Case Analysis

To prepare: Focus on the  complex but precise definition of a mental disorder in the DSM-5 and the  concept of dimensionality both there and in the Paris (2015) and  Lasalvia (2015) readings. Also note that the definition of a mental  disorder includes a set of caveats and recommendations to help find the  boundary between normal distress and a mental disorder.

Then consider the following case:

Ms. Evans, age 27, was awaiting honorable  discharge from her service in Iraq with the U.S. Navy when her  colleagues noticed that she looked increasingly fearful and was talking  about hearing voices telling her that the world was going to be  destroyed in 2020. With Ms. Evans’s permission, the evaluating [social  worker] interviewed one of her closest colleagues, who indicated that  Ms. Evans has not been taking good care of herself for several months.  Ms. Evans said she was depressed.

The [social worker] also learned that Ms.  Evans’s performance of her military job duties had declined during this  time and that her commanding officer had recommended to Ms. Evans that  she be evaluated by a psychiatrist approximately 2 weeks earlier, for  possible depression.

On interview, Ms. Evans endorsed believing the  world was going to end soon and indicated that several times she has  heard an audible voice that repeats this information. She has a maternal  uncle with schizophrenia, and her mother has a diagnosis of bipolar I  disorder. Ms. Evans’s toxicology screen is positive for  tetrahydrocannabinol (THC). The evaluating [social worker] informs Ms.  Evans that she is making a tentative diagnosis of schizophrenia. 

Source: Roberts, L. W., & Trockel, M.  (2015). Case example: Importance of refining a diagnostic hypothesis. In  L. W. Roberts & A. K. Louie (Eds.), Study guide to DSM-5 (pp. 6–7). Arlington, VA: American Psychiatric Publishing.

Study Guide to DSM-5(r), by  Roberts, M.; Louie, A.; Weiss, L. Copyright 2015 by American  Psychiatric Association. Reprinted by permission of American Psychiatric  Association via the Copyright Clearance Center.

Post a 300- to 500-word response in which you address the following:

  • Why is making a “tentative” diagnosis problematic?
  • Discuss how the social worker should have approached the diagnosis. In your analysis, consider the following questions:
    • Identify the symptoms or “red flags” in the case study that may be evaluated for a possible mental health disorder.
    • Should the social worker have shared this suspected diagnosis based on the limited assessment with Ms. Evans at this time?
    • Explain the potential impact of this diagnosis immediately and over time if the “tentative” diagnosis is a 
    • misdiagnosis.