QUESTION 1

1. Todd, a 20 year old African American man has been steadily declining for many years. At 17 years of age, things in his life began to become chaotic. He dropped out of school, dressed in solid black, refused to talk to people, shaved his head, and no longer bathed. He began to walk the halls of his parent’s home with no apparent since of direction. At times, his parents would find him standing in his closet. Todd began to incoherently mumble to himself and talk in rhymes (sometimes singing the rhymes). When his parents do talk to him, he will often repeat their words over and over. As he deteriorated further and his parents took him to many doctors. You are a social worker at a local mental health clinic that specializes in people with psychosis. Todd has become increasingly psychotic and disorganized. His psychosis is generally bizarre. He has a difficult time functioning and is not able to work. His self-care is also non-existent and he rarely talks. He has had these symptoms for over 6 months. Schizoaffective disorder and bipolar I with psychotic features have been ruled out. Todd does like to drink alcohol and he is often intoxicated, but you believe that his behavior is not the result of alcohol.  However, alcohol has certainly exacerbated it. Todd is down much of the time and often talks about killing himself. He often wakes up at 3AM and cannot return to sleep. Todd does not eat and has lost over 25lbs. He seems to have little energy. He occasionally points out that he is worthless. He can’t seem to concentrate. He indicates to you that he has been feeling down for over several months. Todd also likes to smoke marijuana and has done so for years. He says that he has attempted to cut back, but you are unsure. He smokes it even his primary care doctor has advised him to stop. His parents will not let him drive, but he often steals his sister’s car when he is drunk or high on marijuana. You interview his family and find out that his great grandmother was hospitalized for over 20 years because she was “crazy.”

2. Based on the information, provide a comprehensive diagnosis for this case study.

 3) Differential diagnosis is the process of weighing the probability of one disorder versus that of other disorders possibly accounting for a client’s illness. For this case study, what other diagnoses did you consider and why did you rule them out to provide the comprehensive diagnosis above?

4) Using the client’s risk and protective factors, identify three main goals of a treatment plan including the best practice approach or evidence based treatment for this client.

5 ) Discuss the sociocultural issues that impact your assessment and treatment of this case. (Hint: When applicable consider the influence of age, ethnicity, language, immigration, acculturation, gender roles, social class, stigma, illness identity, spirituality/religion etc..). Discuss any effects of current or historical discrimination, oppression and/ or trauma on the client and client system.

Question 2 

1. Lester, a 26 year old white man was recently sent to jail for stealing a truck load of TV sets. This is not Lester’s first offense. He has been charged with assault and carrying a concealed weapon. You work at the jail as a psychiatric social worker and you have asked to interview him. You obtained his juvenile detention history and it is extensive. You also find out that he was adopted from Russia when he was three years old. His parents noted in his juvenile file that he was diagnosed with reactive attachment disorder at a young age and later with oppositional defiant disorder. You begin the interview by asking him what happened. He explains that he was minding his own business and the truck with the TVs sort of stopped in front of him and the back door came open. He calls the correctional officers idiots and boasts about his intelligence. You ask him about the assault and he points out that the person had it coming to them. You notice that he was written up for attacking one of the correctional officers. He maintains that he correctional officer was in his way. He had a cell mate, but he almost killed him and the cell mate was transferred. You ask him about his juvenile record and he admits that he had a bad stretch as a kid. He points out that he was once on Ritalin for ADHD, but his parents took him off. He points out that as he turned 14 – he just started doing stuff. “I would get in fights and often use a weapon.” “Animals got on my nerves so I killed them.” He was accused of rape when he was 15, but convinced the girl to drop the charges. He stole a car when he was 14 and drove to Los Vegas. He often broke curfew and he liked to set fires. He started drinking when he was 14 and has drunk too much over the years. He has been warned to stop, but he continues. He drank more and more to get a high. He had a strong desire to drink and would operate machinery while drunk. He has received 4 DUIs and has spent over a year in jail for his drinking.

2. Based on the information, provide a comprehensive diagnosis for this case study.

 3) Differential diagnosis is the process of weighing the probability of one disorder versus that of other disorders possibly accounting for a client’s illness. For this case study, what other diagnoses did you consider and why did you rule them out to provide the comprehensive diagnosis above?

4) Using the client’s risk and protective factors, identify three main goals of a treatment plan including the best practice approach or evidence based treatment for this client.

5) Discuss the sociocultural issues that impact your assessment and treatment of this case. (Hint: When applicable consider the influence of age, ethnicity, language, immigration, acculturation, gender roles, social class, stigma, illness identity, spirituality/religion etc..). Discuss any effects of current or historical discrimination, oppression and/ or trauma on the client and client system.