Read the following transcript of an interview with an actual client, Samantha. Then answer the questions that follow (questions 4a-4g).
ASSESSMENT INTERVIEW TRANSCRIPT
Assessment Clinician: What types of things do you worry about?
Samantha: I worry about tons of things. Um, well, I mean I worry about the general things that I think people worry about… like… you know… like… well, maybe that’s not true. Um, I guess the future… I’m big in the future – I’m not a really “present” person much… something I try to work on. Um, I always worry about the future – how I’m doing, how far I’m getting in life – if I’m succeeding.
Um, and then there’s worrying about… well not worry, but I have a lot of work, or am I going to get my school work done on time, or maybe financially like am I okay financially, like those kinds of thing.
Assessment Clinician: What does it feel like when your anxiety takes over?
Samantha: Sometimes I just feel like I get foggy… like really foggy. Uh, like today I was working at the clinic, shadowing for the first time, and I hit a point when I was like… you know, for me, I like to think biologically, like, maybe I’m low blood sugar. I didn’t feel like eating this morning, probably because I was nervous, you know, so maybe my not eating was kicking in. But then, um, then I couldn’t concentrate.
And then, I kind of freeze for a second, and I’m thinking “If I have to fill out this form – and there’s like, so many forms – I don’t know if I can fill it out.” And then all of a sudden… it’s like I can’t see as well. I’m going to zone out. At the wall! I’m going to not look into space per se, but it’s like I literally can’t even focus in with my eyes. My vision is fine – I mean I wear contacts, but it’s not an actual vision problem. And then, to follow it, I get a tiredness… you know? Like… yeah, tired? But then, trying to figure out how to rev it up, try to clear up. It’s like if you were waking up from anesthesia I guess or something… like you’ve been drugged I guess! I guess! I don’t know! And then I can’t … I want to be clear – I want to be clear minded, but I can’t. I mean I guess I… um… feel confused, lost, and scared. And then… like I don’t know why I feel this way.
And there’s times when I’m, like foggy, or I’m tired or whatever, where… I could just drink coffee. I could just drink shots of espresso and I wouldn’t wake up, it just wouldn’t happen. And maybe my body would start pounding and my heart would start racing, but my brain, like, won’t go… I can’t rev it up but like… my body is really revved up. Um, and like… I have these thoughts running through my head, um… like… I want to get out of my skin, but I can’t, um… like I’m stuck. Yeah, and… like I was so revved up in my body that I couldn’t sleep for three days straight and, um,…wasn’t eating and like couldn’t really focusing on anything.
Assessment Clinician: When did these issues begin with you?
Samantha: My parents said I was always worried and nervous– since birth! So, I always … I was … always curious about what was going on near me. I had a real desire to learn how to read because I wanted to be able to read notes that people wrote people. And I wanted to know what was going on. I was really afraid to not know what was going on. And that was around the time when my parents got divorced, so I had a lot of anxiety then and I tried … you know, I’m the oldest, so I tried to … watch out for my brothers. My dad was really depressed about it and I had to see him go through that and so, I was constantly trying to keep tabs on everything, you know? Make sure everyone was feeling fine all the time. That kind of thing.
Assessment Clinician: When did you first know that your worry and anxiety were a problem?
Samantha: Well when, puberty hit, you know. And I think that’s when anxiety came on even stronger. Um, I would say like, up until 6th grade, I think I worried a lot more than most kids, but I wouldn’t say that I felt that first true impact of an anxiety attack. Um, and I would think that first attack came right when puberty really hit. And… I think that’s when I started to feel like this kind of fear. Also guilt, guilt comes up in it a lot … which is weird… you know, I don’t really know what I’m feeling guilty about… but it’s like guilt mixed with fear.
Many of the mental disorders you have learned about so far in class share similar features and symptoms or are different variations of the same symptoms. This creates one of the most common, yet difficult, challenges in clinical psychology—differential diagnosis. Differential diagnosis requires doctors to determine from which disorder the patient is suffering by considering and ruling out other disorders that have similar features and symptoms. This requires understanding the many subtle similarities and differences among disorders.
Engage in differential diagnosis for the patient, Samantha, based on the brief interview transcript presented above. Answer the following questions in the process of your differential diagnosis. The following 7 questions are worth a total of 20 points. See individual point values for each question below.
Question 4a (worth 3 points):
Which symptoms are suggestive of a mental health disorder?
Question 4b (worth 1 point):
What disorders are you considering as possible explanations for her symptoms?
Question 4c (worth 7 points):
Compare and contrast the symptoms and risk factors of at least three disorders/conditions that might explain Samantha’s symptoms.
Question 4d (worth 1 point):
What is your provisional diagnosis for Samantha?
Question 4e (worth 2 points):
How did you rule out other diagnoses you were considering?
Question 4f (worth 1 point):
What treatment would you provide Samantha based on her diagnosis?
Question 4g (worth 5 points):
Why did you choose that specific type of treatment? Be sure to link the type of treatment you chose to the specific information you have about Samantha and her symptoms.