Psychological Assessment: A Case Study of Mental Health Issues

This case study presents a detailed analysis of two individuals, Jenny and Marisol, focusing on their mental health conditions. Jenny's case involves symptoms of emotional disturbance and psychological distress, potentially linked to adverse life events and separation from her partner. The differential diagnosis explores depressive and anxiety presentations, utilizing DSM-5 criteria and tools like the Beck Anxiety Inventory. Systemic assessments, such as the Family Environment Scale, are recommended to understand the social and environmental factors influencing her condition, with potential medication referral and counseling suggested. Marisol's case centers on social anxiety disorder, with discomfort in unfamiliar environments. The diagnostic process employs DSM-5 criteria and symptom checklists like the SCL-90-R, alongside systemic assessments like the McMaster Family Assessment Device to identify family patterns. Cognitive behavioral therapy and pharmacological treatment are considered for Marisol. Both cases apply DSM and ICD criteria to ensure appropriate diagnoses and treatment plans.

Running head: MENTAL HEALTH
Mental health
Name of the Student
Name of the University
Author note

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1. Case of Jenny
Presenting Concerns: Case of Jenny
The symptoms that may be causing the most distress to Jenny in present condition is
emotional disturbance and psychological distress. It can be explained on the basis of adverse life
events such financial condition, ups and downs in life. Jenny is currently separated from her
partner and is living with her mother Barbara. She seems to giving up on life. The
neurobiological basis of these anxiety or depressed mood symptoms includes dysfunction of
serotonergic and noradrenergic systems. The neurological link to anxiety or depression in
Jenny’s case can be explained by the activity of norepinephrine and serotonin. Adjusting to the
new life and separation is the risk factor for psychological problems in Jenny. Psychological
mechanism playing role in this situation includes emotional influences, reasoning biases, coping
or temperament style. As per the biomedical model an individual’s chances to psychological
distress is attributed to genetics (40%) (Bystritsky et al., 2013).
Differential Diagnosis: Case of Jenny
For differential diagnosis of Jenny’s condition DSM-5 criteria from handbook of
differential diagnosis was used.
As per decision tree organised by the DSM-5 diagnostic grouping Jenny’s condition
belongs to group, “Depressive presentation”, and specifically depressed mood (2.10) and
“Anxiety presentation”, specifically anxiety (2.13). The differential diagnosis will start from
depressive mood decision tree. Diagnosis may start from psychiatric interview that collects
interview on family background, chief complaint, history of illness, substance of abuse and past
psychiatric history and medical condition and lastly family history. The interview will proceed to

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social life and mental status exam. It may be followed by physical exam and impression. The
major depressive disorder can be ruled out using the “SIG E CAPS” stands for sleep disturbance,
interest reduced, guilt, energy loss, concentration problems, appetite, psychomotor changes and
suicidal thoughts (American Psychiatric Association, 2013). Even if Jenny describes feelings that
pertain to one of the eight category it demonstrates depressed mood or a loss of interest in life or
pleasure. The diagnosis will not move to the right side of tree if no substance is taken, or
elevated irritation of mood observed, and it consequently eliminates other disorder such as
Bipolar.
Similarly using the anxiety disorder tree the patient will be examined for physical
symptoms (palpitation, shortness of breath), psychological symptoms (restlessness, fear and
anxiety), and the functional changes (poor relationship and others). Family members will be
involved n the process and patient will be helped to recognise symptoms. Staring with physical
symptoms lack of phobia, persistent panic attacks eliminates panic and phobia disorder.
Similarly lack of trauma eliminates PTSD. Jenny’s condition mostly aligns with the anxious
thoughts and moving down the tree excessive worry and apprehension about common concerns
denote adjustment disorder and general anxiety disorder. OCD can be eliminated as the case
study does not indicate ritualised behaviour. The second step starts with treating the causes of
anxiety and comorbidities (American Psychiatric Association, 2013).
Symptom Checklists: Case of Jenny
The specific symptom checklist to be used for Jenny is “Beck Anxiety inventory (BAI)”.
The assessment tool compromise of set of 21 questions designed to measure the intensity of
depression in patients with psychiatric diagnosis. Each question is rated on 4 point scale. The

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severity of anxiety is detected by score of 63 and score of 14–19 is considered mild, 20–28 is
moderate anxiety. Relating with differential diagnosis, Jenny’s recent anxiety, and adjustment
changes can be assessed with these tools. It can assess mood within recent two week period,
general anxiety disorder (Beck et al., 1988). The questionnaire will help identify the cause of
excessive worry for Jenny and common concerns. Based on the decision tree Jenny seems to be
experiencing adjustment disorder with depressed mood along with mixed anxiety.
Systemic Assessments: Case of Jenny
In Jenny’s case the assessment method most appropriate is the Family Environment
Scale. It will help determine the social and environmental characteristics of Jenny’s family
influencing her condition such as events from past life. This assessment is justified as Jenny and
Barbara has faced ups and downs in life and the later needs financial support. In order to evaluate
if both mother and daughter are involved in task accomplishment, problem identification, show
involvement or demonstrate values, the appropriate assessment tool is Family Assessment
Measure III (Hamilton & Carr, 2016). Since Jenny had struggling life, is not yet marred and is
recently experienced bereavement, it is necessary to assess the level of support she receives from
her mother to cope up with emotional disturbances.
DSM and ICD Diagnosis: Case of Jenny
In order to ensure that the diagnosis is appropriate, DSM and ICD criteria are applied. As
per the ICD-9-CM, 309.28 and ICD-10-CM code, F43.23 relates to Adjustment
disorder, with mixed anxiety and depressed mood (Dr-bob.org 2018). This clearly
attributes to the recent shift of Jenny with her mother and loss of relationship. It also

