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Case Study For Mental Health Evaluation Discussion Paper

Case Study For Mental Health Evaluation Discussion Paper

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Ike Case Study

  1. Key Clinical Features

-Ike Crocker is a 32 year old man referred for a mental health evaluation by the human resources department

-Supervisors noted frequent arguments, absenteeism, poor workmanship, and multiple errors that might have been dangerous

-He was reportedly dismissive, indicating that the problem was “cheap wood” and “bad management” and added that if someone got hurt, “it’s because of their own stupidity” Case Study For Mental Health Evaluation Discussion Paper

-He complained about the company being unfair, and how he was “a hell of a better carpenter than anyone there could ever be.”

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-His jealousy ended two marriages.

-He claims that both wives lied to judges and got restraining orders saying he was abusive physically.

-As “payback” he refrained from helping the mothers or the kids via child support. He had no interest in seeing either of his children because they were “little liars” too.

-He went to juvenile hall when he was 14 for stealing “kid stuff, like tennis shoes and wallets that were practically empty.”

-He left school at 15 after being “framed for stealing a car” by his principle.

-Mr. Crocker said he smoked marijuana as a teenager and started drinking alcohol on a “regular basis” following his first marriage. Case Study For Mental Health Evaluation Discussion Paper

-Demanded a note from the examiner that he had “bipolar” and “ADHD”

-Denied he had any other symptoms of mania

-Mr. Crocker reported no difficulties with sleep, mood, or appetite.

-He was a casually dressed white man who made reasonable eye contact and was without abnormal movements

-His speech was very coherent.

-No evidence of hallucinations.

-He often blamed others, but this did not appear to be because of delusional thoughts.

-He was cognitively intact.

-He falsified graduation certificates for carpentry after being expelled from the programs.

-He had been fired from his job at one local construction company after a fistfight with his supervisor and from another job after abruptly leaving a job site. Case Study For Mental Health Evaluation Discussion Paper

 

Il. Final Diagnosis- Antisocial Personality Disorder

 

  1. A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three (or more) of the following:

 

  1. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest.

 

-He spent time in juvenile hall at age 14 for stealing “kid stuff, like tennis shoes and         wallets that were practically empty.”

 

-He left school at age 15 after being “framed for stealing a car” by his principle.

 

-As “payback for the jail time,” he refused to pay child support for his two children.

 

-Both his graduation certificates had been falsified.

 

-Fired from his job at one local construction company after a fistfight with his supervisor

 

  1. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.

 

-Both his graduation certificates had been falsified and used to get all of his jobs

  1. Impulsivity or failure to plan ahead.

4.Irritability and aggressiveness, as indicated by repeated physical fights or assaults.

-Fired from his job at one local construction company after a fistfight with his supervisor

-Both of his past wives got restraining orders against him claiming that he hit them

  1. Reckless disregard for safety of self or others.

-At his work, he had made multiple errors that might have been dangerous

  1. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.

-Mr. Crocker had been expelled from two carpentry training programs

-He had been fired from his job at one local construction company after a fistfight with his supervisor and from another job after abruptly leaving a job site

  1. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another. Case Study For Mental Health Evaluation Discussion Paper

-He was reportedly dismissive, indicating that the problem was “cheap wood” and “bad management” and added that if someone got hurt, “it’s because of their own stupidity”

-He spent time in juvenile hall at age 14 for stealing “kid stuff, like tennis shoes and wallets that were practically empty.”

-He left school at age 15 after being “framed for stealing a car” by his principle.

  1. The Individual is at least age 18 years.
  • Ike Crocker was a 32-year-old man

 

  1. There is evidence of conduct disorder with onset before age 15 years.
  2. He spent time in juvenile hall at age 14 for stealing “kid stuff, like tennis shoes and wallets that were practically empty.”

 

  1. The occurrence of antisocial behavior is not exclusive during the course of schizophrenia or bipolar disorder.

 

-There is no evidence that Ike has schizophrenia.

 

-Ike self diagnosed himself with bipolar disorder because he had “ups and downs” and got “mad real fast,” but he denied other symptoms of mania

IlI. Rule Outs

Narcissistic Personality Disorder

 

  1. A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

[CRITERIA MET]

  1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).

