cognitive risk factors

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1. Using the competency based model, please offer your own comprehensive diagnostic assessment for the client in the case study. Include any behavioral, emotional, psychological, social and cognitive risk factors/symptomatology and duration. Also, include at protective/strength factors in the case study.

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

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QUESTION 1

Joshua (25) has been down for a couple of weeks. His wife – Anne suggested that he come to see you. You work in a local mental health clinic. Joshua points out that he has been so down that he does feel like getting out of bed and he has no energy. You ask him about work and he points out that he is a police officer and he has been on sick leave for the last week. Joshua has lost interest in most things including his wife. All he wants to do is to sleep and vegetate. He has lost weight (about 20 lbs) because he says that food tastes like metal. He also has great difficulty falling asleep and he wakes up most nights at 3AM and cannot fall back to sleep. Joshua is on permanent day shift. He feels like a loser and he hears a voice telling him to kill himself. Joshua is not currently suicidal. He does think of suicide often. Joshua has been depressed before. As a child he was depressed at least twice. He also had difficulty in school and he is having some present challenges. Joshua has a very hard time concentrating. He had this same difficulty in school. He acted out and fidgeted a lot as a child and his parents said that he was a bad kid. However, Joshua felt like he could not keep still. He still has challenges with staying on task and always being on the go. His wife complains that Joshua will not slow down. As a child – Joshua would run and jump about. As an adult – Joshua likes to engage in sports such as motor cross and wrestling. Generally, Joshua cannot slow down. However, with this recent depression; he stays in bed. Officers at work complain that Joshua talks too much. Joshua says that he is bored most of the time. He does not “suffer fools easily” and is quite sarcastic. He does not like to wait his turn and drives aggressively. He has taken the Sargent’s exam, but his memory is so bad that he can’t seem to pass it. Joshua also admits that he is afraid of certain bridges, such as the Bay Bridge. He works for a county on the western shore of Maryland and has no friends or family across the Bridge so that he does not travel to the Eastern Shore. He also does not have any dreams about the Bridge. In fact, he rarely thinks about it. His wife kids him about wanting to go to a restaurant on the Eastern Shore, but they have found a restaurant in Annapolis.

QUESTION 2

Using the competency based model, please offer your own comprehensive diagnostic assessment for the client in the case study. Include any behavioral, emotional, psychological, social and cognitive risk factors/symptomatology and duration. Also, include at protective/strength factors in the case study. (4 points)

QUESTION 3

Based on the information, provide a comprehensive diagnosis and your rationale for this case study. (3 points)

QUESTION 4

Sally a 32 year old woman has an appointment to see you at 11:00 AM and is 15 minutes late. You work in an outpatient office of a hospital. Sally comes in an immediately starts to complain about the parking, your receptionist and your rudeness. She looks around the room in disgust and points out that your décor is all wrong. She starts to tell you all her problems (which are many) and they seem to focus on her being abandoned as child and now as an adult. Sally dislikes her mother and refers to her and the devil. You inform her at 11:50 that her time is up and she launches into a tirade about how insensitive you are. She leaves and points out that she may come to see you next week. She comes in next week and is once again 15 minutes late. She tells you about her many therapists and how they were all insensitive. She describes her relationships and how everyone has ended because the other person proved to be unreliable. She has attempted suicide many times, but is not currently suicidal. She describes her mood as intense and irritable. She tends to spend money she does not have. She admits that she does a lot of impulse buying. You ask her how she sees herself? Look- she points out – you are the one who needs therapy- can’t you see I am disturbed. She admits to feeling empty most of the time, which leads her to engage in intense anger and fights. She also admits to experiencing dissociative symptoms when under stress. You smell alcohol on her breath and she admits that she does like to drink alcohol. “Look- I like to drink – it helps me come down.” You ask her about any DUIs and she admits that she has received several. She has lost her driver’s license once, but managed to get it back. She has warned by her doctor to quit and she has started drinking more. She also admits that she has lost several jobs because of her drinking. Then she bursts into hysteria and points out- if you had no one you would drink like me. She admits to spending a lot of time trying to get alcohol and sometimes gets sick at night because of her drinking. Sally begins to talk about her being down. She says that she has been down the last several years. Some days she has a hard time getting out of bed. She has lost interest in most things and some days – just sits around and mopes. She has lost a great deal of weight because food does not taste good. She has difficulty getting to sleep and wakes up most nights at 3AM and cannot go back to sleep. She is fatigued most every day. She tells you again that she often thinks about suicide, but is not currently suicidal. She feels worthless most of the time and she occasionally hears a voice telling her how bad she is. She cannot seem to think clearly.