Review the case of Marcus, and respond to the questions listed below:
Marcus had a miserable life. His father was killed several years ago in a drive-by shooting when Marcus was fifteen. Since then, his mother had brought a string of boyfriends home over the years, insisting that he call them "Dad". The latest one had been a real "piece of work". He would come home drunk and beat Marcus' mother. If he finished with her before passing out, he'd start on Marcus next. A year ago, he'd broken Marcus' jaw with a baseball bat and put Marcus' mother in the hospital.
Not surprisingly Marcus looked for any way to escape that he could. Some kids in the neighborhood had introduced him to a number of different drugs, and he tried them all. His favorite was LSD. He liked watching weird things happen right before his eyes and often thought that he had the power to control what hallucinations he saw. He knew that if he concentrated hard enough he could make them actually happen to his "dad".
During a particularly rough period at home, Marcus stayed on LSD pretty much all day, every day. He started mixing the LSD with other drugs too. One night his "dad" caught Marcus stealing money out of his wallet and threw him down the stairs headfirst.
When Marcus woke up he was in a hospital under restraint. The nurse told him that he'd been babbling for several days about melting walls and scooping out his "dad's" brains and feeding them to a dog.
- What do you believe to be appropriate diagnoses for Marcus at this time? Consider both substance use and mental health diagnoses, and support your response citing the specific criteria for those diagnoses.
- Marcus presents with odd behavior, a recent head injury, recent use of hallucinogens, and high risk factors for a psychotic disorder. What additional information would you want to seek in order to determine the cause of his odd behavior?
Additional Sources:
https://www.psychotherapy.net/article/the-gift-of-therapy
https://www.hmpgloballearningnetwork.com/site/pcn/article/six-steps-better-dsm-5-differential-diagnosis
https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health#:~:text=People%20with%20a%20SUD%20may%20also%20have%20other,bipolar%20disorder%2C%20personality%20disorders%2C%20and%20schizophrenia%2C%20among%20others.
https://www.choosehelp.com/topics/mental-health/co-occurring-disorders-an-overview
Title: Understanding Marcus’s Complex Diagnosis and the Causes of His Odd Behavior
Introduction:
Marcus’s life has been marked by trauma and severe abuse, leading him to seek solace in drugs. This case presents a complex situation where Marcus’s substance use and mental health diagnoses intertwine. To better understand his condition, it is necessary to consider both substance use disorders and potential mental health diagnoses. Additionally, Marcus’s odd behavior, recent head injury, and hallucinogen use raise concerns about a possible psychotic disorder, necessitating further investigation.
Appropriate Diagnoses for Marcus:
a) Substance Use Disorder (LSD and other drugs): Marcus’s regular use of LSD and other drugs, including during a challenging period at home, indicates a substance use disorder (SUD). According to the DSM-5 criteria, the diagnosis of SUD can be made if an individual exhibits impaired control, social impairment, risky use, and pharmacological criteria. Marcus’s consistent drug use, even when it negatively impacted his life, meets these criteria (NIDA, 2019).
b) Post-Traumatic Stress Disorder (PTSD): Marcus’s traumatic experiences, such as witnessing his father’s death and enduring ongoing physical abuse, suggest a potential diagnosis of PTSD. The symptoms of PTSD include intrusive thoughts or memories, avoidance behaviors, negative mood changes, hyperarousal, and alterations in cognition (DSM-5).
c) Co-Occurring Disorders: Given the severity of Marcus’s symptoms and the complex interplay between substance use and mental health issues, it is crucial to consider the presence of co-occurring disorders. Marcus may be experiencing comorbid conditions such as depression, anxiety disorder, or even schizophrenia (NIMH).
Additional Information Required:
To determine the cause of Marcus’s odd behavior and assess whether he may have a psychotic disorder, additional information should be gathered. Key areas to explore include:
a) Psychiatric History: Obtaining Marcus’s psychiatric history would provide insights into any previous mental health diagnoses or treatment he may have received. This information would help establish a baseline for his current condition and enable comparisons to identify any significant changes in symptoms or behavior.
b) Comprehensive Substance Use Assessment: Conducting a comprehensive assessment of Marcus’s substance use is essential. It would involve gathering detailed information about the types of drugs he uses, frequency, dosage, and any potential polysubstance use. Understanding the specific substances involved can aid in diagnosing substance-induced psychotic disorder or co-occurring disorders.
c) Physical Examination and Neurological Assessment: Given Marcus’s recent head injury, a thorough physical examination and neurological assessment are necessary. These assessments can help determine if his odd behavior is a direct result of the head injury or if it is related to mental health conditions.
d) Psychosis Evaluation: To assess Marcus for a possible psychotic disorder, a thorough evaluation of his current symptoms is required. This evaluation should focus on identifying hallucinations, delusions, disorganized thinking or speech, negative symptoms, and any functional impairments caused by these symptoms.
Conclusion:
Marcus’s case demonstrates the complexity that arises when substance use disorders intersect with mental health conditions resulting from trauma. Appropriate diagnoses for Marcus include substance use disorder (LSD and other drugs), post-traumatic stress disorder (PTSD), and potential co-occurring disorders. To determine the causes of his odd behavior and assess the possibility of a psychotic disorder, additional information regarding his psychiatric history, substance use patterns, physical examination, and psychosis evaluation is needed. By understanding the intricacies of Marcus’s condition, clinicians can provide him with tailored treatment approaches that address both his substance use and mental health issues simultaneously.
References:
National Institute on Drug Abuse (NIDA). (2019). Substance Use Disorders.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).