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Case Study: Jax
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:
Jax is a 66-year-old Caucasian female whose wife has encouraged her to seek treatment. She has never been in therapy before, and has no history of depression or anxiety. However, her alcohol use has recently been getting in the way of her marriage, and interfering with her newly-retired life. She describes drinking increasing amounts over the last year, currently consuming approximately a six-pack of beer per day. She notes that this amount “doesn’t give me the same buzz as it used to.” She denies ever experiencing “the shakes” or any other withdrawal symptoms if she skips a day of drinking.
Jax comments that her wife is her biggest motivation to decrease her alcohol use. She tells Jax that she gets argumentative and irritable when she drinks, though she does not always remember these incidents. She has also fallen while intoxicated twice, causing bruises both times and hitting her head on one of the occasions.
Questions:
Remember to answer these questions from your textbooks and NP guidelines. At all times, explain your answers.
Describe the presenting problems/issues. Is there any information that was not provided that you would need to formulate a diagnosis?
Generate a primary and differential diagnosis using the DSM5 and ICD 10 codes.
What physiological and psychological processes lead to substance dependence?
Expert Solution Preview
Introduction:
In this case study, we are presented with the case of Jax, a 66-year-old Caucasian female who is seeking treatment due to the interference of her alcohol use with her marriage and newly-retired life. Jax has been consuming a significant amount of alcohol, around a six-pack of beer per day, and has noticed a decrease in the desired effects of alcohol. She denies experiencing any withdrawal symptoms when she skips a day of drinking but has experienced argumentativeness, irritability, and memory lapses during episodes of drinking. Additionally, she has fallen twice while intoxicated, resulting in bruises and a head injury on one occasion.
Now, let’s address the questions posed in the content:
1. Describe the presenting problems/issues. Is there any information that was not provided that you would need to formulate a diagnosis?
The presenting problems/issues in this case study are as follows:
a) Excessive alcohol consumption: Jax’s alcohol intake has reached a level that is interfering with her daily life and relationships. This can be seen in her marital conflicts and the falls she experienced while intoxicated.
b) Decreased desired effects of alcohol: Jax mentions that her current alcohol consumption does not provide her with the same “buzz” as before, which may indicate the development of tolerance.
c) Memory lapses and blackouts: Jax states that she does not always remember the incidents of argumentativeness and irritability that occur when she drinks. This suggests the occurrence of blackouts, which are associated with heavy alcohol use.
d) Physical consequences: Jax’s falls while intoxicated have resulted in bruises and a head injury, indicating the potential for physical harm due to alcohol use.
To formulate a diagnosis, additional information related to Jax’s medical and psychiatric history, family history, and any underlying physical conditions would be beneficial. Furthermore, a thorough assessment of her alcohol use patterns, including frequency, quantity, and duration, would help in determining the severity of her alcohol use disorder.
2. Generate a primary and differential diagnosis using the DSM-5 and ICD-10 codes.
Primary Diagnosis:
Alcohol Use Disorder, Severe, Without Withdrawal (DSM-5: 303.90, ICD-10: F10.20)
Differential Diagnosis:
1. Bipolar I Disorder, Current Episode Mixed, Severe, Without Psychotic Features (DSM-5: 296.64, ICD-10: F31.61)
2. Major Depressive Disorder, Severe, With Anxious Distress (DSM-5: 296.24, ICD-10: F32.89)
3. Generalized Anxiety Disorder, Severe (DSM-5: 300.02, ICD-10: F41.1)
4. Alcohol-Related Neurocognitive Disorder, Mild, With Alcohol-Induced Persisting Amnestic Disorder (DSM-5: 294.89, 291.1, ICD-10: F10.27, F10.18)
It is important to note that the differential diagnoses provided above are based on the limited information available in the case study. Further assessment and exploration of Jax’s symptoms and history would be required for a more accurate diagnosis.
3. What physiological and psychological processes lead to substance dependence?
Substance dependence, including alcohol dependence, is influenced by a combination of physiological and psychological factors.
Physiological processes:
a) Tolerance: Repeated exposure to a substance, like alcohol, can lead to tolerance, where higher amounts are needed to achieve the desired effects. Tolerance occurs due to changes in the brain’s reward and pleasure pathways, leading to a decreased response to the substance.
b) Withdrawal: Upon abrupt discontinuation or reduction in substance use, individuals with dependence can experience a range of withdrawal symptoms. These symptoms can vary depending on the substance and may include physical symptoms such as tremors, sweating, and nausea.
c) Neuroadaptation: Prolonged and excessive substance use can result in neuroadaptations in the brain, altering neurotransmitter systems and leading to changes in reward processing, stress response, and decision-making.
Psychological processes:
a) Cravings: Substance dependence is associated with cravings, which are intense desires or urges to use the substance. These cravings can be triggered by cues or environmental stimuli associated with substance use.
b) Reinforcement: Substance use provides a rewarding experience, reinforcing its continued use. Positive reinforcement, such as the pleasurable effects of alcohol, increases the likelihood of repeated use.
c) Coping mechanisms: Some individuals may rely on substance use as a means of coping with stress, alleviating negative emotions, or self-medicating mental health symptoms.
It is essential to consider both physiological and psychological factors when addressing substance dependence, as they interact and contribute to its development and maintenance.
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