– Mr. Crocker focused on unfairness at the company and on how he was “a hell of a better carpenter than anyone there could ever be.” Case Study For Mental Health Evaluation Discussion Paper

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  1. Is often envious of others or believes that others are envious of him or her. a.Mr. Crocker claimed that his two marriages ended because of jealousy. His
    wives thought that he was cheating on them with other women.

[CRITERIA NOT MET]

  1. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.

-. There is no evidence that Ike is preoccupied with any of these things.

 

  1. Believes that he is “special” and unique and can only be understood by, or should associate with, other special or high-status people.

-Mr. Crocker said he “must have been smart” because he had been able to

make Cs in school despite showing up only half of the time, but he did not need to be surrounded by other special people.

 

Histrionic Personality Disorder

A pervasive pattern of excessive emotionality and attention seeking, beginning by early

adulthood and present in a variety of contexts, as indicated by five or more of the following:

[CRITERIA MET]

 

  1. Displays rapidly shifting and shallow expression of emotions.

Ike was reportedly dismissive

Ike claimed that he had “ups and downs” and got “mad real fast.”

He said he got down when disappointed, but he had “a short memory” and
“could get out of a funk pretty quick.”

 

  1. Has a style of speech that is excessively impressionistic and lacking in detail

He was “a hell of a better carpenter than anyone there could ever be.”

Mr. Crocker said he “must have been smart” because he had been able to make Cs in school despite showing up only half of the time. Case Study For Mental Health Evaluation Discussion Paper

[CRITERIA NOT MET]

  1. Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior.
  2. There is no evidence that Ike has tendencies of sexual or provocative behavior.
  3. Is suggestible (i.e., easily influenced by others or circumstances).
  4. Ike seems to be strong willed and against the suggestions of others.
  5. Considers relationships to be more intimate than they actually are.

Ike has no interest in seeing his two sons.

Does not have good relationships with his ex-wives, nor desires them.

MODULE TEN—PERSONALITY DISORDERS

  1. GROUP D: Ike Crocker is a 32-year-old man referred for a mental health evaluation by the human resources department of a large construction business that had been his employer for 2 weeks. At his initial job interview, Mr. Crocker presented as very motivated and provided two carpentry school certifications that indicated a high level of skills and training.  Since his employment began, his supervisors had noted frequent arguments, absenteeism, poor workmanship, and multiple errors that might have been dangerous.  When confronted, he was reportedly dismissive, indicating that the problem was “cheap wood” and “bad management” and added that if someone got hurt, “it’s because of their own stupidity.”

When the head of human resources met with him to discuss termination, Mr. Crocker quickly pointed out that he had both attention deficit hyperactivity disorder (ADHD) and bipolar disorder.  He said that if not granted an accommodation under the Americans with Disabilities Act, he would sue.  He demanded a psychiatric evaluation. Case Study For Mental Health Evaluation Discussion Paper

During the mental health evaluation, Mr. Crocker focused on unfairness at the company and on how he was “a hell of a better carpenter than anyone there could ever be.”  He claimed that his two marriages had ended because of jealousy.  He said that his wives were “always thinking I was with other women,” which is why “they both lied to judges and got restraining orders saying I’d hit them.”  As “payback for the jail time,” he refused to pay child support for his two children.  He had no interest in seeing either of his twin boys because they were “little liars” like their mothers.

Mr. Crocker said he “must have been smart” because he had been able to make Cs in school despite showing up only half the time.  He spent time in juvenile hall at age 14 for stealing “kid stuff, like tennis shoes and wallets that were practically empty.”  He left school at age 15 after being “framed for stealing a car” by his principal.  Mr. Crocker pointed out these historical facts as evidence that he was able to overcome injustice and adversity.

In regard to substance use, Mr. Crocker said he smoked marijuana as a teenager and started drinking alcohol on a “regular basis” after he first got married at age 22.  He denied that use of either substance was a problem.

