Primary Diagnosis Using DSM-5 and ICD-10

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Analyze and apply critical thinking skills in the psychopathology of mental health patients and provide treatment and health promotion while applying evidence-based research.Scenario:

Jax is a 66-year-old Caucasian female whose wife has encouraged her to seek treatment. She has never been in therapy before, and has no history of depression or anxiety. However, her alcohol use has recently been getting in the way of her marriage, and interfering with her newly-retired life. She describes drinking increasing amounts over the last year, currently consuming approximately a six-pack of beer per day. She notes that this amount “doesn’t give me the same buzz as it used to.” She denies ever experiencing “the shakes” or any other withdrawal symptoms if she skips a day of drinking.

Jax comments that her wife is her biggest motivation to decrease her alcohol use. She tells Jax that she gets argumentative and irritable when she drinks, though she does not always remember these incidents. She has also fallen while intoxicated twice, causing bruises both times and hitting her head on one of the occasions.

Questions:

Remember to answer these questions from your textbooks and NP guidelines. At all times, explain your answers.

  1. Describe the presenting problems/issues. Is there any information that was not provided that you would need to formulate a diagnosis?
  2. Generate a primary and differential diagnosis using the DSM5 and ICD 10 codes.
  3. What physiological and psychological processes lead to substance dependence?

Submission Instructions:

  • Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.  Your initial post is worth 8 points.
  • You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)
  • All replies must be constructive and use literature where possible.

Primary Diagnosis Using DSM-5 and ICD-10

Presenting Problems/Issues: Jax’s presenting problems primarily revolve around her alcohol use, which has escalated over the past year and is now interfering with her daily life and marriage. She consumes a significant amount of alcohol daily, a six-pack of beer, and has developed a tolerance to its effects. Despite this increasing consumption, she does not experience withdrawal symptoms when she abstains from drinking. Additionally, Jax’s wife reports that she becomes argumentative, irritable, and experiences memory lapses when she drinks. There are also incidents of physical harm, as Jax has fallen while intoxicated, causing injuries.

Additional Information Needed for Diagnosis: To formulate a diagnosis, it’s crucial to obtain more information about Jax’s medical and psychiatric history, as well as conduct a comprehensive assessment. Key information that would be helpful includes:

  1. Family History: Information about any family history of substance use disorders or other mental health issues could provide insight into potential genetic predispositions.
  2. Physical Health: A thorough physical examination is necessary to assess the overall health of the patient, including any signs of liver damage or other alcohol-related physical issues.
  3. Psychological Assessment: Detailed information about Jax’s emotional well-being, past traumas, stressors, and coping mechanisms is essential to understand her motivations and triggers for excessive alcohol use.
  4. Social and Environmental Factors: Information about Jax’s social support system, daily routines, and any recent life changes can provide context for her alcohol use.
  5. Mental Health History: An exploration of any past or present mental health issues, even if they are not related to anxiety or depression, can help in formulating a comprehensive diagnosis.

Primary Diagnosis (DSM-5 and ICD-10): Based on the information provided, the primary diagnosis for Jax could be “Alcohol Use Disorder” according to the DSM-5, with the corresponding ICD-10 code of F10.20. To meet the criteria for Alcohol Use Disorder, a patient needs to exhibit at least two of the following 11 symptoms within a 12-month period:

  1. Alcohol is often taken in larger amounts or over a longer period than was intended.
  2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
  3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
  4. Craving, or a strong desire or urge to use alcohol.
  5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
  6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
  7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
  8. Recurrent alcohol use in situations in which it is physically hazardous.
  9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
  10. Tolerance, as defined by either of the following: a) A need for markedly increased amounts of alcohol to achieve intoxication or desired effect or b) A markedly diminished effect with continued use of the same amount of alcohol.
  11. Withdrawal, as manifested by either of the following: a) The characteristic withdrawal syndrome for alcohol or b) Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

Differential Diagnosis: In addition to Alcohol Use Disorder, other differential diagnoses to consider might include:

  1. Major Depressive Disorder (DSM-5: 296.20, ICD-10: F32): It’s important to rule out depression as Jax mentions that her alcohol use has been interfering with her life, which could be indicative of underlying depression.
  2. Generalized Anxiety Disorder (DSM-5: 300.02, ICD-10: F41.1): Anxiety disorders can sometimes co-occur with substance use disorders, so it’s important to assess if anxiety symptoms are present.
  3. Trauma-Related Disorders: Any history of trauma or PTSD should be explored, as individuals may use alcohol to self-medicate traumatic experiences.
  4. Other Substance Use Disorders: Although alcohol seems to be the primary substance of concern, it’s essential to assess if there are any other substances involved.

Physiological and Psychological Processes of Substance Dependence: The development of substance dependence, in this case, alcohol dependence, involves both physiological and psychological processes.

Physiological Processes:

  1. Tolerance: Over time, the body adapts to the presence of alcohol, requiring larger amounts to achieve the desired effects. This is due to changes in the brain’s reward system and neurotransmitter functioning.
  2. Withdrawal: When alcohol levels in the body drop, withdrawal symptoms can occur. This is the body’s response to the absence of the substance, and it can be both physically and psychologically distressing.
  3. Neurochemical Changes: Chronic alcohol use can lead to alterations in the brain’s chemistry, particularly in neurotransmitter systems like dopamine and GABA, which are involved in reward and relaxation. These changes contribute to cravings and dependence.

Psychological Processes:

  1. Negative Reinforcement: People often use alcohol to alleviate emotional distress, such as anxiety or sadness. This negative reinforcement reinforces the cycle of alcohol use.
  2. Coping Mechanism: Alcohol can become a coping mechanism for dealing with life stressors and difficulties, as it provides temporary relief from emotional pain or discomfort.
  3. Cravings: Psychological cravings for alcohol can be triggered by environmental cues, social situations, or emotional triggers, making it difficult to quit even when physical dependence is not present.

In conclusion, Jax presents with a concerning pattern of alcohol use that is interfering with her life and relationships. A primary diagnosis of Alcohol Use Disorder is indicated, but a comprehensive assessment is necessary to rule out other potential contributing factors. The development of substance dependence involves complex interactions between physiological and psychological processes, which should be considered in developing a treatment plan and health promotion strategies.

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