Analyze and apply critical thinking skills in the psychopathology of mental health patients and provide treatment and health promotion while applying evidence-based research
Analyze and apply critical thinking skills in the psychopathology of mental health patients and provide treatment and health promotion while applying evidence-based research.Scenario:
Jax is a 66-year-old Caucasian female whose wife has encouraged her to seek treatment. She has never been in therapy before, and has no history of depression or anxiety. However, her alcohol use has recently been getting in the way of her marriage, and interfering with her newly-retired life. She describes drinking increasing amounts over the last year, currently consuming approximately a six-pack of beer per day. She notes that this amount “doesn’t give me the same buzz as it used to.” She denies ever experiencing “the shakes” or any other withdrawal symptoms if she skips a day of drinking.
Jax comments that her wife is her biggest motivation to decrease her alcohol use. She tells Jax that she gets argumentative and irritable when she drinks, though she does not always remember these incidents. She has also fallen while intoxicated twice, causing bruises both times and hitting her head on one of the occasions.
Questions:
Remember to answer these questions from your textbooks and NP guidelines. At all times, explain your answers.
- Describe the presenting problems/issues. Is there any information that was not provided that you would need to formulate a diagnosis?
- Generate a primary and differential diagnosis using the DSM5 and ICD 10 codes.
- What physiological and psychological processes lead to substance dependence?
Submission Instructions:
- Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
- You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)
- All replies must be constructive and use literature where possible.
- Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.
- Late work policies, expectations regarding proper citations, acceptable means of responding to peer feedback, and other expectations are at the discretion of the instructor.
- You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.
Presenting Problems/Issues:
Jax, a 66-year-old Caucasian female, has sought treatment due to her escalating alcohol use, which is negatively impacting her marriage and her retired life. The key presenting problems and issues in this scenario include:
1. Alcohol Use Disorder (AUD): Jax has been consuming approximately a six-pack of beer per day, indicating a significant and problematic level of alcohol consumption. This has been ongoing for the past year, and she reports a diminished effect, suggesting tolerance.
2. Interference with Daily Life: Her alcohol use is interfering with her marriage and her newly-retired life. Her wife has observed that she becomes argumentative and irritable when drinking, which is affecting their relationship.
3. Physical Consequences: Jax has experienced two falls while intoxicated, resulting in bruises and a head injury on one occasion. These incidents demonstrate the potential physical harm associated with her alcohol consumption.
4. Motivation to Change: Jax identifies her wife as her primary motivation to reduce her alcohol use. This suggests an awareness of the negative consequences of her drinking and a willingness to seek help.
Additional Information Needed:
To formulate a diagnosis and treatment plan, it would be helpful to gather more information, including:
1. Detailed history of alcohol use: A more comprehensive history of her alcohol use, including when it started, any prior attempts to cut down or quit, and whether she experiences cravings, is essential for a diagnosis.
2. Assessment of withdrawal symptoms: Although Jax denies experiencing withdrawal symptoms, a thorough assessment of her physical and psychological symptoms during periods of abstinence is important.
3. Co-occurring mental health issues: It is necessary to explore whether there are underlying mood or anxiety disorders contributing to her alcohol use, as well as any family history of mental health issues.
Primary Diagnosis (DSM-5 and ICD-10 Codes):
Based on the information provided, the primary diagnosis for Jax can be Alcohol Use Disorder (AUD).
DSM-5 Criteria for AUD:
A diagnosis of AUD is made when an individual meets at least two of the following criteria within a 12-month period:
1. Taking the substance in larger amounts or over a longer period than intended.
2. Persistent desire or unsuccessful efforts to cut down or control substance use.
3. A great deal of time spent obtaining, using, or recovering from the effects of the substance.
4. Craving or a strong desire or urge to use the substance.
5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance.
7. Important social, occupational, or recreational activities are given up or reduced because of substance use.
8. Recurrent alcohol use in situations in which it is physically hazardous.
9. Continued alcohol use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
10. Tolerance, as defined by either a need for markedly increased amounts of the substance to achieve intoxication or desired effect or markedly diminished effect with continued use of the same amount of the substance.
11. Withdrawal, as manifested by the characteristic withdrawal syndrome for the substance.
ICD-10 Code: F10.2 – Alcohol Dependence Syndrome
Differential Diagnosis:
It is important to consider other potential diagnoses or contributing factors:
1. Major Depressive Disorder: Although Jax has no history of depression, her increased alcohol use and irritability could be indicative of an underlying mood disorder. Further assessment is needed to rule this out.
2. Adjustment Disorder: Given her recent retirement and the impact on her marriage, an adjustment disorder could be contributing to her symptoms. It is crucial to assess her emotional response to these life changes.
3. Medical Conditions: Some medical conditions can mimic symptoms of alcohol use disorder. Comprehensive medical evaluation is necessary to rule out any underlying medical issues.
Physiological and Psychological Processes Leading to Substance Dependence:
Substance dependence, including alcohol use disorder, is influenced by a complex interplay of physiological and psychological processes. These include:
1. Neurochemical Changes: Repeated substance use leads to alterations in brain chemistry, particularly in the reward pathway. The brain becomes accustomed to the presence of the substance and may require increasing amounts to achieve the desired effect.
2. Tolerance: Tolerance develops as the body adapts to the substance, requiring higher doses to achieve the same effect. This can lead to escalated substance use over time.
3. Withdrawal: Physiological and psychological withdrawal symptoms can be distressing, reinforcing continued substance use to avoid or alleviate these symptoms.
4. Cravings: Psychological cravings are intense desires or urges to use the substance, often triggered by environmental cues or emotional states.
5. Coping Mechanism: Substance use may serve as a coping mechanism to deal with stress, negative emotions, or life changes, as seen in Jax’s case with retirement-related stress.
6. Social and Environmental Factors: Social and environmental factors, such as peer influence, family dynamics, and availability of the substance, play a significant role in the development and maintenance of substance dependence.
In conclusion, Jax’s presentation is indicative of Alcohol Use Disorder, and further assessment is needed to determine the severity and formulate an appropriate treatment plan. Understanding the physiological and psychological processes underlying substance dependence is essential for providing evidence-based treatment and health promotion interventions.
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