Read the case study of “Jack” located in the Topic 4 materials and provide the appropriate DSM-5 diagnoses in descending order, from the dominant, to the least dominant. For each diagnosis you assign, provide an explanation of the diagnostic criteria you assessed to be compelling, as found in the DSM-5 diagnostic criteria monograph for each disorder.
Case Study: Jack
Jack, a
pleasant
67-year-old gentleman
and
his wife Jill, age
63, are referred to
your outpatient
counseling practice by their family
physician. Referral information identifies
difficulties
coping
with issues
pertaining
to their stage in life.
Both
retired, Jill was previously employed as a
schoolteacher for
35 years until the age
of 60 when
she stopped working
to
help her husband
Jack, who underwent bilateral knee replacement surgeries. Jack
worked
as an
accountant for a
local firm and even though
he
wanted
to continue
to work
well
into his
60s,
he retired because
the recuperation from
his
knee replacement surgeries
proved
to
be
more
extensive than
anticipated.
During the first session, you assess that
Jill
does
most of the talking,
often answering
questions
directed at Jack. Most
of
Jack’s responses
are
short, closed-ended remarks,
or just shrugs,
followed by charming smiles. It is evident that
the couple has been struggling for some time with
the drastic change in their roles from high functioning professionals to
the role
of
caregiver
for
Jill and
patient
for
Jack. At this time, you focus your assessment on Jack and
ascertain that there
were noticeable changes to his mood as early
as
four years ago. Jill describes that approximately
one year prior to his retirement, Jack’s
mood became persistently
grumpy
—which for him was
a
significant change
from the happy, energetic, optimistic individual he
had been most
of his life.
At that time, Jill
feared
that Jack had
difficulties coping with
the thought of retirement and tried
to be supportive. During
that year, he gradually lost approximately 10 pounds and was
prescribed
a sleeping aid in order to help him get his customary six hours of sleep per
night.
Always active and an
avid
golfer, Jack
decided
to take a medical leave
from
work 3 years ago
in
order to get “new
titanium
knees.” His knees had
been getting worse
progressively
over
the past
10 years and the impairment
became
increasingly bothersome. While the
surgery was
successful,
Jack’s recuperation took longer
than expected. Medically, he met
all the rehabilitative markers,
but this
took considerable
effort. At the skilled nursing facility it soon became
evident that
Jack’s
schedule had to be divided
in small, achievable increments. Normal
tasks requiring
longer
amounts of
time to complete. At this time he started to become
forgetful, exhibiting
difficulties
recalling recent events or activities
scheduled
for
his physical rehabilitation. He was visibly
frustrated by this occurrence which he
described as having a
“fuzzy head
in
the morning.” He
attributed this to his
pain
medications. To compensate, Jack started to carry a
small notebook in
the front pocket of his shirt. He humorously referred to
it as his
detective
notebook
. During this
time Jill noticed a
subtle
but steady change in his overall attitude
and
personality.
Jack
was
becoming more and more apathetic, exhibiting decreased affection and empathy towards Jill, and
increased frustration with himself and his caregivers when he could not readily
think of a
word
or when he had difficulties recalling a fact or situation. After his discharge from
the
skilled
nursing facility, during a routine visit, the family
physician completed a mini mental status
exam.
At that time, Jack became frustrated with his
inability to recall the three random objects named
by his
doctor. Jill started to
cry, reporting
to the
family
doctor
the ordeal she had
undergone
since Jack’s surgery and
all the tasks she had to assume on his behalf (like
paying bills), tasks
which he could no longer
perform reliably.
She expressed
concerned
over how
their
life will look Like now that he
has
returned home, raising
questions about her ability to
take over all
the tasks
that he was
previously attending
to. The
couple’s
distress was
clinically
significant
as to warrant
a referral to you