“Andrew…, a 60-year-old businessman, returned to see his longtime psychiatrist


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“Andrew…, a 60-year-old businessman, returned to see his longtime psychiatrist 2 weeks after the death of his 24-year-old son. The young man, who had struggled with major depression and substance abuse, had been found surrounded by several emptied bottles and an incoherent suicide note. (Andrew)…had been very close to his troubled son, and he immediately felt crushed, like his life had lost its meaning. In the ensuing 2 weeks, he had constant images of his son and was ‘obsessed’ with how he might have prevented the substance abuse and suicide. He worried that he had been a bad father and that he had spent too little time on his son. He felt constantly sad, withdrew from his usual social life, and was unable to concentrate on his work. Although he had never previously drunk more than a few glasses of wine per week, he increased his alcohol intake to half a bottle of wine each night. At that time, his psychiatrist told him that he was struggling with grief and that such a reaction was normal. They agreed to meet for support and to assess the ongoing clinical situation. (Andrew)…returned to see his psychiatrist weekly. By the sixth week after the suicide, his symptoms had worsened. Instead of thinking about what he might have done differently, he became preoccupied that he should have been the one to die, not his young son. He continued to have trouble falling asleep, but he also tended to awake at 4:30am and just stare at the ceiling, feeling overwhelmed with fatigue, sadness, and feelings of worthlessness. These symptoms improved during the day, but he also felt a persistent and uncharacteristic loss of self-confidence, sexual interest, and enthusiasm. He asked his psychiatrist whether he still had normal grief or had a major depression. (Andrew)…had a history of two prior major depressive episodes that improved with psychotherapy and antidepressant medication, but no significant depressive episodes since his 30s. He denied a history of alcohol or substance abuse. Both of his parents had been “depressive” but without treatment. No one in the family had previously committed suicide” (Barnhill, 2013, p. 79) Reference: Barnhill, J. W. (Ed.) (2013). DSM-5 clinical cases. Arlington, VA: American Psychiatric Publishing. Read case vignette and respond to all questions using the DSM-5 as reference for diagnostic criteria requirements. Diagnosis must be in DSM-5 format, using codes, correct disorder name, and specifiers (if applicable). 1. What do you observe about the case or the person in the vignette that is diagnostically significant (i.e., symptoms, mental status elements)? (5 correct responses for full credit; 10 points total) 2. What general diagnostic category would fit this person’s behavior & why? (4 points) 3. Name at least two possible diagnoses for the person in the vignette. (2 points) 4. Name one diagnosis or diagnostic category you would “rule out” and why. (4 points) 5. Which diagnosis best fits the information provided in the case and why? (Use the DSM-5 diagnostic classification system) (5 points)

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