Mr. H, a 61-year-old high school science department head and his wife have stopped by your office at the church concerned about recent events. He is an experienced camper and hiker but became extremely fearful while on a recent hike in the mountains a few months ago. Gradually, over the next few months, he lost interest in all his usual hobbies. Formerly a voracious reader, he stopped reading. He had difficulty doing computations and made gross errors in home financial management. On several occasions he became lost while driving in areas that were formerly familiar to him. He began to write notes to himself so that he would not forget to do errands. Very abruptly, and in uncharacteristic fashion, he decided to retire from work, without discussing his plans with his wife. Intellectual deterioration gradually progressed. He spent most of his day piling miscellaneous objects in one place and then transporting them to another spot in the house. He became stubborn and querulous. Eventually he required assistance in shaving and dressing.
Mr. H sometimes appears disoriented with respect to time of day or location although he is always alert and cooperative. At times he appears to have difficulty naming objects and often cannot recall the names of four or five objects after a 5-minute interval of distraction. On one occasion, he could not remember the names of his college or graduate school or the subject in which he had majored. He could describe his job by title only. His speech is fluent and well articulated, but he has considerable difficulty finding words and uses many long, essentially meaningless phrases. He does simple calculations poorly and has no insight into the nature of his disturbance.
Please respond (short answer is fine) to all of the following questions:
In your diagnosis, please use DSM IV-TR diagnoses when appropriate (found in your powerpoint presentations)
- What are the client’s most prominent ‘presenting issues’ (that is, what seems to take priority as being wrong)?
- What else do you feel you need to know (or, what might be some areas you may ask about in order to determine what is going on and how severe the problem may be)?
- What do you think may be your ‘initial diagnosis’ based on the information given in the case study? Why?
- What, if any, psychospiritual factors might be present and maintaining the presenting issue?
- What are possible methods of treatment or referral?