Despite the fact that there exist discrepancies when it comes to the presentation of a DSM-5 diagnosis of co-occurring disorders, the underlying principle in the communication of the clients mental health information encompasses the purpose of the discussion and the audience involved. Equally important is the fact that the DSM-5 criteria provide guidelines on the arrangement of a clients information whereby the principal diagnosis, which is the primary focus of clinical treatment is given top priority as far as mental health assessment is concerned. Additionally, subsidiary diagnoses are represented based on hierarchical ranking where conditions of great significance are given prominence. Consequently, this paper focuses on developing a hypothetical diagnostic analysis using the DSM-5 framework where a client elucidates symptoms of the presence of co-occurring disorders. Furthermore, the review of the case report of the client offers insights into the contemporary evidence-based measures which have been incorporated to optimise the reliability of the treatment interventions applied.
The Developing a Dual Diagnosis from a Clients Interview
The psychological evaluation of the client named Jessica elicits symptoms behavioral patterns that are consistent with the DSM-5 diagnosis of Major Depression. One of the dominant catalysts of this mental health disorder is the clients exposure to a disruptive environment while growing up (American Psychiatric Association, 2013). During the interview, Jessica confesses to having her younger siblings as her dependants hence the need to attempt to strike a balance between school and acting as their guardian while her mother was away. This predicament appears to be among the origins of depression since at a tender age, Jessica had to cope with responsibilities that were seemingly a tall order for her. Moreover, her depressive mood was exacerbated by the physical abuse and quarrelsome relationship that pervaded Jessicas interaction with her mother. Smiths father was also a figure in absentia who came off as an alcoholic hence leaving the client isolated as she was devoid of any role models and neither could she seek their advice. All these demystify the fundamentals of Major Depression that are characteristic of Smiths condition owing to the subjugation to the challenging environment that only served to incapacitate her by corrupting her emotional and cognitive functioning.
In regards to secondary diagnoses, substance use disorder suffices as Smith meets the DSM-5 criteria for the aforementioned mental health condition. The client vividly states that she turned to alcoholism to cope with the severe family-based problems that afflicted her. Besides, she continued on this trajectory, and as a result of peer influence, she began to partake even in recreational drugs alongside drinking alcohol actively. Worse, the death of her younger sister stimulated her experimentation with hard drugs such as crystal meth which served as a mood regulation mechanism (DeWit et al., 2000). Furthermore, after contemplating suicide, Smith saw it fit to induce death through the ingestion of prescription medication which is a clear indicator of a person who was hooked on psychoactive drugs. Interestingly, her psychotherapy sessions reveal that she had to be introduced to methadone which is a drug that clinically administered to wean off clients on heroin dependency. Smiths frequent contact with the criminal justice system due to driving under the influence charges also epitomize an individual who indiscriminately engages in drug use without the regard for the rule of law.
Distinguishing Principal from Secondary Diagnosis
One of the unique features that are akin to the prevalence of Major Depression is the prostration of ones ability to efficiently execute their duties at school, in the workplace or at home. In principle, Smith sought psychiatric help as she has been unable to hold onto a job for more than six months, and currently, she relies on government aid to fend for her family. A closer look at the clients background information and family history reveals an individual who has been subjected to emotionally draining relationships that subsequently culminated into depression. Major Depression is characterized by the interference of the cognitive functioning coupled with impairment of the decision-making process of a client. Perhaps this presents the grandest reason as to why Smith is unable to keep a job for a prolonged period. Besides, the WAIS-III test administered to reveal Smiths cognitive functioning indicates that she possesses a low average to the average range with a relative weakness in abstract reasoning (Regier et al., 2013). Depression also plays a crucial role in suppressing the emotions affiliated with motivational factors where an individual is constantly irritable and in a dampened mood which results in a below-par delivery of services at the workplace. People who suffer from depression also endure suicidal tendencies and acts of self-mutilation as a means of eliminating the feelings of personal guilt. Smith asserts that whenever she got into an altercation with her mother, she would get drunk and cut her wrists with her razor blade so that she could bleed to death. On another instance, she consumed prescription drugs after contemplating suicide and even burned herself with a lighter following the consuming feelings of rejection, loss of loved ones and arguments with her mother. Social withdrawal represents a norm for depressed people as evidenced by Smiths spontaneous decision to relocate just to get away from friends whom she described as bad influences. Major depression is known to aggravate the physical well-being of clients whereby a client is bound to suffer more back pains and aches, especially when doing heavy weight lifting which matches Smiths experience as a result of a medical history with back injury.
