Subjective

This paper examines the case of a female patient named Ally for psychological disorders and addiction. Ally Patel is 45 years old, was raised as an only child in San Francisco, California, and works as a college tutor. Recently, Ally developed substance a drinking problem that interfered with her effectiveness at work and her supervisor sent her to counseling.

CC (chief complaint): Ally’s problems at work have increased alongside substance use issues due to an unfavourable workplace environment. In her view, most learners disrespect tutors (including herself), and the administration lacks proper measures to contain the situation.

HPI: Ally admitted that her father was an alcoholic for a better part of his life. Although her mother was increasingly strict and prohibited her from drinking, she started drinking as a teenager, in college and graduate school. Ally acknowledged that she drank a lot more alcohol recently due to work-related stress, among other reasons.

Past Psychiatric History

• General Statement:  the client pointed out that the school environment was hostile because the students had become exceedingly intolerant. Secondly, she noted that the administration had overlooked the problem. Consequently, she drinks every night for consolation due to stress and frustration.
• Hospitalizations:  The client has never been hospitalized.
• Medication trials: None.
• Psychotherapy or Previous Psychiatric Diagnosis: The Client has never undergone a psychiatric diagnosis or psychotherapy.

Substance Current Use and History: The Client started drinking when she was a teenager and presently drinks every night and possibly uses other substances.

Family Psychiatric/Substance Use History: The Client’s family has no psychiatric history, although her father was an alcoholic in his youth.

Psychosocial History: The client never mentioned any adverse childhood events. Nevertheless, she seemed disturbed by claims concerning her workplace behaviour and previous relationship.

Medical History:

• Current Medications: None
• Allergies: None.
• Reproductive Hx: The Client has no considerable reproductive history.

ROS:

• GENERAL: Initially, the client seemed irritated and impatient and wanted to leave. Although responsive, the client evaded the most sensitive questions that could reveal the root cause of her problem.
• HEENT: The Client exhibited no visual or auditory problems. As per medical history, her sense of smell is ordinary.
• SKIN: The patient’s skin is healthy and normal, with no visible rashes, itching, redness, burns, or bruises.
• CARDIOVASCULAR: A standard heart rate was recorded.
• RESPIRATORY: The Client exhibited no sign of respiratory complications.
• GASTROINTESTINAL: The Client experienced normal bowel movements and never reported nausea, vomiting, diarrhea, and cramps.
• GENITOURINARY:  The Client did not experience pain while urinating. Chronic Renal failure, Endometrial ablation, and fecal Incontinence were not present.
• NEUROLOGICAL: No headaches or dizziness was reported. The client has a good memory and never reported any arm or back pains.
• HEMATOLOGIC:  Blood disorders were not present.
• LYMPHATICS: The Client’s lymph nodes were normal, with no signs of swelling or inflammation.
• ENDOCRINOLOGIC: The patient did not exhibit any endocrine or related issues.

Objective:

Physical exam: A physical examination WNL was recommended. The first tool employed was the CAGE questionnaire. The CAGE questionnaire is a series of questions used mainly by family physicians to test alcoholism (Williams, 2014). The questions inquire if the patient has Cut down/reduced drinking, is Annoyed at criticism concerning drinking, is Guilty about drinking, or considers alcohol an Eye-opener (Richoux et al., 2011). Laboratory examinations for alcoholism involve the CDT, GGT, and MCV tests (Deas et al., 2019). In addition, endocrine and neurological tests were conducted to investigate depression.

Diagnostic results:  The Client’s serum exhibited high GGT, MCV, and CDT levels signifying heavy drinking.

Assessment:

Mental Status Examination: Despite appearing normal and well-groomed, the patient arrived late and seemed unprepared for the session. Besides, the client maintained a pessimistic attitude throughout the session and was unwilling to answer some questions. Although she had a good memory and her speech was straightforward and well-coordinated, her insight, thoughts, and judgment were poor.

