Prior to beginning work on this interactive assignment, please view the required video PSY645 Grand RoundsPresentation; read Chapters 15, 20, and the Classes (or Names) of Medications That Can Cause Mental Disorders appendix in DSM-5-TR® Made Easy: The Clinician’s Guide to Diagnosis; read Chapter 1 of DSM-5: Handbook of Differential Diagnosis; and read Section 4: Privacy and Confidentiality from the APA’s Ethical Principles of Psychologists and Code of Conduct: Including 2010 Amendments.

To view the written transcript, please click here.

Mental health professionals hold grand rounds events to maintain their current knowledge of health care practices and to consult with colleagues on particularly difficult cases. During these professional events, mental health professionals sometimes present a case and seek feedback from peers regarding conceptualization and treatment of a patient’s problems. This interactive assignment is an opportunity to simulate a grand rounds event.
For your initial post in this forum, you will provide written feedback regarding your colleague’s presentation and questions. Your post must include the following:

• Provide an evaluation of the degree to which the presenter followed the ethical standards outlined in Section 4 of the APA’s Ethical Principles of Psychologists and Code of Conduct: Including 2010 Amendments.
• Highlight the relevant information from the patient’s history you will use to inform your conceptualization of the patient’s problems and diagnosis.
• Provide an evaluation of the patient’s symptoms and presenting problems within the context of a theoretical orientation that seems to be most appropriate for the situation. Be sure to indicate which theory you are using for your evaluation and provide a justification for your choice. (e.g., cognitive, behavioral, humanistic, biological, sociocultural, evolutionary, psychoanalytic, integrative, etc.). NOTE: Be clear that you are writing about theoretical orientations and using the theoretical orientations to explain the client’s symptoms and presenting problems. Do not use the theoretical orientations to discuss any therapy or treatment approaches. Your application of the theoretical orientations should answer the question: How did this client develop the symptoms and current presenting problems? For example, “Based on the cognitive perspective, how did this client develop the symptoms and current presenting problem?” “Based on the humanisitic perspective, how did this client develop the symptoms and current presenting problem?” Etc.
• Provide a diagnosis for the patient based on the American Psychiatric Association’s (2022) Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.; DSM-5-TR). Be specific about the DSM-5-TR criteria required for the diagnosis and how the client meets those criteria.
• Describe at least one evidence-based and one non-evidence-based treatment option for this diagnosis.
• Pose appropriate questions that you would ask the client to help determine the most accurate diagnosis for this patient.

This is what I need done!
Guided Response: Review several of your colleagues’ posts, and respond to at least two of your peers by 11:59 p.m. on Day 7 of the week. You are encouraged to post your required replies earlier in the week to promote more meaningful interactive discourse in this discussion.

Examine your colleague’s feedback and formulate a response based on your colleague’s questions. Assess the validity of your colleague’s diagnosis from a sociocultural perspective using the theoretical orientation from which you wrote your initial post. The goal of your response is to present information and feedback from your theoretical orientation for your colleague’s consideration, rather than forcing your colleague to take on your orientation as their own. Describe how your conceptualization differs from your colleague’s, if there is a significant difference.

classmate one:

Jacob Eder

Aug 30, 2023 at 7:28 PM

Grand Rounds

Ethical Considerations:

The presenter, Dr. Stephen Brewer, did not entirely follow the APA’s Ethical Principles of Psychologists and Code of Conduct (American Psychological Association, 2010). While he did obtain consent from Bob to contact his friends, he did not obtain consent to contact Bob’s mother and instead hired a private detective to find her contact information. This is a violation of Bob’s privacy and the principle of respect for the client’s autonomy. In addition, contacting Bob’s mother without his consent could potentially harm Bob or the therapeutic relationship.

