. He drooled at times and did not notice until his wife wiped his chin.
When asked to do cognitive testing, he shrugged his shoulders and said, “I don’t know.””
Example Student Response:
Diagnosis is
Major neurocognitive disorder with Lewy bodies
Major neurocognitive disorder with Lewy bodies Diagnostic Criteria A – meeting criteria for major neurocognitive disorder.
Major Neurocognitive Disorder Criteria A – Mr. Estel experienced significant cognitive decline (A) since retirement
Major Neurocognitive Disorder Criteria B – Cognitive deficits interfere with his independence and he is unable to pay bills and drive
Major Neurocognitive Disorder Criteria C – There are no indication of delirium for Mr. Estel.
Major Neurocognitive Disorder Criteria D – Mr. Estel has not history of mental illness and symptoms do not seem related to another mental disorder
Major neurocognitive disorder with Lewy bodies Diagnostic Criteria B – gradual onset – Mr. Estel has had worsening of symptoms over time.
Major neurocognitive disorder with Lewy bodies Diagnostic Criteria C – core diagnostic features and suggestive diagnostic features
Major neurocognitive disorder with Lewy bodies Core Diagnostic Features – fluctuating cognition (A)- wife reports he is sometimes a “zombie”, recurrent visual hallucinations (B) – although the specifics are not clear, wife reports he waves in the air, spontaneous features of parkinsonism (C) – sleeping pill caused extreme rigidity and confusion,
Major neurocognitive disorder with Lewy bodies Suggestive Diagnostic Features – rapid eye movement sleep behavior disorder (A) – Mr. Estel meets criteria for this disorder which wife describes as “acting out his dreams” and she now sleeps on the couch. It is unclear if the Mr. Estel has severe neuroleptic sensitivity (B), but if the sleeping pill was an antipsychotic like Seroquel, then he would also meet this criteria.
Trauma- and Stressor- Related Disorders Case Study
Dylan, a 15-year-old high school student, was referred to a psychiatrist to deal with the stress from being involved in a serious automobile accident 2 weeks earlier. On the day of the accident, Dylan was riding in the front passenger seat when, as the car was pulling out of a driveway, it was struck by an oncoming SUV that was speeding through a yellow light. The car he was in was hit squarely on the driver’s side, which caused the car to roll over once and come to rest right side up. The collision of metal on metal made an extremely loud noise. The driver of the car, a high school classmate, was knocked unconscious for a short period and was bleeding from a gash in his forehead. Upon seeing his injured friend, Dylan became afraid that his friend might be dead. His friend in the back seat of the car was frantically trying to unlatch her seat belt. Dylan’s door was jammed, and Dylan feared that their car might catch fire while he was stuck in it. After a few minutes, the driver, Dylan, and the other passenger were able to exit through the passenger doors and move away from the car. They realized that the driver of the SUV was unharmed and had already called the police. An ambulance was on its way. All three were transported to a local emergency room, where they were attended to and released to their parents’ care after a few hours.
Dylan had not had a good night’s sleep since the accident. He often awoke in the middle of the night with his heart racing, visualizing oncoming headlights. He was having trouble concentrating and was unable to effectively complete his homework. His parents, who had begun to drive him to and from school, noticed that he was anxious every time they pulled out of a driveway or crossed an intersection. Although he had recently received his driving permit, he refused to practice driving with his father. He was also unusually short-tempered with his parents, his younger sisters, and his friends. He had recently gone to see a movie but had walked out of the theater before the movie started; he complained that the sound system was too loud. His concerned parents tried to talk to him about his stress, but he would irritably cut them off. After doing poorly on an important exam, however, he accepted the encouragement of a favorite teacher to go to a psychiatrist.
When seen, Dylan described additional difficulties. He hated that he was “jumpy” around loud noises, and he could not shake the image of his injured and unresponsive friend. He had waves of anger toward the driver of the SUV. He reported feeling embarrassed and disappointed in himself for being reluctant to practice driving. He stated that about 5 years earlier, he had witnessed the near-drowning of one of his younger sisters. Also, he mentioned that this past month was the first anniversary of his grandfather’s death.
These are the three case study
Dissociative Disorders Case Study:
Jason Vaughan, a 20-year-old college sophomore, was referred by his dorm’s resident adviser to the school’s mental health clinic after appearing “strange and out of it.” Mr. Vaughan told the evaluating therapist that he had not been his “usual self” for about 3 months. He said his mind often felt blank, as if thoughts were not his own. He had felt increasingly detached from his physical body, going about his daily activities like a “disconnected robot.” At times, he felt uncertain if he were alive or dead, as if existence were a dream. He said he almost felt like he had “no self.” These experiences left him in a state of terror for hours on end. His grades declined, and he began to socialize only minimally.
