Mental Health Triage
Most postings to our blog are formatted as either psychoeducational or experiential in nature. We generally post clinical mental health information based on statistical or fundamental counseling principles guiding the practice of behavioral health. At times we have designed postings to simulate real-life examples of interactions between mental health consumers and clinicians. Both of these formats are meritorious in their own right. But in an ever evolving effort to create additional approaches for educating and entertaining those who frequent our blog (especially our clinical colleagues), we are introducing an additional format-type that will consist of behavioral health case scenarios followed by actual “continuing education”-like Q & A’s that readers can respond to and receive feedback regarding effective DSM-IV case diagnostics and level of care recommendations. It is our intention to promote and enhance the foundations of clinical mental health by assisting mental health practitioners with information and ways to increase their professional skills and confidence.
With that being said……
Scenario #1:
A 36 year-old female presents at your outpatient clinic. She reports she is coming to therapy due to relationship problems with her husband of 5 years. She indicates she thinks her husband may be having an affair and she is worried he may be planning to divorce her. She reports she has 2 children and is also worried for them. Her parents divorce when she was 8 years old and she does not want her children to go through what she did.
She describes that she has been struggling at work to concentrate and complete her assignments for the last 6 months, her boss has noticed and has been lenient at this point but she is worried this could lead to termination. She says her thoughts are constantly focused on her marriage, what her husband is doing, who he is with and why he seems more distant from her. She thinks she is not as attractive since having her children and that he is probably “turned off” by her appearance, saying “I don’t blame him for not being attracted to me anymore, men have needs you know”. In addition, she explains that her sleeping has become more disrupted and at times she lies awake worrying about everything; she says she is so tired during the day she can hardly keep her head up at work some days and on the weekends does not feel like showering or eating sometimes. On top of that, she says she worries about thyroid disease because her mother had that problem about her age.
When asked about history of depression or any thoughts of suicide, she says she does not want to end her life because of her kids but does reveal she fantasizes at times about running away or maybe having her own affair to get back at her husband. As far as depression, she says “I think I am really depressed” and says it’s hard to find anything to look forward to, she feels she is distancing herself from her family and friends and that nothing makes her feel happy anymore.
What really brought her to therapy now is that she says last week, she was in the store and she started feeling dizzy, sweaty, and nauseous and scared feeling. She does not know why this happened, “it just came over me and really freaked me out”. She says she is now worrying about that and about having another “attack”.
She says she is just overwhelmed with how she feels physical, mentally and emotionally and does not know what to do. She says when she went off to college at age 18 she had some similar feelings of loneliness and “problems adjusting” but said this did not last long and she regarded this as merely transitioning from home to college. She says she did meet with a health center counselor briefly, felt it helped some but did not feel the need to continue very long.
She says she wonders if she needs “an antidepressant or something” to make her feel better. Says she has seen a lot of commercials on TV for Zoloft, Paxil and other drugs and thinks she may have some of those symptoms. Sometimes she does drink some alcohol, couple times a week and has noticed drinking “a little more” on the weekends especially when her husband is around. She says, “you know, my husband drinks beer on the weekends, I thought that maybe if I drink a little with him he will want to be around me more”, “it also relaxes me”.
Q & A:
1. Give Axis I-V from DSM-IV (each axis can have multiple diagnoses)
2. Identify the least restrictive yet most clinically suitable level of care for this case, i.e. outpatient only, outpatient w/ medication management, inpatient, etc
With that being said……
Scenario #1:
A 36 year-old female presents at your outpatient clinic. She reports she is coming to therapy due to relationship problems with her husband of 5 years. She indicates she thinks her husband may be having an affair and she is worried he may be planning to divorce her. She reports she has 2 children and is also worried for them. Her parents divorce when she was 8 years old and she does not want her children to go through what she did.
She describes that she has been struggling at work to concentrate and complete her assignments for the last 6 months, her boss has noticed and has been lenient at this point but she is worried this could lead to termination. She says her thoughts are constantly focused on her marriage, what her husband is doing, who he is with and why he seems more distant from her. She thinks she is not as attractive since having her children and that he is probably “turned off” by her appearance, saying “I don’t blame him for not being attracted to me anymore, men have needs you know”. In addition, she explains that her sleeping has become more disrupted and at times she lies awake worrying about everything; she says she is so tired during the day she can hardly keep her head up at work some days and on the weekends does not feel like showering or eating sometimes. On top of that, she says she worries about thyroid disease because her mother had that problem about her age.
When asked about history of depression or any thoughts of suicide, she says she does not want to end her life because of her kids but does reveal she fantasizes at times about running away or maybe having her own affair to get back at her husband. As far as depression, she says “I think I am really depressed” and says it’s hard to find anything to look forward to, she feels she is distancing herself from her family and friends and that nothing makes her feel happy anymore.
What really brought her to therapy now is that she says last week, she was in the store and she started feeling dizzy, sweaty, and nauseous and scared feeling. She does not know why this happened, “it just came over me and really freaked me out”. She says she is now worrying about that and about having another “attack”.
She says she is just overwhelmed with how she feels physical, mentally and emotionally and does not know what to do. She says when she went off to college at age 18 she had some similar feelings of loneliness and “problems adjusting” but said this did not last long and she regarded this as merely transitioning from home to college. She says she did meet with a health center counselor briefly, felt it helped some but did not feel the need to continue very long.
She says she wonders if she needs “an antidepressant or something” to make her feel better. Says she has seen a lot of commercials on TV for Zoloft, Paxil and other drugs and thinks she may have some of those symptoms. Sometimes she does drink some alcohol, couple times a week and has noticed drinking “a little more” on the weekends especially when her husband is around. She says, “you know, my husband drinks beer on the weekends, I thought that maybe if I drink a little with him he will want to be around me more”, “it also relaxes me”.
Q & A:
1. Give Axis I-V from DSM-IV (each axis can have multiple diagnoses)
2. Identify the least restrictive yet most clinically suitable level of care for this case, i.e. outpatient only, outpatient w/ medication management, inpatient, etc
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