Mr. Crocker concluded the interview by demanding a note from the examiner that he had “bipolar” and “ADHD.”  He said that he was “bipolar” because he had “ups and downs” and got “mad real fast.”  Mr. Crocker denied other symptoms of mania.  He said he got down when disappointed, but he had “a short memory” and “could get out of a funk pretty quick.”  Mr. Crocker reported no difficulties in his sleep, mood, or appetite.  He learned about ADHD because “both of my boys got it.”  He concluded the interview with a request for medications, adding that the only ones that worked were stimulants (“any of them”) and a specific short-acting benzodiazepine. Case Study For Mental Health Evaluation Discussion Paper

On mental status examination, Mr. Crocker was a casually dressed white man who made reasonable eye contact and was without abnormal movements.  His speech was coherent, goal directed, and of normal rate.  There was no evidence of any thought disorder or hallucinations.  He was preoccupied with blaming others, but these comments appeared to represent overvalued ideas rather than delusions.  He was cognitively intact.  His insight into his situation was poor.

The head of human resources did a background check during the course of the psychiatric evaluation.  Phone calls revealed that Mr. Crocker had been expelled from two carpentry training programs and that both his graduation certificates had been falsified.  He had been fired from his job at one local construction company after a fistfight with his supervisor and from another job after abruptly leaving a job site.  A quick review of their records indicated that he had provided them with the same false documentation.

Reference:

Barnhill, J.W. (Ed.).  (2014). DSM-5: Clinical cases. American Psychiatric Association Publishing.

Adult Psychiatric Evaluation

Reference Kaplan & Sadock Chapters 5

Identifying data

Source and Reliability

Chief Complaint

History of Present Illness (Bold symptoms that meet DSM-5 Diagnostic Criteria)

Psychiatric Review of Systems: (address any area not covered in HPI, all positive findings must be addressed in HPI) Case Study For Mental Health Evaluation Discussion Paper

Mood:

Anxiety:

Mania:

Psychosis:

Other:

Psychiatric History:

Medications:

Hospitalizations:

Counseling/Therapy:

Suicide Attempts:

Substance Use/Abuse

Alcohol:

Drugs:

Caffeine:

Tobacco:

Supplements:

Medical History:

Illness/Injuries:

Last medical exam:

Surgeries:

Current Medications:

 Allergies:.

 Women only:  LMP and Contraception

Family Psychiatric/Medical History:

Developmental/Social History:

 Work/ Educational History:

Current Family:

Social Supports/Faith:

Adverse life events:

Medical Review of Systems (as appropriate for client’s medical history)

Constitutional: Case Study For Mental Health Evaluation Discussion Paper

HEENT:

Cardiovascular:

Respiratory:

Gastrointestinal:

Genitourinary:

Skin:

Neurological:

OBJECTIVE

Vital signs, weight, waist circumference, body mass index, and height

Mental Status Examination:

Appearance:

Orientation:

Concentration:

Manner:

Speech:

Mood:

Affect:

Thought Process:

Thought Content:

Perceptions:

Memory and Cognition:

Judgment:

Insight:

Physical Exam: (Musculoskeletal/skin/neuro-if indicated)

Formulation/Diagnosis:

Include criteria in DSM-5 to substantiate diagnoses

Treatment Plan:

Medications) Side effects/client teaching, Informed Consent (written)

Diagnostic Testing (Rational based on medication/diagnosis)

Client Education

Health promotion/disease education

Risk Assessment

Self-Assessment of Practice

  • Identify forgotten or unnecessary components of note (may do above by different color font or underlying). Note here how this was done
  • Medications: Symptoms/behaviors targeted with each medication
  • Treatment plan and adherence to/modification of EBP
    • Forgotten components of note: The history of forgotten psychiatric disorders has been included in the template and highlighted with a different colour.
    • Medications: The client was prescribed lithium carbonate, targeted at reducing aggression and impulsive behaviors.
    • Treatment plan and adherence to EBP: The treatment plan adhered to EBP. Lithium carbonate was recommended as the client’s medication therapy since it is an EBP intervention for reducing the severity of aggression and impulsive behaviors in individuals diagnosed with antisocial behaviors.
    • TeamSTEPPS Concept: In the case of disagreement, I would refer to the established clinical practice guidelines for diagnosing and managing a particular condition. TeamSTEPPS conflict resolution technique that I would apply in case of a conflict is formative feedback. This technique would enable me to call attention, protecting the patient from potential risks.TeamSTEPPS Concept: Conflict Resolution.  What if other providers or other members of the treatment team disagree with your assessment or plan for a particular patient?  How would you handle this issue?  What TeamSTEPPS conflict resolution strategies could you use in helping to resolve this issue? Case Study For Mental Health Evaluation Discussion Paper                                                            Adult Psychiatric Evaluation

      Identifying data

      Initials: I. C.          Age: 32yo            Sex: Male

      Source and Reliability: The client, reliable.

