Vignette Case Study and Analysis

Vignette Analysis
Name
Institutional Affiliation
Part 1
Description of demographic information
The patient is a 26-year-old female. She is described as a college graduate who has currently moved from one area to another for a new job opportunity. Being from the San Francisco Bay area, her ethnicity is most likely to be a non-Hispanic white female. The city has an over 70 percent population of non-Hispanic. Thus, making the patient’s possibility to be white and non-Hispanic. Furthermore, the patient, being freshly off from college and on her first job, she is most likely to be unmarried. On the other hand, in Joan’s case study, there is no mention of her husband or any spouse.
Description of symptoms
The patient suffers from the following symptoms:
She says that she feels unstable particular under a high-stress situation such as during her final exam period.
After the completion of the examination period, Joan, the patient, continues to feel unstable and feels more isolated.
Joan acquired a job that made her feel more energized. The energy made her think that she did not need any sleep. The lack of sleep saw her working over 10 hours a day with 3 to 4 hours of sleep.
During the high energy period, she would feel her thoughts “racing” with what she thought were “creative” and “new” ideas. However, people surrounding her did not understand her “creative” thoughts. Furthermore, she did not follow up in any of her ideas.
Joan is in denial of substance abuse despite her admittance of her socializing and partying.

Joan also claims to be preoccupied with thoughts of sex and could find some sexual implications on what people said on TV or in her presence.
Sometimes, Joan reports feeling very euphoric and can be very talkative. The euphoric moments are also coupled with episodes of extreme irritability and feels easily annoyed by people.
Joan reports of starting conversations with strangers and in some episodes speaking to “imaginary’ people. She claims the discussions are as a result of the voices she hears in her head. The “voices” tell her to perform activities in a particular order, take different routes or even shout some words.
Joan also feels like she can read other people’s minds and that the same people could understand her thoughts. Furthermore, she claims that she is psychic and could “sense” many things around her environment.
After stopping her medication, she feels “jittery” and lacks sleep as she expresses difficulty in sleeping. Additionally, she has difficulty focusing on her work-related projects because her thoughts are “racing.”
Diagnosis
schizoaffective disorder (DSM-V 295.70)
Joan can be diagnosed with schizoaffective disorder which is a psychological issue portrayed by irregular points of view and deregulated feelings. The conclusion is made when the individual has highlights of both schizophrenia and a mindset problem either bipolar, or depression yet does not entirely meet symptomatic criteria for either alone. The bipolar sort is recognized by indications of mixed episodes, mania or hypomania; the depressive kind by side effects of discouragement as it were. Typical signs of the confusion incorporate mind flights, neurotic fancies, and disrupted discourse and considering. The beginning of side effects, for the most part, starts in young adulthood which is the case with Joan. She is in her mid-20’s which can be considered young adulthood. The disorder can also be associated with other subtypes that may fall under bipolar type (F25.0) or depressive type (F25.1). The subtypes are determined by the presentation of the major depressive episodes. In this case, according to the DSM-5 criteria, she has an F25.0 bipolar type of schizoaffective disorder (Black & Grant, 2014). 
The DSM-5 criteria for this disorder is as follows;
A continuous time of ailment amid which, eventually, there is either a Major Depressive Episode, a Manic Episode, or a Mixed Episode simultaneous with indications that meet Criterion A for Schizophrenia. It is crucial to note that the Major Depressive Episode must incorporate Criterion A1 which is a depressed mood.
Amid a similar time of sickness, there have been hallucination or delusions for no less than two weeks without noticeable disposition side effects.
Manifestations that meet criteria for a Mood Episode are available for a significant bit of the aggregate length of the dynamic and leftover times of the disease.
The unsettling influence isn’t because of the direct physiological impacts of substance use or abuse or a general therapeutic condition.
Differential diagnosis
Schizoaffective diagnosis is characterized by examination of the state of mind of the patient. The symptoms should issue free psychosis with regards to mood and prolonged psychotic disorders. Psychosis must meet the DSM-V Criteria A for schizophrenia which may incorporate incoherent speech, hallucinations and thinking that has adverse side effects. The two, hallucinations and delusions are exemplary indications of psychosis. Daydreaming or delusions are false convictions which are firmly held in spite of proof despite what might be expected. Delusional thoughts ought not to be viewed as hallucinating on the off chance that they are with regards to social convictions. Capricious convictions might reflect the state of mind side effects. Hallucination s, on the other hand, are unsettling influences in discernment including any of the five senses, albeit sound-related mental “flights” or “hearing voices” are the most widely recognized. Therefore, disorders not meeting the criteria were not considered as possible ailments for Joan. Additionally, some of the other complications did not meet at least three of the DMS-5 requirements for a diagnosis of the diseases (Cosgrove & Suppes, 2013).
