Explain the differences and similarities in your choice of criteria used to determine diagnosis, including Z codes

• Explain the differences and similarities in your choice of criteria used to determine diagnosis, including Z codes (other conditions that may be a focus of clinical attention).
• Explain whether or not you agree with your colleague’s treatment recommendations.

Leticia Cortez

Cornell DiagnosisCOLLAPSE

F32.1               Major Depressive Disorder, single episode, moderate

Z63.5               Disruption of Family by Separation  or Divorce

Z59.6               Low Income

Cornell met criteria A1, A2, A4, A6, A7, and A8 and criteria B and C for Major Depressive in correlation to his current separation. 

A1: Cornell expressed feeling “sad mood, fearfulness, and passive suicidal ideation”.

A2:Decreased in motivation and low interest in chores at home engages in “sitting around”

A4:Sleep pattern length of 3 to 4 hours, over several years.

A6:When sleeping little time frames he then becomes tired and oversleeps.

A7: Cornell reported feeling more irritable, decreased self-esteem, and feelings of guilt/self-blame

A8: He reported, “experienced increasingly withdrawn/non-communicative”.

Criteria B: Cornell’s current behaviors have caused the strain in his relationship with his kids and family.

Criteria C: No other medical condition was reported.

Z codes have been given due to unstable income and inability to pay the debt accumulated with therapeutic stays and other expenses. His divorce has influence his current emotional state for which has impacted his life.

OR

F43.23             Adjustment Disorder, with mixed anxiety and depressive mode

Cornell met criteria A, B, C, D, and E.

Criteria A: Cornell has been married for 13 years and has been separated from his wife for the past three months.

Criteria B1:  The official physical separation when his wife moved out and he moved in with his family.

Criteria B2:The major problem for Cornell is “learn to deal with my wife wanting a divorce.” He has engaged in comments of suicide and shown no interest in spending time with kids.

Criteria C:The current behaviors have increased due to the wife and kids moving out. His previous diagnosis was given based on problems with his wife.

Criteria D: Cornell is not grieving the loss of a deceased (bereavement) but rather a separation from his wife of many years.

Criteria E: With the time of his current situation Cornell has expressed wanting to learn how to deal with the separation.

Scale & Intervention 

Depression is commonly underdiagnosed for African American’s and does not seek help for symptoms, this causes severe and disabling symptoms compared to white peers (Walton, & Payne, 2016). The scale that would be used to measure Cornell’s self-esteem is the Interpersonal Support Evaluation List (ISEL). This scale would measure the “belonging-, self-esteem-, and appraisal-based social support”  in his current situation by the measure of 40-items (Odafe, Salami, & Walker, 2017). With the measure of ISEL, the Beck Hopelessness Scale (BHS) would be used to measure the improvement while he engages in support groups with other male divorced fathers  (Odafe, Salami, & Walker, 2017). Monitoring the current support Cornell has with his sister and parents as well as support from friends or other community members facing a separation. Intervention includes a social support group with goal setting and cognitive-behavioral interventions. As they explore setting goals to help gain focus and becoming more aware of their thought process as they continue to cope with symptoms (Odafe, Salami, & Walker, 2017).

Reference

American Psychiatric Association. (2013). Anxiety disorders. In Diagnostic and statistical manual of mental disorders(5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm05

Diagnostic and statistical manual of mental disorders: DSM-5. (2017). Arlington, VA: American Psychiatric Association.

Odafe, M. O., Salami, T. K., & Walker, R. L. (2017). Race-related stress and hopelessness in community-based African American adults: Moderating role of social support. Cultural Diversity and Ethnic Minority Psychology, 23(4), 561–569. https://doi-org.ezp.waldenulibrary.org/10.1037/cdp0000167

Walton, Q. L., & Payne, J. S. (2016). Missing the mark: Cultural expressions of depressive symptoms among African-American women and men. Social Work in Mental Health, 14(6), 637–657. doi:10.1080/15332985.2015.1133470

Torri Weese

Wk 6 Depressive DisorderCOLLAPSE

F32.2 Major Depressive Disorder, severe, with melancholic features

Z63.0 Relationship distress with spouse or intimate partner

Z63.5 Disruption of family by separation or divorce

Demographics Data

Cornell is a 32 year old black male. He received counseling services two months prior to voluntary admitting himself to the hospital due to concerns of self harm. Cornell has been married for 13 years, has three children with his wife and has been separated from his wife the last three months. Cornell completed technical college following high school and has held a job for the past three years at a print shop. Cornells’ religious identification is Baptist. Cornell grew up in a two parent home and the father had some history of drinking. Typically Cornell enjoys activities like softball, skiing, reading, and watching football. Cornell having a drinking problem but stated he previously would binge drink in 2009. Medical history indicated a car accident with loss of memory of the accident. Cornell smokes two packs of cigarettes a day.