      Chief Complaint: “I have been referred by the human resource department for a mental health examination.”

      History of Present Illness

      The client reported clinical symptoms aligning with the four DSM-5 diagnostic criteria. First, he meets the diagnostic criterion, which involves disregarding for and violating rights of others since the age of 15. This criterion is characterized by stealing of “Child stuffs” at the age of 14, resulting in imprisonment at the juvenile. The client also demonstrated impulsive behavior by fighting with his supervisor. Moreover, the client demonstrated irritability and aggression by hitting his wives. Furthermore, the client disregards safety of self and others by making multiple errors at his previous workplace, which endangered his coworkers. The client also demonstrated a pattern of irresponsibility by withdrawing child support for his two sons, claiming they were liars just like their mothers. Additionally, the client’s features aligns with other diagnostic criteria. The client is 32yo, meeting the diagnostic criterion that requires an individual diagnosed with ASPD to be at least 18 years. Moreover, the client’s antisocial behaviors started at the age of 14, meeting the criterion that requires the ASPD symptoms to present before the age of 15. Lastly, the client denies manic episodes, meeting the diagnostic criterion that requires antisocial behavior not to be associated with schizophrenia or bipolar disorder. Case Study For Mental Health Evaluation Discussion Paper

      Psychiatric Review of Systems:

      Mood: The client reported mood swings, describing it as getting “mad real fast.”

      Anxiety: Denies anxiety

      Mania: The client denies incidents of mania.

      Psychosis: The client describes himself as a hell of a carpenter,

      Other: No other psychiatric issues were reported.

      Psychiatric History:

      History of Psychiatric Disorders: Bipolar disorder and ADHD.

      Medications: Short-acting benzodiazepine.

      Hospitalizations: I. C. denies hospitalization history.

      Counselling/Therapy: Denies psychotherapies.

      Suicide Attempts: Denies history of suicide attempts.

      Substance Use/Abuse

      Alcohol: He started drinking alcohol regularly but stopped at 22.

      Drugs: The client smoked marijuana as a teenager but quit smoking at 22.

      Caffeine: Denies caffeine use.

      Tobacco: Denies tobacco use.

      Supplements: Denies using supplements.

      Medical History:

      Illness/Injuries: Denies history of serious medical issues or injuries.

      Last medical exam: His last comprehensive health examination was October 23rd 2023. Case Study For Mental Health Evaluation Discussion Paper

      Surgeries: I. C. denies a history of surgeries.

      Current Medications:

      Allergies: I. C. denies food or drug-related allergic reactions.

      Women only:  Not applicable

      Family Psychiatric/Medical History: His sons were diagnosed with ADHD.

      Social History: The client is divorced. He lives alone after separating from his two wives. He does not visit his sons, claiming they are liars like their mothers. He was imprisoned in juvenile at the age of 14 after stealing some “kids’ stuff.”

      Work/ Educational History: He dropped school at age 15 after being framed to have stolen a car. He attended carpentry school. He has been a carpenter in a large construction business for the last two weeks.

      Current Family: He does not have a family after separating from his two wives.

      Social Supports/Faith: The client does not have social or religious support.

      Adverse life events: Denies history of adverse life incidents.

      Medical Review of Systems

      Constitutional: I. C. denies weight loss, increased fatigue, or fever.

      HEENT: I. C. denies a history of head trauma. He denies past incidents of yellow sclera. He denies a history of ear pain. He denies a recent incident of nasal blockage. The client denies bleeding gums. Case Study For Mental Health Evaluation Discussion Paper

      Cardiovascular: I. C. denies a recent incident of edema or shortness of breath.

      Respiratory: He denies a history of dry or productive cough.

      Gastrointestinal: I. C. denies a history of constipation or diarrhea.

      Genitourinary: The client denies painful urination.

      Skin: I. C. denies skin rashes or lumps.

      Neurological: He denies a history of dizziness or severe headache.

