PSY 650 WEEK 2 DISCUSSION Reply to Stephanie Malave post on Assessment and Diagnosis “Under the Gun”
Question
Details: Review several of your colleagues’ posts and respond to at least two of your peers who chose a different case. You are encouraged to post your required replies earlier in the week to promote more meaningful interactive discourse in this discussion.
In your responses, evaluate whether your peer took into account the ethical guidelines outlined in the APA’s Ethical Principles of Psychologist and Code of Conduct when he or she assessed and diagnosed the client. Suggest additional questions your peer might ask the client. Propose an alternative diagnosis that might arise from the additional questions you have suggested. (SEE STEPHANIE’S POST BELOW)
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Stephanie Malave
The Beck Depression Inventory-II is a 21-item measure used as a self-reporting tool for clients. The BDI-II is the most popular measure used by professionals and is the most updated form of assessment. It has been translated into 17 different languages showing that it has been accepted internationally (Wang & Gorenstein, 2013). The Hamilton Depression Rating Scale is used in a clinical setting, usually used during research, including randomized controlled trials (RCT). It has 17-items used by the observer to annotate the client’s behaviors. The assessment evaluates depression severity based on presenting symptoms and differences between clinical populations (Nixon et al., 2020).
I would use both of these techniques to aid in the diagnosis, including a mental status examination (MSE) and combining the information to formulate a possible diagnosis. The MSE consists of observing a client based on appearance, behavior, speech, and thought process (Tasman & Ursano, 2013). Additional information needed to formulate a diagnosis would be previous if any, mental health diagnosis and treatments. Information gathered directly from the client is essential information to include the information received from the assessment.
The following are a few questions that I would as the patient for further information:
1. Have you lost interest in hobbies?
2. Have you gained or lost weight in the last two weeks?
3. Have you been sleeping too much or too little?
4. Have you been overtired or have a loss of energy?
5. Have you had the inability to concentrate?
I would use the environmental theoretical orientation for this client as he is dealing with an external factor. In this situation, he is going through a divorce that influences his current moods. It is important to understand the situation that led to the divorce and how he deals with the emotions from the divorce. The environmental orientation focuses on the events that took place before the illness and the stressors that are involved (Tasman & Ursano, 2013).
Per the criteria in the DSM-5, the proposed diagnosis would be another specified depressive disorder. He has a depressive episode with vague symptoms; however, he is facing depressed affects, at least one of the eight symptoms of a major depressive episode, does not meet the requirement for active or residual criteria for psychotic disorder, and does not meet the criteria for mixed anxiety or depressive disorder symptoms. Based on the DSM-5, he shows symptoms A1 for depressed moods, A9 for recurrent suicidal ideation without a specific plan, and section B states the symptoms are causing impairment in his job (APA, 2013).
The client is a 33-year-old African American man presenting symptoms of suicidal ideation, agitation, anger, sadness, and stress most days. He is currently going through a divorce, and his emotional state is impacting his performance at work, and he is in fear of losing his job. He is open to receiving treatment and has insurance out of network but can be reimbursed fees with an acceptable diagnosis. The assessment and diagnosis must be rendered within 48 hours of the initial session with the client. I do not believe this is an efficient amount of time to get an appropriate diagnosis. Even if there was 24-hour access to the patient, fully understanding the patient’s presenting symptoms takes time.
I do not believe it is ethical to render a diagnosis within the required timeframe. Or even justifiable in this situation to render a diagnosis to obtain a third-party payment. The short time frame was given to render a diagnosis can lead to a misdiagnosis due to the lack of information. The misdiagnosis can leave the client looking at themselves differently based on the diagnosis provided. The negative view of self can exacerbate presenting symptoms (Keilbasa et al., 2004).
Studies have shown that when comparing clients that pay through insurance or those who pay out of pocket, the individuals paying the third party are more likely to get a diagnosis quickly. In contrast, clients that are paying out of pocket take more time. The quick diagnosis leads to the client have the diagnosis on their record (Keilbasa et al., 2004). The diagnosis in the record can be beyond the confidentiality of the provider and can be limited. Along with the misdiagnosis, a patient will need to change medications and treatment plans when the correct diagnosis is found (Keilbasa et al., 2004).
References
American Psychiatric Association. (2013). DSM-5: The diagnostic and statistical manual of mental disorders (5th ed.)[E-book]. Washington, D.C.: American Psychiatric Publishing.
Kielbasa, A. M., Pomerantz, A. M., Krohn, E. J., & Sullivan, B. F. (2004). How does clients’ method of payment influence psychologists’ diagnostic decisions? Ethics & Behavior, 14(2), 187-195. doi:10.1207/s15327019eb1402_6
Nixon, N., Guo, B., Garland, A., Kaylor-Hughes, C., Nixon, E., & Morriss, R. (2020). The bi-factor structure of the 17-item Hamilton Depression Rating Scale in persistent major depression; dimensional measurement of outcome. PLoS ONE, 15(10), 1–13. https://doi-org.proxy-
Yuan-Pang Wang, & Clarice Gorenstein. (2013). Psychometric properties of the Beck Depression Inventory-II: a comprehensive review. Brazilian Journal of Psychiatry, 35(4), 416–431. https://doi-org.
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