Note: Areas in () indicate responses from Cornell or his wife.

Diagnostic criteria for Major Depressive disorder, severe, with melancholic features is characterized and qualified by meeting the following diagnostic criteria; 1. Cornell has met the diagnostic criteria of 2 weeks or more as (1) for depressed mood and (2) for loss of interest of pleasure, in addition to meeting 5 or more symptoms; 1. Cornell has exhibited a generally depressed mood most of the day and every day identified by himself (sad, hopeless) and his wife’s observation (extremely depressed) 2. Cornell has lost interest in activities most of every day (chores, hanging with friends, spending time with his kids) 3. Experiences both insomnia and hypersomnia 4. Psychomotor retardation (sitting around) 5. Feelings of worthlessness or guilt (feeling ashamed and guilty) 6. Diminished ability to think or concentrate daily (increased distractibility) 7. Recurrent thoughts of death (suicidal ideation, passive) (APA, 2013).

Cornell meets the criteria for Major depressive disorder, severe due to the intensity of his depressive symptoms and his inability to manage his symptoms (indicated by voluntarily checking into the hospital). Further, his diagnostic criteria for melancholic features as he meets the diagnostic criteria as follows; A. Loss of pleasure in all or almost all activities and B. meeting up to three of the following; 1. a quality of depressed mood and feeling empty (sad mood, fearful, guilt, self blame) 2. Psychomotor retardation (sitting around) 3. Excessive or inappropriate guilt (feelings of guilt, self blame) (APA, 2013).

Morrison (2014) discusses the importance of clinicians identifying major depressive disorder and the many subtypes and specifiers as mood disorders can be difficult and challenging to diagnose.

Rating scales help to validate the diagnosis and help access the appropriate treatment outcomes. In the 17-Item Hamilton Depression Scale (HDRS17) a measurement is taken to help determine the baseline and help identify two factors; vegatative worry and retardation-agitation and further negative item loading measured over twelve month period (Nixon, Guo, Garland, Kaylor-Hughes, Nixon & Morriss, 2020). The scoring system is using a scale of 0-7 as normal, 8-16 as mild depression and 17-23 as moderate depression and 24 or higher representative of severe depression (Nixon, 2020). This type of scale is currently utilized by both the Federal Drug Administration in the US and the National Institute for Care Excellence and due to having over 1500 randomized controlled trials (Nixon, 2020).

Treatment for Cornell would be effective by applying mindfulness-based cognitive therapy approach (MBCT) (Barnhofer, Crane, Hargus, Amarasinghe, Winder  & Williams, 2009). Using a mindful approach with meditation interventions with cognitive therapy to address recurrent depression and suicidal ideation can decrease the severity of symptoms from severe to mild using MBCT (Barnhofer, 2009). MBCT is a useful treatment tool in reducing depressive symptoms and if patients identify as meeting the full criteria for depression, MBCT has been shown to successfully decrease depression (Barnhofer, 2009). Due to Cornell’s intense feelings of SI and checking himself into the hospital, he will likely need to be prescribed psychotropic medications. Until Cornell is released from the hospital and his SI can better be managed, psychotropic medications will likely be necessary for stabilization and should be reassessed as treatment is provided following his hospitalization.

Depressions opposite, according to Andrew Soloman,  is not happiness, but vitality (TED, 2013).

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

Barnhofer, T., Crane, C., Hargus, E., Amarasinghe, M., Winder, R., & Williams, J. M. G. (2009). Mindfulness-based cognitive therapy as a treatment for chronic depression: A preliminary study. Behaviour Research and Therapy, 47(5), 366–373. https://doi-org.ezp.waldenulibrary.org/10.1016/j.brat.2009.01.019

Morrison, J. (2014). Diagnosis made easier (2nd ed.). New York, NY: Guilford Press.

Nixon, N., Guo, B., Garland, A., Kaylor-Hughes, C., Nixon, E., & Morriss, R. (2020). The bi-factor structure of the 17-item Hamilton Depression Rating Scale in persistent major depression; dimensional measurement of outcome. PloS One, 15(10), e0241370. https://doi-org.ezp.waldenulibrary.org/10.1371/journal.pone.0241370

TED Conferences, LLC (Producer). (2013). Depression, the secret we share [Video file]. Retrieved from https://www.ted.com/talks/andrew_solomon_depression_the_secret_we_share