Treatment plan
PROBLEM TREATMENT GOALS TREATMENT OBJECTIVES TREATMENT INTERVENTION/PLANS
Hallucinations are evidenced by the hearing of voices and having conversations with fictions people. The initial step is to reduce the effects of hallucinations.
The second goal is to manage the hallucinations and their effects entirely.
The long-term goal is to manage the hallucinations and hopefully eradicate the, The client will be required to take any antipsychotics prescribed by the psychiatrist.
The client is also required to engage in psychotherapy which may involve group and individual therapy. Joan is expected to attend the stipulated number of therapy sessions given. The meetings can be a minimum of 3 times a week for an estimated one hour Psychotherapy and psychoeducational programs
These activities will require the client engage in psychotherapy that will involve social and family-based therapies. These therapies will ensure the patient understands the underlying hallucinate effects.
Mood instability which is evidenced by euphoria and instances of extreme irritability and anger towards people in her immediate environment The initial step is to stabilize moods by use of antipsychotics
The second level is to ensure the client can manage her moods without necessarily by the use of drugs. The client will be required to note the instances that led to the fluctuation of mood. These cases can be recorded in a journal for review by the therapist. The therapist will prescribe mood stabilizers that the client will take for a period of stipulated time.
The therapist will also ensure that they follow up with social therapeutic techniques that will teach the patient to manage mood without the drugs
Psychosis which is evidenced by hallucinations and inherent conversations with strangers The first step is to reduce the effects of psychosis.
The second step is to reduce the psychosis entirely If the client suffered from acute psychosis, she would be required to stay in a hospital where she can undergo treatment.
The client will also engage in community or family-based groups that are tailored for support of psychotic patients. The client is expected to attend and participate fully in these activities and associations The therapist will prescribe the best mode of treatment for the patient. If the patient has acute psychosis hospitalization is required. On the other hand, the therapist will engage the patient in the long-term management of the disorder through social based approach. The therapist is required to monitor the progress of the client and offers advice.
Mania which is evidenced when the client says that she would feel her thoughts “racing” with what she thought were “creative” and “new” ideas. Also when she claims to be preoccupied with thoughts of sex and could find some sexual implications on what people said on TV or in her presence and euphoria and instances of extreme irritability and anger towards people in her immediate environment
The initial step is to reduce the immediate effects of mania. It will be achieved by prescription of antidepressants and antipsychotics.
The long-term effect is to manage and eventually reduce the adverse effects through community-based therapy The client will adhere to the drug program prescribed by the therapist.
The client will be required to attend therapy and group sessions.
The therapist will prescribe drugs and in cases hospitalize the patient shows acute mania symptoms.
The therapist will also follow up on the notes and any side effects that may arise from treatment and medication.
Part 2
Ethical issues
Ethics are rules that depend on the essential standards of the therapist code of conduct. The following are accompanying standards in which limits of the moral law of behavior depend on:
Beneficence which states that the therapist must take the responsibility of making decisions that are for the good of the client. The decisions must be made in the expectations that the client will benefit from the sessions.
Nonmaleficence that states that the therapist must avoid situations that may cause a conflict of interest.
The autonomy that shows that the therapist must give the client the independence of thinking and decision making and limit those that may form a dependency.
Justice which states that the therapist must be fair to the client despite their age, ethnicity, gender or any social class.
Fidelity where the therapist must be truthful and must commit to the client’s progress.
In Joan’s case, the following issues may arise
Sexual relationship
Joan is a sexually active individual who has problems with sex-based conversations. She may want to steer therapy sessions towards sex or want to form a sexual relationship with the therapist. Thus according to the ACA code A.5.a, Sexual or any potentially sentimental counselor-client cooperation or associations with current customers, their romantic partners, or their relatives are prohibited.t the act applies to both face to face and electronic connections (Herlihy & Corey, 2014).
