Reference no: EM133349241

Questions

1. What would you diagnose the client with? Please justify and ensure you use proper specifiers if applicable.

2. Are there any differentials that you would consider? If so, what are they?

3. What would your treatment recommendations be? (is there a certain theory you'd use? Would you suggest individuals, family, couples, etc? Would you suggest medication and if so what would you think a prescriber would prescribe?). Please ensure you explain why you chose the recommendations you did.

Hakim was a 25-year-old U.S. Army veteran turned community college student who presented to the emergency room with his girlfriend and sister. On examination, he was tall, slim, and well-groomed. He spoke softly, with an increased latency of speech. His effect was blunted except when he became anxious while discussing his symptoms.

Hakim stated that he had come to the ER at his sister's suggestion. He said he could use a "general checkup" because of several days of "migraines" and "hallucinations of a spiritual nature" that had persisted for 3 months. His headache involved "sharp, shooting" sensations in various bilateral locations in his head and a "ringing" sensation along the midline of his brain that seemed to worsen when he thought about his vices.

Hakim describes his vices as being "alcohol, cigarettes, disrespecting my parents, girls". He denied guilt, anxiety, or preoccupation about any of his military duties during his tour in Iraq, but he had joined an evangelical church 4 months earlier in the context of being "riddled with guilt" about "all the things I've done". Three months earlier he began "hearing voices trying to make me feel guilty" most days. The last auditory hallucination had been the day before. During these past few months, he had noticed that strangers were commenting on his past sins.

Hakim believed that his migraines and guilt might be due to alcohol withdrawal. He had been drinking three or four cans of beer most days of the week for several years until he "quit" 4 months earlier after joining the church. He still drank "a beer or two" every other week but felt guilty afterward. He denied alcohol withdrawal symptoms such as tremors and sweats. He had smoked cannabis up to twice monthly for years but completely quit when he joined the church. He denied using other illicit drugs except for one uneventful use of cocaine 3 years earlier. He slept well except for occasional nights when he would sleep only a few hours to finish an academic assignment.

Hakim denied depressive, manic, or psychotic symptoms and violent ideation. He denied PTSD symptoms. Regarding stressors, he felt overwhelmed by his current responsibilities, which included attending school and near-daily church activities. He had been a straight-A student at the start of the school year but was now receiving Bs and Cs.

His girlfriend and sister were interviewed separately. They agreed that he had become socially isolative and quiet, after having previously been fun and outgoing. He had also never been especially religious before this episode. His sister believed that he had been "brainwashed" by the church. His girlfriend, however, had attended services with him. She reports that several members of the congregation had told her they occasionally talked to new members who felt guilt over their prior behaviors, but none who had ever hallucinated, and they were worried about him.