- What Axis I diagnoses would you consider for James? Support your choices to specific DSM-IV-TR criteria.
-What other information needs to be gathered in order to make firm diagnoses on Axis I?
-What factors to take into account when developing a treatment plan for working with James? (Describe three treatment goals and the approaches you would use in sessions to meet these goals).
Support your ideas with references
James R. is a 52-year-old African American man who feels anxious about a number of issues in his life. He worries frequently about his two adult children and some of the problems they are having; he is anxious about new responsibilities at work; he is dreading an upcoming performance review; and he worries all of the time about finances. James has been feeling worried almost every day for the past year and says he cannot control the worry. It keeps him awake at night, prevents him from concentrating, and adds to his overall feeling of irritability and restlessness. He is extremely distressed about this.
James also discloses that he drinks alcohol most nights. He has two or three glasses of wine with dinner and frequently has another drink or two later in the evening. His drinking has increased during the past year to the point that his wife and children have confronted him about it. James denies that his drinking is a problem, even though he admits that he argues much more often with his wife when he has been drinking. He also has had repeated absences at work and has submitted late or substandard work projects because of drinking heavily the night before.
(1) What Axis I diagnoses would you consider for James? Support your choice to specific DSM-IV-TR criteria.
Axis I 291.81 Alcohol Withdrawal
303.90 Alcohol Dependence
The rationale for the dual Axis I Diagnosis for James is that he presents with withdrawal symptoms such (e.g. sleep problems, irritability). In addition, his symptoms cause significant distress in social (e.g. his marriage), occupational (his work). On the other hand, his dependence on the alcohol continues despite evidence of adverse psychological or physical consequences Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR [APA], 2002, p. 213).
The Diagnostic criteria for Alcohol Dependence are the same for Substance dependence that include:
? A maladaptive pattern of substance use that leads to clinically important distress or impairment.
? Tolerance, shown by either of the following:
x Increased intake of the substance is needed to achieve the same effect
Continued use of the subject has less effect.
? Withdrawal is shown by either of the following
Withdrawal syndrome is experienced
The substance is used to avoid or relieve symptoms
The amount or duration of use ...
This solution discusses a dual diagnosis for a specific case study.