Diagnostic Labels as Powerful Communications Discussion Response

Respond to at least two colleagues who had a different position than your own in the following way:

• Explain why you agree or disagree with whether the client meets diagnostic criteria and should be told about a “tentative” diagnosis, approach to diagnosis, or impact of diagnosis.
• Explain how the social worker could have worked with a supervisor to make an initial diagnosis.

Colleague 1: Tiffany Snidarich 

RE: Discussion – Week 2

As I was reviewing this case one of the first things that I picked up on was that she was being honorably discharged, but the study did not indicate that this was because of her current behavior. Immediately I assumed there must be more going on that people did not know about. The next thing was that there were reports that “she looked increasingly fearful and was talking about hearing voices telling her that the world was going to be destroyed in 2020” (Roberts and Trockel, 2015). She also stated that she thought she was depressed and her performance had declined. So much so that her commanding officer suggested that she sees a psychologist. Finally “she has a maternal uncle with schizophrenia, and her mother has a diagnosis of bipolar I disorder” (Roberts and Trockel, 2015).  We should also address the fact that she was using drugs and could have been contributing to her symptoms.

In regards to the social worker sharing her diagnosis I would say that she should have waited. In my opinion she could have done further testing and or monitored her before jumping to this diagnosis. “The problem with impressionistic diagnosis is that it is particularly prone to cognitive error, such as coming up with the first diagnosis that comes to mind” (Paris, 2015).  This diagnosis does tend to run in families so I completely understand why she would jump to this conclusion; however it’s better to give the client the right diagnosis the first time.

In this case if the wrong diagnosis were to be given it could cause a lot of issues. First it could complicate things with her discharge from the military or prevent her from staying if that were an option. Next, she could be prescribed the wrong medications which could have horrible side effects. This could even prevent her from getting a job in the future.

I believe that it’s ok to give a patient a provisional diagnosis when more information is needed. “When the clinician thinks a particular disorder is present but realizes more information is required to be confident of a specific diagnosis”(carpenter and William, 2016). In this case Mrs., Evans can be educated and help the social worker get any necessary information needed.  

To diagnose a client with other specified and unspecified disorders it must be proven that the symptoms are due to another medical condition. “For other specified and unspecified mental disorders due to another medical condition, it must be established that the disturbance is caused by the physiological effects of another medical condition” (DSM, 2013).

References 

Carpenter, William T., and Darrel Regier.(2016)  “Diagnostic Categories: Provisional, Not Otherwise Classified, or Place-Holder?” Schizophrenia Bulletin, vol. 42, no. 6, 1 Nov. 2016, pp. 1305–1306, www.ncbi.nlm.nih.gov/pmc/articles/PMC5049540/, 10.1093/schbul/sbw127.

“Other Mental Disorders.” Diagnostic and Statistical Manual of Mental Disorders, 22 May 2013, 10.1176/appi.books.9780890425596.dsm20. Accessed 10 June 2021.

Joel Paris. (2015). The Intelligent Clinician’s Guide to the DSM-5®: Vol. Second edition. Oxford University Press.

Roberts, L. W., & Trockel, M. (2015). Case example: Importance of refining a diagnostic hypothesis. In L. W. Roberts & A. K. Louie (Eds.), Study guide to DSM-5 (pp. 6–7). Arlington, VA: American Psychiatric Publishing.

Colleague 2: Britney Leverett

Red Flags

The case study of Ms. Evans presented several ed flags. The first red flag would be her drastic behavior change; Her colleagues stated that she was able to take care of herself initially, but her job performance declined due to the lack of personal care. The social worker should gather various information based on her behavior that has been occurring for several months. The next red flag is her increased fearfulness and hallucinations. These red flags indicate more complex issues, and Ms. Evan’s pending discharge could be considered a red flag. According to (Neukrug & Fawcett, 2015), “Psychosocial and environmental trigger on negative emotional response. 

Suspected Diagnosis

The social worker shared a tentative diagnosis of schizophrenia. Two weeks prior, Ms. Evans received a diagnosis of depression. Different diagnoses may cause an adverse reaction for Ms. Evans. The new diagnosis can have harmful effects such as panic, anxiety, or increased stress. “The result of previous experience with mental health and negative stereotype portrayed in social. (Campbell & Mowbray, 2016). Social work standards assert that social workers must ensure that their actions promote the client’s wellbeing (Brasky, 2015). Therefore, it’s imperative to consider whether or not a diagnosis is in the client’s best interest (Brasky, 2015). In this case, the diagnosis did not service the client in any way. It’s essential to understand that a diagnosis “helps an individual understand his or her prognosis and aids in forming reasonable expectations for treatment (Neukrug & Fawcett, 2015). 

Provisional Diagnosis

A provisional diagnosis is offered when it is believed that the known symptoms fit a diagnosis, but one does not have ample information to proclaim such without a doubt (Neukrug & Fawcett, 2015). According to (Neukrug &Fawcett, 2015), “The type of diagnosis is utilizing when offering a diagnostic summary and communicating with other clinicians.” 

Other specific/Unspecific Disorder

Unspecific and another specified diagnosis should be offered when an individual does not meet the full criteria of a specific diagnosis (American Psychiatric Association, 2013). According to the (American Psychiatric Association, 2013), “A diagnosis assets that more information and research should be gathered regarding individual experience symptoms, and severity.

References:

Barsky, A. (2015). DSM-5 and the Ethics of Diagnosis. https://www.socialworker.com/feature-articles/ethics-articles/dsm-5-and-ethics-of-diagnosis/. 

Campbell D., & Mowbray, O. (2016). The stigma of depression: Black American experiences. https://eds-a-ebscohost-com.ezp.waldenulibrary.org/eds/detail/detail?vid=5&sid=7e67ac03-3b44-4cb1-912e-bf74dd838479%40sessionmgr4008&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=2016-55729-002&db=psyh. 

Neukrug, E., & Fawcett, C. (2015). The essentials of testing and assessment: a practical guide for counselors, social workers, and psychologists. https://www.worldcat.org/title/essentials-of-testing-and-assessment-a-practical-guide-for-counselors-social-workers-and-psychologists/oclc/929953288.