Relevant History:

Bob grew up in a low-income, conservative, and religious household with an absent father and a strict, rule-based mother prone to outbursts. He moved to San Diego at 18, proceeded to cease contact with his parents when his mother planned to move closer, and worked as a psychiatric technician for 14 years. Bob’s friends reported a significant personality change three years ago, suspecting drug use and noting his absence from work and social circles. This information is crucial for conceptualizing Bob’s problems and diagnosis.

Theoretical Conceptualization:

From an integrative theoretical orientation, combining psychodynamic and biopsychosocial perspectives can be helpful (Prochaska & Norcross, 2018). Psychodynamically, Bob’s guardedness about his family and decision to cut offcontact with his mother suggest unresolved conflicts from his childhood. His mother’s controlling nature and the absence of his father could have led to attachment issues and difficulties in forming and maintaining close relationships (Bowlby, 1988). The biopsychosocial perspective considers biological, psychological, and social factors (Engel, 1977). Bob’s significant personality change, weight loss, and withdrawal from work and social interactions could indicate a biological component, possibly substance abuse or a mental health disorder.

Development of Symptoms from an Epigenetic Perspective:

From an epigenetic perspective, which considers the interplay between genetic predisposition and environmental influences (Meaney, 2010), Bob’s upbringing in a stressful environment with a controlling mother and absent father could have activated genetic predispositions for anxiety or other mental health issues. The significant personality change and withdrawal from friends and work could be related to a stressful event or substance abuse, which may have further activated or exacerbated genetic predispositions.

DSM-5-TR Diagnosis:

Based on the information provided, a differential diagnosis should consider Substance Use Disorder, given the significant personality change, weight loss, and withdrawal from social interactions and responsibilities, as reported by Bob’s friends (American Psychiatric Association, 2022). Wherever, more information is needed to confirm this diagnosis. The criteria for Substance Use Disorder include impaired control, social impairment, risky use, and pharmacological criteria. Bob’s behavior aligns with some of these criteria, but more information is required for a definitive diagnosis.

Treatment Options: Evidence-Based Treatment:

Cognitive-Behavioral Therapy (CBT) is an evidence-based treatment for Substance Use Disorder and may help Bob address maladaptive thought patterns and behaviors related to substance use (Magill & Ray, 2009).

Non-Evidence-Based Treatment:

Acupuncture, as an example for a holistic, non-evidence treatment approach, is a non-evidence-based treatment that some people find helpful in managing cravings and withdrawal symptoms associated with substance use (Lu, Liu, & Robinson, 2002).

Questions for the Client:

1. Have you noticed any changes in your mood, behavior, or daily activities over the past three years?

2. Have you used any substances, including alcohol, prescription medications, or illicit drugs, in the past three years?

3. Can you tell me more about your relationship with your mother and how it has affected you?

4. Have you experienced any significant stressors or life events in the past three years?

The presenter should approach Bob with empathy and a nonjudgmental attitude, asking open-ended questions to gather more information about Bob’s experiences and symptoms. This will assist in producing the most accurate diagnosis and developing an appropriate treatment plan.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR).

American Psychological Association. (2010). Ethical principles of psychologists and code of conduct: Including 2010 amendments.

Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. Basic Books.

Engel, G. L. (1977). The need for a new medical model: a challenge for biomedicine. Science, 196(4286), 129-136.

Lu, L., Liu, Y., & Robinson, N. (2002). Acupuncture for drug addiction. Neurochemistry International, 41(1), 1-10.

Magill, M., & Ray, L. A. (2009). Cognitive-behavioral treatment with adult alcohol and illicit drug users: A meta-analysis of randomized controlled trials. Journal of Studies on Alcohol and Drugs, 70(4), 516-527.

Meaney, M. J. (2010). Epigenetics and the biological definition of gene× environment interactions. Child development, 81(1), 41-79.