Mr. Vaughan said he had become depressed over the breakup with a girlfriend, Jill, a few months earlier, describing sad mood for about a month with mild vegetative symptoms but no impairment in functioning. During this time, he began to noticesome feelings of numbness and unreality, but he did not pay much attention at first. As his low mood resolved and he found himself becoming increasingly disconnected, he began to worry more and more until he finally sought help. He told the counselor that his 1-year romantic relationship with Jill had been very meaningful to him and that over the holidays he had planned to introduce her to his mother for the first time.
Mr. Vaughan described a time-limited bout of extreme anxiety in tenth grade. At that time, panic attacks had begun and then escalated in severity and frequency over 2 months. During those attacks, he had felt very detached, as if everything were unreal. The symptoms sometimes lasted for several hours and were reminiscent of his current complaints. The onset appeared to coincide with his mother’s entry into a psychiatric hospital. When she was discharged, all his symptoms cleared fairly rapidly. He did not seek treatment at that time.
Mr. Vaughan also described several days of transient unreality symptoms in elementary school, just after his parents divorced and his father left young Jason living alone with his mother, who had paranoid schizophrenia. His childhood was significant for pervasive loneliness and the sense that he was the only adult in the family. His mother was only marginally functional but generally not actively psychotic. His father rarely returned for visits but did provide enough money for them to continue to live in reasonable comfort. Jason often stayed with his grandparents on weekends, but in general he and his mother lived a very isolated life. He did well in school and had a few close friends, but he largely kept to himself and rarely brought friends home. Jill would have been the first girlfriend to meet his mother.
Mr. Vaughan denied using any drugs, in particular cannabis, hallucinogens, ketamine, or salvia, and his urine toxicology was negative. He denied physical and sexual abuse. He denied any history of depression, mania, psychosis, or other past psychiatric symptoms. He specifically denied amnesia, blackouts, multiple identities, hallucinations, paranoia, and other unusual thoughts or experiences.
Results of routine laboratory tests, a toxicology screen, and a physical examination were normal, as were a brain magnetic resonance imaging scan and electroencephalogram. Consultations with an otorhinolaryngologist and a neurologist were noncontributory.
Obsessive-Compulsive and Related Disorders Case Study
Vincent Mancini, a 26-year-old single white man, was brought for an outpatient evaluation by his parents because they were distressed by his symptoms. Since age 13, he had been excessively preoccupied with his “scarred” skin, “thinning” hair, “asymmetrical” ears, and “wimpy” and “inadequately muscular” body build. Although he looked normal, Mr. Mancini was completely convinced that he looked “ugly and hideous,” and he believed that other people talked about him and made fun of him because of his appearance.
Mr. Mancini spent 5-6 hours a day compulsively checking his disliked body areas in mirrors and other reflecting surfaces such as windows, excessively styling his hair “to create an illusion of fullness,” pulling on his ears to try to “even them up,” and comparing his appearance with that of others. He compulsively picked his skin, sometimes using razor blades, to try to “clear it up.” He lifted weights daily and regularly wore several layers of T-shirts to look bigger. He almost always wore a cap to hide his hair. He had received dermatological treatment for his skin concerns but felt it had not helped.
Mr. Mancini missed several months of high school because he was too preoccupied to do schoolwork, felt compelled to leave class to check mirrors, and was too self-conscious to be seen by others; for these reasons he was unable to attend college. He became socially withdrawn and did not date “because no girl would want to go out with someone as ugly as me.” He often considered suicide because he felt that life was not worth living “if I look like a freak” and because he felt isolated and ostracized because of his “ugliness.” His parents expressed concern over his “violent outbursts,” which occurred when he was feeling especially angry and distressed over how he looked or when they tried to pull him away from the mirror.
Mr. Mancini reported depressed mood, anhedonia, worthlessness, poor concentration, and suicidal ideation, all of which he attributed to his appearance concerns. To self-medicate for his distress over his appearance, he drank alcohol and smoked marijuana. He used protein powder to “build up muscle” but denied use of anabolic steroids or other performance-enhancing drugs and all substances of abuse. He had distressing and problematic anxiety in social situations during his late teens that he attributed to feeling “stupid,” but he denied recent social anxiety.
Mr. Mancini had no significant medical history and was taking no medication. His mother had obsessive-compulsive disorder (OCD).
Mr. Mancini was neatly dressed and groomed and wore a baseball cap. He had no obvious physical defects. His eye contact was poor. He was oriented and grossly cognitively intact. His affect was irritable; his mood was depressed, with passive suicidal ideation. He had no psychomotor abnormalities; his speech was normal. He was completely convinced that he was ugly but had no other psychotic symptoms. He believed his appearance “defects” were real and not attributable to a psychiatric disorder.

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