Carefully read over the following case and then, using your DSM-5, complete the

form that follows, all the way through the treatment plan. Take the time and

explore differential diagnosis, cultural factors, life experience, and

circumstances. There may not be enough information provided within the case to

substantially fill in all of the area of the form, but try to be thorough. Case Study the treatment plan

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Nancy Ingram, a 33-year old stock analyst and married mother of two children,

was brought to the emergency room (ER) after 10 days of what her husband

described as “another cycle of dark days.” His wife was tearful, then explosive,

and she had almost no sleep.

Ms. Ingram’s husband said he had decided to bring her to the ER after he

discovered that she had recently created a blog entitled Nancy Ingram’s Best Stock

Picks. Such an activity not only was out of character but, given her job as a stock

analyst for a large investment bank, was strictly against company policy.

Mr. Ingram said his wife was working on the stock picks around the clock,

forgoing her own meals as well as her responsibilities at work and with her

children. Ms. Ingram argued with her husband at this time and said, her blog

“would make them rich.” Case Study the treatment plan

The patient had first been diagnosed with depression in college, after the death of

her father from suicide. On examination, the patient was pacing angrily in the

exam room. Her eyes appeared glazed and unfocused. She responded to the

examiner’s entrance by sitting down and explaining that this was all a

miscommunication, that she was fine and needed to get home immediately to tend

to her business. She was speaking so rapidly, it was difficult for the examiner to

interrupt. Case Study the treatment plan

She denied hallucinations, but admitted with a smile, to a unique ability to predict

the stock market. She refused to be cognitively tested and she said, “I will not be a

trained seal, a guinea pig, or a barking dog, thank you very much, and may I leave

now?”

Case Formulation • Presenting problem – What is the client’s problem list? –

What are DSM diagnoses?

• Predisposing factors – Over the person’s lifetime, what factors contributed to the

development of the problem? – Think biopsychosocial

•Precipitants – Why now? – What are triggers or events that exacerbated the

problem?

• Perpetuating factors – What factors are likely to maintain the problem? – Are

there issues that the problem will worsen, if not addressed

• Protective/positive factors – What are client strengths that can be drawn upon? –

Are there any social supports or community resources ? Case Study the treatment plan