Confidentiality and privacy
According to the ACA code of conduct, therapists perceive that trust is a foundation of the directing relationship. They try to procure the trust of customers by making a continuous partnership, establishing and maintaining proper limits, and keeping up confidentiality. Counselors impart the parameters of secrecy in a socially equipped way. Due to the nature of Joan’s case, privacy issues may arise due to her need to talk and the hallucinations she has. Thus, she might mention individual elements that this code requires the therapist. Therefore, as Cottone & Claus (2000) argue the therapist must keep up mindfulness and affectability concerning social implications of secrecy and security. On the hand, they regard varying perspectives toward exposure of data and have continuous exchanges with customers in the matter of how, when, and with whom data is to be shared. Counselors regard the protection of forthcoming and current customers while asking for private data from customers just when it is useful to the directing procedure.
Role of diversity-related factors
Sexual orientation is a fundamental determinant of psychological well-being and dysfunctional behavior. The horribleness related with mental instability has gotten generously more consideration than the sexual orientation particular determinants and systems that advance and secure the emotional well-being and encourage versatility to pressure and difficulty. Sexual orientation decides the differential power and control men and ladies have over the economic determinants of their emotional wellness and lives, their social position, status and treatment in the public eye and their weakness and introduction to particular psychological well-being dangers.
Sex contrasts happen especially in the rates of regular mental issue despondency, tension, and environmental protests. These scatter, in which ladies prevail, influence around 1 of every three individuals in the group and constitute a genuine general medical issue. Notwithstanding being normal, psychological sickness is underdiagnosed by specialists. Specialists recognize not as much as half of the individuals who meet indicative criteria for mental scatters. Patients, as well, for example on account of Joan seemed hesitant to look for expert help. Just 2 in every five individuals encountering a state of mind, tension or substance utilize clutter looking for help with the time of the beginning of the turmoil. Her sexual orientation must also be considered as part of both the ACA code and professionalism. The treatment must also place into consideration of her sexual behavior to ensure that the treatment plan is effective.
With an apparently interminable scope of subgroups and individual varieties, culture is imperative since it bears upon what all individuals convey to the clinical setting. It can represent minor variations in how individuals communicate their side effects and which ones they report. A few parts of culture may likewise underlie culture-bound disorders – sets of manifestations significantly more typical in a few social orders than in others. All the more regularly, culture bears on whether individuals even look for help in any case, what sorts of assistance they look for, what kinds of adapting styles and political backings they have, and how much shame they append to psychological instability. Culture additionally impacts the implications that individuals bestow to their disease. Purchasers of emotional well-being administrations, whose societies fluctuate both between and inside gatherings, usually convey this assorted variety straightforwardly to the administration set. Therefore, it was crucial to ensure that the treatment plan was by the culture and beliefs of the patient.
It is essential to focus on the culture and beliefs of Joan during the making of her treatment plan Since natural social groupings have their societies, this part has isolate segments on the way of life of the patient and also the way of life of the clinician. Where social impacts end and more significant societal implications start, there are forms not separated efficiently by social researchers. This section takes an expansive view of the significance of both culture and society, yet perceives that they cover in ways that are hard to unravel through research. What turns out to be clear is that culture and social settings, while not by any means the only determinants, shape the psychological wellness of minorities and adjust the kinds of emotional wellness administrations they utilize. Social mistaken assumptions amongst patient and clinician, clinician predisposition, and the discontinuity of psychological wellness administrations discourage minorities from getting to and using care and keep them from accepting appropriate consideration. Thus to avoid the above mentioned clinical hitches, the therapist must ensure all ethnic and cultural factors are considered. These factors were considered while making Joan’s diagnosis and treatment plan.

References
Black, D., & Grant, J. (2014). DSM-5 guidebook. Washington, DC: American Psychiatric Publ.
Cosgrove, V., & Suppes, T. (2013). Informing DSM-5: biological boundaries between bipolar I disorder, schizoaffective disorder, and schizophrenia. BMC Medicine, 11(1).
Cottone, R., & Claus, R. (2000). Ethical Decision-Making Models: A Review of the Literature. Journal Of Counseling & Development, 78(3), 275-283.
Herlihy, B., & Corey, G. (2014). ACA ethical standards casebook.