Case Study: Vee
Purpose: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:
Vee is a 26-year-old African-American woman who presents with a history of non-suicidal self-injury, specifically cutting her arms and legs, since she was a teenager. She has made two suicide attempts by overdosing on prescribed medications, one as a teenager and one six months ago; she also reports chronic suicidal ideation, explaining that it gives her relief to think about suicide as a “way out.”
When she is stressed, Vee says that she often “zones out,” even in the middle of conversations or while at work. She states, “I don’t know who Vee really is,” and describes a longstanding pattern of changing her hobbies, style of clothing, and sometimes even her job based on who is in her social group. At times, she thinks that her partner is “the best thing that’s ever happened to me” and will impulsively buy him lavish gifts, send caring text messages, and the like; however, at other times she admits to thinking “I can’t stand him,” and will ignore or lash out at him, including yelling or throwing things. Immediately after doing so, she reports feeling regret and panic at the thought of him leaving her. Vee reports that, before she began dating her current partner, she sometimes engaged in sexual activity with multiple people per week, often with partners whom she did not know.
Remember to answer these questions from your textbooks and NP guidelines. At all times, explain your answers.
- Describe the presenting problems.
- Generate a primary and differential diagnosis using the DSM5 and ICD 10 codes.
- Discuss which cluster the primary diagnosis belongs to.
- Formulate and prioritize a treatment plan.
Expert Solution Preview
In this case study, we are presented with the story of Vee, a 26-year-old African-American woman who has a history of self-injury, suicide attempts, and chronic suicidal ideation. She also experiences dissociation, identity disturbance, and unstable interpersonal relationships. Our task is to analyze and apply critical thinking skills to understand the psychopathology of Vee’s mental health issues and provide an evidence-based treatment plan.
1. Describe the presenting problems:
Vee presents with a range of complex mental health issues. These include non-suicidal self-injury (cutting arms and legs), chronic suicidal ideation, and a history of two suicide attempts through medication overdose. She also experiences dissociation, where she zones out during conversations or work, and expresses a sense of identity confusion, describing a pattern of changing hobbies, clothing styles, and even jobs based on her social group. She also exhibits impulsive behaviors, such as lavishly buying gifts for her partner and engaging in risky sexual activity with multiple partners.
2. Generate a primary and differential diagnosis using DSM-5 and ICD-10 codes:
Primary Diagnosis: Borderline Personality Disorder (DSM-5: 301.83, ICD-10: F60.3)
– Bipolar Disorder (DSM-5: 296.xx, ICD-10: F31.xx)
– Major Depressive Disorder (DSM-5: 296.xx, ICD-10: F32.xx)
– Post-Traumatic Stress Disorder (DSM-5: 309.81, ICD-10: F43.1)
– Substance Use Disorder (DSM-5: 304.xx, ICD-10: F10-F19)
3. Discuss which cluster the primary diagnosis belongs to:
The primary diagnosis, Borderline Personality Disorder, belongs to Cluster B of personality disorders in the DSM-5. Cluster B includes disorders characterized by emotional dysregulation, impulsive behavior, and unstable relationships. Other disorders in this cluster include Antisocial Personality Disorder, Histrionic Personality Disorder, and Narcissistic Personality Disorder.
4. Formulate and prioritize a treatment plan:
A comprehensive treatment plan for Vee should consider multiple approaches, including psychotherapy, medication management, and supportive services. The plan should be individualized based on Vee’s specific needs and preferences. Prioritization of interventions may include:
– Psychotherapeutic Interventions:
– Dialectical Behavior Therapy (DBT) to address emotional dysregulation, self-harm, and impulsive behaviors.
– Trauma-focused therapy to address any underlying trauma contributing to Vee’s difficulties.
– Cognitive-Behavioral Therapy (CBT) to address distorted thinking patterns and improve coping skills.
– Medication Management:
– Collaborate with a psychiatrist to assess the need for medication, such as mood stabilizers for emotional instability or antidepressants for co-occurring depressive symptoms.
– Supportive Services:
– Connect Vee with community resources and support groups that focus on self-harm, suicide prevention, and emotion regulation skills.
– Involve Vee’s partner in therapy to address the dynamics of their relationship and provide education on how to support Vee.
It is crucial to regularly assess and reassess the effectiveness of the treatment plan, considering progress made and adjusting interventions as needed. Collaboration and communication among the treatment team members, including therapists, psychiatrists, and support services, are essential for Vee’s successful recovery.