Case Study: J.T.
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:
J.T. is a 20 year-old who reports to you that he feels depressed and is experiencing a significant amount of stress about school, noting that he’ll “probably flunk out.” He spends much of his day in his dorm room playing video games and has a hard time identifying what, if anything, is enjoyable in a typical day. He rarely attends class and has avoided reaching out to his professors to try to salvage his grades this semester. J.T. has always been a self-described shy person and has had a very small and cohesive group of friends from elementary through high school. Notably, his level of stress significantly amplified when he began college.
You learn that when meeting new people, he has a hard time concentrating on the interaction because he is busy worrying about what they will think of him – he assumes they will find him “dumb,” “boring,” or a “loser.” When he loses his concentration, he stutters, is at a loss for words, and starts to sweat, which only serves to make him feel more uneasy. After the interaction, he replays the conversation over and over again, focusing on the “stupid” things he said. Similarly, he has a long-standing history of being uncomfortable with authority figures and has had a hard time raising his hand in class and approaching teachers. Since starting college, he has been isolating more, turning down invitations from his roommate to go eat or hang out, ignoring his cell phone when it rings, and habitually skipping class. His concerns about how others view him are what drive him to engage in these avoidance behaviors.
Questions:
Remember to answer these questions from your textbooks and NP guidelines. At all times, explain your answers.
- Generate a primary and differential diagnosis using the DSM-5 criteria.
- Develop a biopsychosocial plan of care for this client.
- Compare and contrast fear, worry, anxiety, and panic.
Expert Solution Preview
Introduction:
In this case study, we will analyze the psychopathology of J.T., a 20 year-old college student who is experiencing symptoms of depression and stress. We will apply critical thinking skills to understand his condition and provide treatment and health promotion strategies based on evidence-based research.
Answer 1: Generate a primary and differential diagnosis using the DSM-5 criteria.
Primary Diagnosis: Major Depressive Disorder (MDD)
According to the DSM-5 criteria, J.T. meets the criteria for MDD based on the following symptoms:
– Depressed mood: J.T. reports feeling depressed and stressed about school, and he perceives a lack of enjoyment in his daily life.
– Markedly diminished interest or pleasure: J.T. spends much of his time playing video games in his dorm room and has difficulty identifying enjoyable activities.
– Significant weight loss or appetite disturbance: Although not mentioned in the case study, changes in eating habits could be indicative of depressive symptoms.
– Insomnia or hypersomnia: The case study does not provide specific information about J.T.’s sleep pattern, but it can be explored further in the evaluation.
– Fatigue or loss of energy: J.T.’s avoidance behaviors, isolation, and disengagement suggest a lack of energy or motivation.
– Feelings of worthlessness or excessive guilt: J.T. constantly worries about what others think of him, assuming they find him “dumb,” “boring,” or a “loser.”
– Diminished ability to think or concentrate: J.T. experiences difficulty concentrating during interactions with others.
– Recurrent thoughts of death: This aspect is not explicitly mentioned in the case study but could be investigated further during the assessment.
Differential Diagnosis:
It is important to consider other conditions with overlapping symptoms to rule out alternative diagnoses. In J.T.’s case, social anxiety disorder and avoidant personality disorder could be considered as differential diagnoses due to symptoms related to social interactions, avoidance behaviors, and self-perception. However, these conditions do not fully encompass all the symptoms mentioned and can be explored during further assessment.
Answer 2: Develop a biopsychosocial plan of care for this client.
Biological:
1. Medication: Consider prescribing selective serotonin reuptake inhibitors (SSRIs), which have proven effectiveness in treating depressive disorders.
2. Sleep evaluation: Assess J.T.’s sleeping patterns and, if necessary, refer to a sleep specialist to address any sleep disturbances.
3. Nutritional counseling: Evaluate J.T.’s eating habits and provide nutritional guidance to optimize his physical well-being.
Psychological:
1. Cognitive-behavioral therapy (CBT): This therapy can help address J.T.’s negative self-perception, irrational thoughts, and social anxiety by challenging and modifying cognitive distortions.
2. Exposure therapy: Incorporate exposure techniques to gradually expose J.T. to social situations that cause distress, aiming to reduce avoidance behaviors and promote self-confidence.
3. Stress management techniques: Teach J.T. relaxation strategies, such as deep breathing exercises or mindfulness, to help him cope with stress and promote emotional well-being.
Social:
1. Supportive therapy: Encourage J.T. to engage in therapy sessions where he can express his feelings, fears, and concerns in a supportive environment.
2. Social skills training: Provide opportunities for J.T. to develop and practice effective social interaction skills, enhancing his confidence in social situations.
3. Encourage engagement: Motivate J.T. to participate in social activities, attend class regularly, and connect with peers, fostering a sense of belonging and reducing isolation.
Answer 3: Compare and contrast fear, worry, anxiety, and panic.
Fear: Fear is an emotional response to a real and specific threat or danger. It is a normal human reaction and triggers a “fight-or-flight” response. Fear is time-limited and subsides when the threat is removed or resolved.
Worry: Worry refers to a persistent and excessive concern or apprehension about future events or potential problems. It is often accompanied by a sense of uncertainty and can be difficult to control. Worry tends to focus on potential negative outcomes.
Anxiety: Anxiety is a general term that encompasses both fear and worry. It is characterized by a sense of unease, restlessness, and a heightened alertness. Anxiety can be related to specific situations or events, but it can also be more generalized, occurring without a specific trigger.
Panic: Panic is an intense and sudden onset of fear or discomfort, accompanied by physical symptoms such as heart palpitations, shortness of breath, and dizziness. Panic attacks are often unpredictable and can occur in various situations, even in the absence of an immediate threat.
While fear and panic are immediate responses to present threats, worry and anxiety are more focused on future or anticipated events. Anxiety can be a broader state of unease, while panic is a more intense and sudden experience. Both anxiety and panic can have physiological symptoms, but panic attacks are more severe and debilitating.