On the other hand, the diagnosis of substance use disorder is embedded in the fact that Smith began drinking at a tender age and gradually developed a high affinity for hard drugs such as crystal meth. According to medical health professionals, this disorder is associated with the repetitive use of psychoactive drugs climaxes in an encounter with legal problems, failure to fulfill professional duties and endangering the lives of themselves and others. Indeed, Smith meets the DSM-5 criteria for substance use disorder which has been fragmented into various categories (Hasin et al., 2013). The client has previously experienced substance intoxication which accordingly affected her cognitive process leading to maladaptive behavior that put her life at high risk. The numerous DUI arrests exemplify this that Smith has endured following her sobriety relapses which made her lose her driving license tentatively. Additionally, Jessica portrays instances of substance which is evidenced by the psychotherapeutic approach of administering methadone as a preferred drug to heroin. Smith may be described as substance dependent since she admits to drug indulgence as a stratagem of regulating her negative feelings which she claims help her achieve a sense of normalcy. Moreover, her frequent relapses even after therapeutic sessions are analogous to substance use clients who perceive such a phase as inevitable and is a long-term pathway towards full recovery.
Comprehending DSM-5 Assessment of Co-occurring Disorders
According to mental health professionals, Major Depressions involves the comprehension of sadness that goes beyond the facets of a sullen mood. This is because the effects of Major Depression has a bearing on all the aspects of ones humanity as it creates an influence on patterns such as those of eating, sleeping, emotions, and interference with the intellectual processes of an individual. Even so, the symptoms of Major Depression may be characterized as firstly impairing ones rationality which stimulates a ripple effect on the decision-making process and also blocking memories. According to Kalu et al. (2012), the above observation may be expressed as absentmindedness where an individuals actions are a conglomeration of harmful ideologies (Torrens et al., 2012). The management of such symptoms would necessitate the utilization of pharmacological interventions where psychoactive medication is administered to aid in the regulation of distress levels. These drugs are given for purposes of treating mental illness by balancing out the chemicals in the brain which ultimately leads to the stabilization of moods leading to predictable behavior from the client (Carra et al., 2014). Moreover, clinicians work closely with their patients to elevate the levels of comfort and relaxation during pharmacological treatment to optimise the outcomes of the intervention.
According to Mueser and Gingerich (2013), co-occurring disorders can prove to be difficult in its determination since the symptoms associated with substance use or dependence may disguise the signs of mental illness and vice versa. Substance use refers to the maladaptive pattern of using drugs illegally despite the substance-related problems that may ensue. Such issues may include the repeated failure to deliver on ones responsibilities, possible contact with the law and the advent of interpersonal and social problems (Black & Grant, 2014). In addition to this, individuals with co-occurring disorders often experience social, emotional and chronic medical issues and the presence of two disorders increases the vulnerabilities to relapse which aggravates psychiatric distress (Wusthoff, Waal & Grawe, 2014). Thus, the ideal treatment would integrate the detoxification process where the clients body is cleansed of the illicit medication as she is slowly weaned off her addition. This procedure may be followed suit by relapse prevention techniques where the client is offered cognitive-behavioral training on how to stay clean once the intervention is terminated.
Treatment Interventions for Co-occurring Disorders
Psychologists argue that the ideal short-term intervention for the above condition is through the administration of antidepressant drugs such as MAOIs and SSRIs. According to Watkins et al. (2012), these drugs act as reuptake inhibitors, therefore, resulting in the neurotransmitter serotonin staying a while longer leading to improved moods. Accordingly, psychiatrists advice that medication should be managed consistently for not less than three weeks before it can take effect on the neurological pathways (Morisano, Babor & Robaina, 2014).The use of electroconvulsive therapy (ECT) is also considered as a suitable approach particularly for clients who are suicidal which propels their needs to the critical status. Moreover, ECT is essential for clients who exhibit psychotic symptoms or are unable to ingest antidepressants due to diverse health problems. According to Najavits and Hien (2013) therapy is often perceived as the long-term solution that helps create a sense of stability in the clients mental health condition. This may be embodied through the use of psychotherapy, more so interpersonal therapy, where the psychologists illustrate how the deviation from acceptable societal norms aggravates the problem of depression. According to McIntyre et al. (2013), the use of cognitive behavioral therapy (CBT) helps restrict the challenge of morbid patterns of thinking where she feels that she is to blame for adverse events take place in her life. In its place, mental health professionals help clients suffering from depression to be inclined towards more adaptive and logical ways of reasoning.
Perhaps the bests plan for continuity of care for a client would incorporate the use of integrated treatment which...
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