Differential Diagnoses:

1. Alcohol use disorder.

According to McHugh & Weiss (2019), alcohol use disorder refers to a condition in which patients experience several problems linked to alcohol consumption. In this case, patients cannot control intake, spend most of their time drinking, and continue drinking even when it adversely affects their health. Alcohol use disorder stems from a wide range of social, genetic, psychological, and environmental factors. Other studies postulate that some people are more vulnerable to alcohol use disorder than others. The main risk factors linked to alcohol use disorder include family history, mental health problems, trauma, drinking at an early age, excessive drinking, and social-cultural aspects. The DSM-5lists all the above signs as symproms of alcohol use disorder (2013). In this way, I selected it as a differential diagnosis since the client in this scenario exhibits all the above symptoms.

• Major depressive disorder

Major depressive disorder refers to a psychological state in which patients experience persistent and intense sadness, lack of interest, and hopelessness (Ote et al., 2016). The main symptoms include mood swings, sadness, lack of appetite, anxiety, outbursts of anger, distorted thoughts, self-blame, suicidal ideation, and inexplicable illnesses (2013). Depression stems from hormonal changes, biological differences, brain chemistry, and family history. The risk factors of depression include substance use, other mental illnesses, low self-esteem, specific medications, family history, and chronic illnesses like stroke and cancer (2013). As per the client’s case, I selected depression as one of the differential diagnoses because she expressed a lack of interest in work and indulged in excessive drinking. More importantly, the client was psychologically disturbed, sad, lost her temper, and had no hope for recovery.

• Paranoid personality disorder

Personality disorders describe a condition in which patients exhibit harmful and flexible thoughts, behavior, and functioning (Mulder and Tyrer, 2019). According to DSM-5, paranoid personality disorder refers to a state where patients are increasingly suspicious of others, hold grudges, react angrily to personal questions, hesitate to confide in others and perceive harmless situations as dangerous (2013). In the case of this paper, I selected paranoid personality disorder because the client exhibited the above symptoms. Again, extensive and recent studies link mental health issues, including personality disorders, to excessive alcohol consumption.

Reflections

Like other mental illnesses, substance use problems are complex and have a wide range of adverse physical, psychological implications. In most situations, patients with substance use disorders perceive their addictions as usual and delay seeking medical help. Much worse, most interventions for substance use disorders neglect the psychological perspective, which often bears the underlying issues. In this light, interventions for treating substance use disorders should be holistic and multidimensional. The client seemed defensive and barely recognized the severity of her condition. However, she has a family history of alcohol use and other reasons. If we could have another session, I would engage the client more to find out more issues, recent life events, and other risk factors linked to her problem. Although such an engagement would compromise the client’s privacy and autonomy, it would be more effective and valuable to the treatment process.

Reference

Deas, D., Johnson, N., & Thomas, S. (2019). Carbohydrate-deficient transferrin (CDT) predicts heavy drinking in adolescents with alcohol dependence. Alcohol, 81, 27-30.

Edition, F. (2013). Diagnostic and statistical manual of mental disorders. Am Psychiatric Assoc, 21.

McHugh, R. K., & Weiss, R. D. (2019). Alcohol use disorder and depressive disorders. Alcohol research: current reviews, 40(1).

Mulder, R., & Tyrer, P. (2019). Diagnosis and classification of personality disorders: novel approaches. Current Opinion in Psychiatry, 32(1), 27-31.

Otte, C., Gold, S. M., Penninx, B. W., Pariante, C. M., Etkin, A., Fava, M., … & Schatzberg, A. F. (2016). Major depressive disorder. Nature reviews Disease primers, 2(1), 1-20.

Richoux, C., Ferrand, I., Casalino, E., Fleury, B., Ginsburg, C., & Lejoyeux, M. (2011). Alcohol use disorders in the emergency ward: choice of the best mode of assessment and identification of at-risk situations. International Journal Of Emergency Medicine, 4(1), 1-5.

Williams, N. (2014). The CAGE questionnaire. Occupational medicine, 64(6), 473-474.