DSM-5 Assignment Discussion Paper

Assignment 4: Practicum-Week 4 Journal Entry and Journal Submission

Client History

AS a 62 y/o Caucasian Male who was on 1013 hold who presented at the emergency department with complaints of homicidal ideations, abnormal behavior, and was a danger to himself and others was admitted in the inpatient psychiatry unit on notice that he had elevated lipase. The patient acknowledged a past medical history of cocaine use disorder, schizophrenia and COPD. Currently, he also acknowledged to using alcohol, cocaine and cigarrete smoking. He however declined a familial history of mental illness. Physical examination was consistent with the patient’s narration for the use of cocaine and utox positive multiple drugs, was bizarre, appeared to be chronically ill, alert and agitated. His mucosal membranes were dry, he had auditory hallucinations and BNL judgments. The vital signs were normal, the skin was dry and intact but other systems were normal. Currently, the patient is on haloperidol 5mg PO bedtime, Quetiapine (seroquel) 400 mg po bedtime, trazodone pamoate (vistaril) 50 mg po q6h prn for agitation and anxiety and Cyanocobalamin (vitamin b-12) 1000 mcg pop DSM-5 Assignment Discussion Paper .

Efficiency Of The DSM-5 In Diagnosis

The DSM-5 criterion for diagnosing schizophrenia requires that a patient should have the symptoms of: disorganized speech, hallucinations, delusions, catatonic behavior and negative symptoms such as speech poverty and loss of interest (American Psychiatric Association, 2013). Similarly, the patient for this week’s journal presented with the complaints of auditory hallucinations, homicidal ideations, abnormal and bizarre behavior, agitation and delusions. Besides, the patient had some form of disorganized speech and could not recall or verbalize words appropriately, which warrants the diagnosis of Schizophrenia. It is worth noting that, the occurrence of schizophrenia with a substance use disorder does exist and in most cases, it happens as a way of self-medication or alleviation of the feelings of depression and anxiety that may be experienced by a patient (Nowak, Sabariego, Świtaj, et al., 2016).. Therefore, the patients abuse of cocaine and alcohol were potential triggers to the underlying condition of schizophrenia that the patient had.

Efficacy Of Cognitive Behavioral Therapy For This Client And Expected Outcomes

CBT would be highly effective for this client as it will help to focus on the positive symptoms of auditory hallucinations, disorganized speech and delusions. It will also help the patient to assess his negative symptoms of emotional range and loss of interest, mood and depressive symptoms and the cognitive symptoms (Chien, Leung, Yeung et al., 2013). The patient will be able associate his feelings, behavior and emotions to identify areas of weakness and establish approaches and goals on how normal functioning can be regained with the help of a counselor (American Psychiatric Association, 2013).The expected outcome is that the patient would no longer experience auditory hallucinations, and delusions. Besides, the patient will be able to overcome the symptoms of a depressed mood and other abnormal behaviors. With regards to alcohol use, cocaine abuse and smoking, it is expected that the patient will be able to associate his behavior of drug abuse with individual thoughts and feelings and through rehabilitation, will be able to overcome the abuse of drugs that trigger schizophrenic episodes (Stahl, 2013) DSM-5 Assignment Discussion Paper.

Legal And Ethical Implications Related To Counseling This Client.

The most significant legal and ethical issue when counseling this client is that of confidentiality and informed consent (Morris & Heinssen, 2014). Basing on the fact that the patient was on a 1013 hold, it means that he was brought for care involuntarily. The patient has a mental illness which causes impairment to his overall ability in making well informed decisions about his personal care and treatment (Benfield, 2018). Therefore, maintaining confidentiality and at the same time obtaining an informed consent is a huge challenge. Although a counselor is expected to maintain confidentiality, there are instances where the support of close family and friends would be required for proper health outcomes.


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders

(5th ed.). Washington, DC: Author.

Benfield, J. (2018). Professional Practice In Counselling And Psychotherapy: Ethics And The

Law. Healthcare Counselling & Psychotherapy Journal, 18(1), 30.

Chien, W. T., Leung, S. F., Yeung, F. K., & Wong, W. K. (2013). Current approaches to

treatments for schizophrenia spectrum disorders, part II: psychosocial interventions and patient-focused perspectives in psychiatric care. Neuropsychiatric Disease and Treatment, 9, 1463–1481.

Morris S & Heinssen R. (2014). Informed consent in the psychosis prodrome: ethical, procedural and cultural considerations. Philosophy, Ethics, and Humanities in Medicine.

Nowak, I., Sabariego, C., Świtaj, P., & Anczewska, M. (2016). Disability and recovery in

schizophrenia: a systematic review of cognitive behavioral therapy interventions. BMC Psychiatry, 16, 228.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical

applications (4th ed.). New York, NY: Cambridge University Press DSM-5 Assignment Discussion Paper.




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