      OBJECTIVE

      Vital signs: Weight 142 pounds; waist circumference 38 inches; height 5 “4” and body mass 24.4

      Mental Status Examination:

      Appearance: I.C. appears well-nourished and looks younger than his age.

      Orientation: I.C. is oriented to persons, events, places, and times.

      Concentration: His concentration throughout the mental health evaluation was reasonable.

      Manner: He is composed and respectful.

      Speech: He speaks in an average tone and volume.

      Mood: His self-reported mood is “Good.”

      Affect: His effect is intact

      Thought Process: No delusional thought process was noted.

      Thought Content: He demonstrated preoccupations

      Perceptions: No hallucinations or illusions were noted

      Memory and Cognition: Reported a short memory.

      Judgment: His judgment was sound.

      Insight: His insight was good

      Physical Exam:

      Musculoskeletal: No swollen joints were noted on examination.

      Skin: No swollen or red skin was noted during the exam.

      Neuro: No mood or anxiety symptoms were noted on examination.

      Formulation/Diagnosis:

      The client’s diagnosis is antisocial personality disorder (ASPD). This personality disorder is characterized by various symptoms, including repeatedly breaking the law, being deceitful frequently, and being impulsive (Wulandari, 2020). Persons with ASPD also demonstrate aggressiveness or irritability, disregarding personal safety or that of others, lack of remorse, or being irresponsible consistently (Wulandari, 2020). I. C’s most significant pertinent positive involves breaking the law repeatedly. He reported being jailed at the juvenile at the age of 14 for stealing. His principal also framed him for stealing a car at the age of 15. His wives were also issued with restraining orders after reporting that he hit them. Moreover, the client has been irresponsible consistently since he reported withdrawing child support for his sons. Furthermore, his graduation certificates had been forged, and he presented false documents. Additionally, the client meets the DSM-5 diagnostic criteria for antisocial personality disorder. An individual must be at least 18 years old to be diagnosed with antisocial personality disorder with an onset of antisocial disorder before 15 years (Paap et al., 2020)Case Study For Mental Health Evaluation Discussion Paper. Therefore, ASPD is the most appropriate diagnosis for this client since he is 32 years old with the onset of antisocial behaviors at the age of 14.

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      Treatment Plan:

      Medication: The medication therapy for the client’s antisocial personality disorder is Lithium carbonate. This drug regimen is recommended since it has demonstrated effectiveness in controlling symptoms of antisocial personality disorder, including impulsive behavior and aggression (Sesso & Masi, 2023). The client should be informed about potential lithium-related side effects, including urinary frequency, nausea, and vomiting. A written informed consent was obtained from the client before the prescription of this medication regimen.

      Diagnostic Testing: The client was prescribed lithium therapy. Regular blood tests were necessary to monitor lithium levels regularly and ensure that the client was taking an appropriate dose.

      Client Education: The client was informed about lithium-related undesired effects, including urinary frequency, nausea, and vomiting. Thus, the client would contact the provider if these symptoms became more severe.

      Health promotion/disease education: The client was advised to enrol in psychotherapies to reduce the risk of developing other personality disorders.

      Risk Assessment: Suicide and self-harm risk assessment should be conducted on this client since persons with ASPD are at a high risk of causing harm to themselves or others (Paap et al., 2020).

      Self-Assessment of Practice 

  • References

    Paap, M. C., Braeken, J., Pedersen, G., Urnes, Ø., Karterud, S., Wilberg, T., & Hummelen, B. (2020). A psychometric evaluation of the DSM-IV criteria for antisocial personality disorder: dimensionality, local reliability, and differential item functioning across gender. Assessment27(1), 89-101. https://doi.org/10.1177/1073191117745126

    Sesso, G., & Masi, G. (2023). Pharmacological strategies for the management of the antisocial personality disorder. Expert Review of Clinical Pharmacology16(3), 181-194. https://doi.org/10.1080/17512433.2023.2181159

    Wulandari, P. (2020). Diagnosis and Treatment of Antisocial Personality Disorder: A Case Report. Scientia Psychiatrica1(3), 64-67. http://scientiapsychiatrica.com/index.php/SciPsy/article/view/15

    Case Study For Mental Health Evaluation Discussion Paper

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