S‌‍‍‍‌‍‍‌‌‍‍‍‌‍‍‍‍‌‍‍unil is a 40-year-old Indian-American male self-referred to
S‌‍‍‍‌‍‍‌‌‍‍‍‌‍‍‍‍‌‍‍unil is a 40-year-old Indian-American male self-referred to
S‌‍‍‍‌‍‍‌‌‍‍‍‌‍‍‍‍‌‍‍unil is a 40-year-old Indian-American male self-referred to therapy at an outpatient clinic for anxiety and life stress. Based on Sunil’s self-report and clinical assessment by a psychologist, draw a conclusion regarding the most appropriate diagnosis or diagnoses for Sunil. In doing so, take into account the following: (40 points) Consider possible diagnoses or co-morbidities. Indicate whether any further assessment is necessary to support your conclusions. Provide a diagnosis, in light of the currently available information about Sunil. Utilize the axis system to structure Sunil’s diagnosis(es). (40 points) Identify and explain potential treatments and/or evidence-based approaches for Sunil based on the presenting information provided. What type of treatment(s) (short and long term), may Sunil benefit from, and why? Does Sunil present a suicidal risk and/or is therefore in need of psychiatric hospitalization? Draw a conclusion and make a clinical recommendation regarding the best treatment available for Sunil. (20 points) Identify any additional factors (., cultural, medical, environmental, biological, etc.) that may complicate Sunil’s diagnosis or success in treatment. Your paper should be a maximum of 2 pages single-spaced (4 pages double-spaced, or 1,300 words). The following criteria will be considered for your grade: Diagnostic Considerations Considered appropriate diagnosis(es) based on DSM-5 criteria Treatment Considerations Identification of appropriate treatments Critically evaluated appropriate treatment options Drew appropriate conclusions regarding treatment based on diagnosis Overall Presentation Arguments clearly and effectively articulated Clarity of writing: Spelling, grammar, vocabulary Recommended Readings American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). (DSM-5). Washington, DC: American Psychiatric Association. Case Description of Sunil Sunil is a 40-year-old, married, Indian-American male self-presenting to treatment for worsening anxiety and life stress. Sunil also wonders whether he has post-traumatic stress disorder or obsessive compulsive disorder. Sunil recently completed his first semester of graduate school. He reports feeling stressed yet relieved now that he has completed his classes. He reports feeling traumatized from one of his professors throughout the semester and that he experienced increased anxiety and periodic panic attacks “about one to two panic attacks a week” during midterms and finals. He considered dropping one of his classes but decided not to. Sunil describes his anxiety as, “I worry about everything,” “always worried,” and has a tendency to engage in catastrophizing and what if thinking. He frequently ruminates about not earning A's and failing his classes, and he worries about his family’s financial situation. To add, Sunil’s wife recently‌‍‍‍‌‍‍‌‌‍‍‍‌‍‍‍‍‌‍‍ revealed that she would like to move to a less expensive state at some point, however, he finds himself worrying that she might leave him because he has yet to complete his studies. He says his anxiety drains him and affects his ability to concentrate. Sunil is currently not taking any psychotropic medication. He tried taking prescribed medication once 1 year ago from his primary care doctor. Past hx of psych meds include Xanax “horrible, more anxious,” and “Prozac “ineffective.” The latter he stopped after 3 days. Because of this experience, Sunil is suspicious of doctors, especially psychiatrists “they’re useless,” “a joke.” Sunil worries about the potential side effects from medication and becoming addicted to pills. Additionally, Sunil has concerns about becoming suicidal after reading reviews on Google about anti-anxiety medication. He would rather try herbal/alternative treatments. Sunil denies significant symptoms of intrusive thoughts or rituals. Sunil describes his mood as feeling down and at times hopeless due to his anxiety. His anxiety extends to worrying about how others perceive him. Since his teens, Sunil has tended to keep to himself, and he has few friends due to fearing he will embarrass himself around others. His isolation from others and constant obsessive rumination affects his ability to fall asleep. He denies any nightmares however often feels on edge and hyper-vigilant when in public. Sunil felt severely depressed in his early 20s, although now only endorses struggling with self-doubt and poor self-esteem. Sunil reports his family is Christian and “very religious” and his brother once told him to focus on prayer rather than taking medication. He often feels misunderstood by his family and has kept his anxiety and past depression largely from them describing his mood as “stressed.” He worries his community will find out about his struggle with anxiety. Sunil reports experiencing anxiety since childhood. He smokes cannabis daily “1-2 joints in the AM and at night” to help lower his anxiety and improve his sleep. He tells you “it’s legal now” despite noticing the need to increase his MJ to lower his anxiety. Sunil later adds he attempts to not let his wife know that he is smoking daily as she disapproves of this. Sunil finds himself isolating, preferring to smoke rather than “deal with people.” Regarding treatment, Sunil declines attending an anxiety support group, stating “I’m not like those kind of people.” Mental Status Examination Appearance: appropriately dressed Behavior: fidgety & restless Speech: normal rate & tone Mood: “I’m anxious, I’m rarely relaxed” Affect: congruent to mood Thought process: logical, linear Thought content: denies any AH/VH, no SI/HI Orientation: fully-oriented X 4 Attention: within normal limits Concentration: within normal limits Memory: intact recent and intact remote ‌‍‍‍‌‍‍‌‌‍‍‍‌‍‍‍‍‌‍‍Fund of knowledge: normal Impulse control: good Insight: fair Judgment: good

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