1. The Case of David

            David, who is twenty years old presented to the office with several symptoms including lack of interest in relationships and friends, staying alone most of the time, lack of interest in making progress, getting bored from time to time, and dislike of parents. Due to the symptoms mentioned, I had to perform a further assessment to determine the exact diagnosis for him. Based on the symptoms, the patient had a mental illness which I had to determine its specific identity. Therefore, after collecting subjective data, I suspected a diagnosis of schizoid personality disorder. Still, I need to carry out a further assessment which include ruling out other possible diagnoses, answering questions concerning the selected diagnosis, and asking the client some questions that could help verify the diagnosis.

First of all, I need to rule other factors that could lead to similar symptoms. For instance, the patient had no history schizophrenia. Patients who have schizophrenia develop symptoms such as social withdrawal whereby they opt to stay away from the public, including close family members (Winarick, & Bornstein, 2015). Besides, schizophrenic patients lack self-motivation in performing activities of daily living in that they do not care about making progress. David had the two symptoms explained, but those two could not meet the DSM-5 diagnostic criteria for schizophrenia. Secondly, I need to rule out a pervasive developmental disorder which refers to the delay in the development of socialization skills among growing. According to reports from his parents, the symptoms started showing since the past one year. Thus, it is unlikely that he is suffering from such an illness.

More so, I need to rule out any possibilities of the patient showing such symptoms due to taking medications that could affect the physiologic functioning of the nervous system. In this case, his parents reported that he had not been diagnosed with a medical condition recently, and so no medication has been prescribed for him. Having ruled out the possible diagnoses and factors resulting in his symptoms, I need to proceed with further assessments to confirm that the patient indeed had a schizoid personality disorder as I had suspected from the start.

Having ruled out other mental illnesses that relate to the selected diagnosis, I need to ask myself several questions based on the mental status examination of the patient. Firstly, I can ask myself about the patient’s appearance, as this aspect is crucial while assessing mental illnesses in patients. As such, I had observed him, and I noticed that he looked aloof and detached. He could not concentrate fully during the assessment. He as well looked unconcerned with the history-taking process. During the physical examination, the patient was not concerned about what was being done on him. In this regard, I confirmed that he had a mental illness. Furthermore, I need to ask myself about the patient’s mood while in the office. Unlike normal individuals, the patient showed a flattened mood such that he could not change the mood even when triggers are provided. Concerning his affect, I noticed that he showed some emotional coldness. Following this assessment, I can make a decision about his mental status. As such, I concluded that he had a schizoid personality disorder.

Still, I need to assess the patient to get subjective data that can confirm that he has a schizoid personality disorder. This involves asking the patient questions about how he feels and what he is going through at home. David confirmed that he always felt bored while at home. Besides, he had no interest in spending time with friends, and he had no further explanation as to why that usually happens. In this case, my aim is to find proof that David is actually out of his mind. Following this assessment, I confirmed that he actually met the DSM-5 diagnostic criteria for schizoid personality disorder. According to DSM-5 diagnostic criteria, patients should present with symptoms including detachment from other individuals, lack of a desire to engage in relationships, and infrequent engagement in activities for fun or pleasure among other key symptoms (Morey, & Benson, 2016). Therefore, it is clear that David had a schizoid personality disorder.

In this case, am tending towards the selected diagnosis because it suits most of the subjective and objective data obtained from the client during the assessment. Besides, sticking on this specific diagnosis will lead to effective management of the patient as specific therapies will be prescribed for him. As a result, David will recover from a schizoid personality disorder.

2. The Case of Breanna

Breanna is a seventeen-year-old girl who behaves in an arrogant manner and claims of her underrated superiority. She as well looks down upon others who try to explain to her what she is exactly going through. While presenting at the office, she behaved in a strange manner which provoked me to perform a thorough assessment so as to determine her specific diagnosis. It is clear that she has a mental disorder. Thus, a mental status assessment is as well required to determine her exact condition. Additionally, ruling out other possible diagnoses for the client is vital as it enables health care workers to come up with a specific diagnosis that can be managed successfully. Hence, I need to do all of these to come up with a reliable diagnosis.

There are several diagnoses that I need to rule out to come to the actual diagnosis. Firstly, patients with borderline personality disorder experience some of the symptoms depicted by Breanna. They demand attention by speaking out things that make others that they are superior. However, they are possessed with self-harm behaviors which are not evident in the case-patient. Thus, it is unlikely that Breanna has a borderline personality disorder.

Secondly, the fact that Breanna tends to associate rarely with her teachers at schools shows that she might have an antisocial personality disorder. Such patients think that others are against them and their dreams, and so they opt to stay at a distance from them. Still, patients with an antisocial personality disorder are characterized by physical aggressiveness and a history of conduct disorder which are not evident in the case-patient. In this case, Breanna does not have an antisocial personality disorder (Derefinko, & Widiger, 2016). Lastly, the patient might be suffering from histrionic personality which is characterized by attention-seeking behaviors. In this case, Breanna seems to be seeking attention from others so that they can believe that she is finishing a Ph.D. program in nuclear physics. However, patients with histrionic personality disorder demonstrate deep emotions which were not depicted by Breanna. Following this, I need to rule out this condition too.

Having ruled out all the differential diagnoses, I need to apply all the necessary approaches to come up with an actual diagnosis for the patient. As such, I finalized that the patient had a narcissistic personality disorder which is characterized by several characteristics including having an exaggerated sense of self-importance, faked achievements, and expecting to be recognized as being superior among other (Pincus, Dowgwillo, & Greenberg, 2016). Apart from the symptoms depicted by the patient, i need to carry out a further assessment, including asking myself questions pertaining to the selected disease. Besides, I need to question the patient so as to get first-hand information that can help in verifying the condition.

In this case, asking the patients questions is aimed to determine her cognitive ability. The fact that she began talking even without seeking permission shows that she is mentally disoriented. Therefore, asking her questions will not help, as she will keep on explaining herself the way she likes. Her responses as well show that she is mentally affected and she is totally convinced that she is misunderstood. Her expressions on arrival in the office also answers my personal questions about her condition since she starts talking immediately at a rapid. Such an act is not normal, and so a thorough assessment is required.

In this regard, I arrived at the diagnosis of narcissistic personality disorder after ruling out all the other differential diagnoses. Therefore, this diagnosis is fully proved, and it can help health care workers to come up with correct treatment measures for the patient to enhance quick recovery. Since this is a personality disorder, symptomatic management is required to enhance patient wellness, as such conditions tend to be complicated to treat.

 Reference

Derefinko, K. J., & Widiger, T. A. (2016). Antisocial personality disorder. The medical basis of psychiatry (pp. 229-245). Springer, New York, NY.

Morey, L. C., & Benson, K. T. (2016). An investigation of adherence to diagnostic criteria revisited: Clinical diagnosis of the DSM-IV/DSM-5 Section II personality disorders. Journal of personality disorders, 30(1), 130-144.

Pincus, A. L., Dowgwillo, E. A., & Greenberg, L. S. (2016). Three cases of narcissistic personality disorder through the lens of the DSM-5 alternative model for personality disorders. Practice innovations, 1(3), 164.

Winarick, D. J., & Bornstein, R. F. (2015). Toward resolution of a longstanding controversy in personality disorder diagnosis: Contrasting correlates of schizoid and avoidant traits. Personality and Individual Differences, 79, 25-29.