Analyze a case study and make appropriate diagnosis and treatment recommendations.

 Objective: Analyze a case study and make appropriate diagnosis and treatment recommendations.

Learning how to make appropriate diagnoses is key to creating a client’s treatment plan and making recommendations. A client may meet two of the criteria for a disorder but the DSM may state that four criteria are needed for diagnosis, so the clinician cannot use that particular disorder for a diagnosis. One way to learn is to practice using case studies and receiving your instructor’s feedback on your work.

Case Study – Laura 

Laura is a very successful businesswoman in the high-stress high-powered world of corporate

finance. She has been referred to you by the company’s employment assistance program. Laura

presents herself as a no-nonsense business professional. She is frank and honest about the events

that has brought her to your office.

Laura tells you that although she tells herself that she will only have one or two glasses with

dinner, she usually finishes the whole bottle.

“About five years ago I started having trouble sleeping and started to take a

tranquilizer (5 mg Valium) I normally take one or two pills every two to four times a

week to help her sleep through the entire night.”

In the morning she drinks at least 3 to 4 cups of coffee daily, even on the weekends. She noticed

that her sleeping problems developed around the same time her Dad died. He was only in his early 50’s and they were very close. His death hit her hard and she says she wanted to give in to a big depression. However, she fought it and lost herself in her work. She makes it a point to work out at least three times a week in the morning before going to work. In addition to the above medications, Laura is also prescribed Xanaxas needed for panic attacks and diet pills (amphetamine congeners) to control her weight, a problem she had since she was a child. Over the last year she has become more reclusive. She can barely make it to business dinners and after-work functions. Lately however, she has noticed that she has been steadily increasing her use of wine. Before, she would only have a few glasses with dinner but now

“....more often than not I finish off the bottle before going to bed. I just can’t seem to

stop. A lot of times I will come home and tell myself that I’ll only have one glass and no

more but by the time I go to bed, the bottle is empty and I’m deciding whether I should

open another or not. I never used to drink to excess or take anti-anxiety medication

before. Now I can’t seem to stop drinking or taking these ‘downers’ at social events. I

can’t seem to control when I take them and things are happening that I’m not too

happy about. Of course the alcohol adds to my weight problem which then causes me to

take more of my Redux. Then I have to increase my Xanax to calm my nerves and also

take my Valium to make sure I get a full nights sleep. It has become a very vicious

circle. All this has been going on for about a years but last week put the “cherry on the

pie.”

Laura tells you that last week she was to meet the firm's top client at a business luncheon. She

could not get out of bed that morning. It took all her willpower to get up and get dressed. As it was, she was still 20 minutes late, "which is inexcusable." She was so nervous and sick she had to excuse herself in the middle of her presentation. In the bathroom she took another Xanaxto calm her nerves. Then at the luncheon she could not stop herself from ordering several glasses of wine and had to be assisted to her car after the meeting was over.

1. What would your initial assessment of Laura be?  Explain. 

2. What would you say Laura’s main drug of choice is and do you think she will need to be 

placed in a detox unit?  

3. Based on Laura’s emotional situation and the medications she is taking, what if any dangers do you need to be aware of?

4. What possible dual diagnosis issue(s) might Laura have and how would you do to confirm thispossibility.

5. Are there any other issues that you feel may need to be addressed in this case?

6. Finally, what treatment recommendations would you make for Laura and why?