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attributes to the past history of distress and growing up with Barbara as single child.
So the psychological issues may not be attributed to just present relationship related
distress. Since her mother is supportive it is outcome of overall traumatic history. The
cumulative effect may be cause of Jenny’s loss of interest in life.
Medication Referral/Consultation: Case of Jenny
Referral for medication is appropriate for Jenny as she slightly meets the criteria for
general anxiety and is experiencing prolonged psychological distress owing tom past history. She
also needs counselling programmes owing to her trouble adjusting tom recent changes and past
psychological distress. Interventions like psychotherapy added to pharmacological interventions
(drugs such as Duloxetine) are considered optimal care for common mental disorders and
psychological problems (Cuijpers et al., 2014).

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2. Case of Marisol
Presenting Concerns: Case of Marisol
The presenting concerns of Marisol are difficulty in adjusting with new environment. She
is uncomfortable with people whom see had never met before or travelling new places. She
enjoys living alone and is only comfortable with her own family. It is commonly attributed to
anxiety like symptoms in socially unfamiliar setting. The neurobiological basis of the specific
phobias and social anxiety is hyperactivation in emotion-generating regions in brain. The
hypoactivation in prefrontal regions is also found in literature as cause of these
symptoms. The amygdala and dorsal anterior cingulate cortex (dACC) are known to
play role in defensive behaviour as they process aversive signals (Duval et al., 2015).
Differential Diagnosis: Case of Marisol
For differential diagnosis of Jenny’s condition DSM-5 criteria from handbook of
differential diagnosis was used. As per decision tree organised by the DSM-5 diagnostic
grouping, Marisol condition belongs anxiety presentation category (2.13)
Using the DSM decision tree for anxiety disorders the diagnosis will process would start
with physical symptoms to panic followed by specific situation of occurrence. If there is phobia
avoidance of situation as found in Marisol (who avoids unfamiliar environment), the diagnosis
can move down the tree if patients say yes. Further assessment will consider the panic related to
specific trigger, setting where panic may be difficult to escape or public setting of negative
evaluation. If the diagnosis is positive with the last one then it may be regarded as social phobia.
If the physical symptoms are considered “NO” by the patients then the diagnosis will shift to

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right side of tree towards OCD or GAD/. Further, panic disorder may ruled out if panic is out of
blue and is not avoidance of situation phobia. In this process the methods to be used are
psychiatric interview (screening tool for anxiety such as mini international neuropsychiatry
interview) and assessment of the physical and psychological symptoms along with functional
changes. It will also include discussion with family, and provision of educational material to
client to recognise symptoms (American Psychiatric Association, 2013).
Symptom Checklists: Case of Marisol
The specific symptom checklist to be used for Marisol is “Symptom Checklist-90-R
(SCL-90-R)”. This tool can evaluate variety of psychological symptoms and consist of 90 items.
Among global distress indices it gives three scores related to “wellness index, hardiness, and
symptom free”. The primary symptom dimensions is yield by 9 scores that includes conditions
like, obsessive-compulsive, depression, anxiety, phobic anxiety, paranoid ideation, and others
(Pellecchia et al., 2018). To evaluate the Marisol condition anxiety symptom checklist (Prevatt et
al., 2015) will be used and to assess the severity of anxiety Beck Anxiety Inventory will be used
to know which public setting causes phobia (Beck et al., 1988). Knowing the level of phobia will
ensure effective treatment and will rule out possibility like avoidant personality disorder.
Systemic Assessments: Case of Marisol
As described in Hamilton and Carr (2016), it is effective to use the McMaster Family
Assessment Device, when patients presents with brother and parents. It will help identify the
dysfunctional family patterns such as family conflicts or bullying. It will better engage in treating
Marisol’s social anxiety or phobia. The focus of therapeutic interventions in this case problem
solving, communication, affective involvement, and behaviour control to help family overcome

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clients issues (Baños, 2018). This assessment tool is justified as the patients is very close to her
parents and well bonded.
DSM and ICD Diagnosis: Case of Marisol
In order to ensure that the diagnosis is appropriate, DSM and ICD criteria are applied. As
per the ICD-9-CM, 300.23 and ICD-10-CM code, F40.10 relates to Social anxiety
disorder (social phobia) (Dr-bob.org 2018). It is due to social phobia that the patients
feel uncomfortable with unfamiliar people. She is 40 years old and is not dating
anyone can be explained by inability to develop close relationship with people outside
and family and friends circle.
Medication Referral/Consultation: Case of Marisol
Marisol may be referred to the cognitive behavioural therapy which is considered the
most effective treatment for social anxiety disorder. It will help in eliminating maladaptive
beliefs and assumptions. Pharmacological treatment may be combined with it such as
administering of escitalopram. Combined treatment is considered optimal care (Hofmann &
Otto, 2017).

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