Prochaska, J. O., & Norcross, J. C. (2018). Systems of psychotherapy: A transtheoretical analysis. Oxford University Press.

classmate two: Brandee Forster

Aug 31, 2023 at 11:55 AM

Ethics

This provider followed some ethical standards and did not follow others. In the section 4.01 of maintaining confidentiality (American Psychological Association, 2010), this was upheld with obtaining consent from the client to talk to his friends from college, and with the way he presented the information in the grand rounds. However, this was not followed when it came to the clients mother, the client specifically denied access to talking to his mother and the provider decided to hire a private investigator to find means to contact her against the clients wishes.

History

Bob is a 36 year old male who has been receiving therapy for about 6 months. He presents with some anxiety symptoms, rocky relationship with his mother and a deceased father. Relationship with mother had been cut off years ago due to short temper, controlling and overbearing behaviors. Bob seems unfulfilled with work and the life around him, his friends explain that he has become reclusive and suspicious in the last three years. They also explain they suspect he might be using explicit substances, has been hard to reach, and hasn’t been working regularly.

Theoretical perspectives

When looking at theoretical perspectives the psychoanalytic theory allows us to explain normal and abnormal personality development behind someones behaviors (Cannon, 2023). Bob has withdrawn from his friends, work, and outgoing life which can in part be from his mother being overbearing and feeling overwhelmed with anxiety, as well as depression due to the loss of his father and his lack of enthusiasm in life as he knows it today. Cognitive behavioral therapy can be beneficial for both anxiety and depression symptoms. Another perspective is psychosocial theory, which assesses trauma in small community or groups of people. Trauma types can include work related tensions, long time animosities between, drug and alcohol dependency, death, depression and other mental health disorders (Dewey, 2022). When looking at bob, he may have depressive problems as well as a clear unwell relationship with his mom, and unfulfilling feelings about work which could benefit from psychosocial therapies.

Diagnosis

I agree with the providers diagnosis of adjustment disorder, but feel that it would be better described as with mixed anxiety and depressed moods. Symptoms that bob has described as loss of interest in his work and symptoms that his friends described as weight loss, possible drug use, and an overall change from an outgoing person to a socially reclusive person aligns with depressive mood.

Evidence-based treatment

Cognitive behavioral therapy (CBT) is a great option for bob, CTB is a set of problem specific interventions that allow improvement for different mental health disorders (Roth & Pilling, 2008).

Non-evidence-based treatment

Non-evidence-based treatment option for anxiety and depression would include smartphone apps. In our current world there is an app for everything, although those apps may not be giving great advise there is little to no way of knowing if the information one is receiving is true or evidence based. One out of five apps for depression focus on non-evidence based treatment options (Martinengo et. al., 2022). These apps would not helpful for those looking for relief.

Questions for the client

-do you feel overwhelmed or stressed about your work?

-do you feel overwhelmed or stressed about being around other people?

-do you feel depressed or upset about your current life?

-do you feel like you have lost who you are?

References:

American Psychological Association. (2010). Ethical principles of psychologists and code of conduct: Including 2010 amendmentsLinks to an external site. Links to an external site..

Brewer, S., & Simpelo, V. (2014). PSY645 grand rounds presentation Links to an external site. Links to an external site. [Video]. University of Arizona Global Campus: San Diego, CA.

Cannon, J. B. (2023). Psychoanalytic psychology. Salem Press Encyclopedia of Health.

Dewey, J., PhD. (2022). Psychosocial. Salem Press Encyclopedia.

Martinengo L, Stona A, Tudor Car L, Lee J, Griva K, & Car J. (2022). Education on Depression in Mental Health Apps: Systematic Assessment of Characteristics and Adherence to Evidence-Based Guidelines. Journal of Medical Internet Research, 24(3), e28942. https://doi.org/10.2196/28942

Morrison, J. (2023). DSM-5-TR® made easy: The clinician’s guide to diagnosis. Guilford Press. https://redshelf.com

Roth, A. D., & Pilling, S. (2008). Using an evidence-based methodology to identify the competences required to deliver effective cognitive and behavioural therapy for depression and anxiety disorders. Behavioural and Cognitive Psychotherapy, 36(2), 129–147. https://doi.org/10.1017/S1352465808004141