The diagnosis for Gary’s case

Gary's condition can be diagnosed using the five axes of the DSM-IV diagnostic system for mental disorders. The DSM is a five-axis multi-axial evaluation approach aiming to provide a thorough diagnosis that takes into consideration the entire range of factors affecting a patient's mental health (Lobbestael, Leurgans, & Arntz, 2011). As a good friend, I will assist Gary in gaining control of his position by devising a plan to break the loop. The purpose of this paper is to analyze Gary's circumstance and provide a tentative diagnosis. Gary has expressed concerns about weight gain, overall exhaustion, anxiety, diminished libido, and low self-esteem. He is feeling guilty due to his economic troubles which appear to interfere with his personal and social life. Gary’s psychological conditions are also emanating from the fact that he thinks his wife is overworking and ailing with a chronic disease.

The top level of DSM-IV diagnostic system is the Axis I, which represents acute symptoms that should be treated. In Gary’s case, some of his symptoms such as insomnia, anxiety, decreased libido, and loss of appetite are clinical in nature and need treatment. These disorders are as a result of the mental issues he is experiencing (Lobbestael, Leurgans, & Arntz, 2011).

Axis II is for evaluating intellectual disabilities and personality disorders. These disorders are different from the disorders of Axis I because they are usually life-long problems that arise in childhood. For instance, Gary is suffering from moodiness and depression caused by economic troubles. Axis II disorders are often accompanied by social stigma as a result of failing to adapt well to the society. Gary finds it difficult to adapt to their new financial conditions because his wife who was his sole supporter has developed a chronic illness. Axis II disorders seem difficult to pinpoint and untreatable. It is usually disputed that these disorders are genetic influences or environmental causes (Lobbestael, Leurgans, & Arntz, 2011).

The DMS Axis III explains physical problems that are relevant in treating and diagnosing mental disorders. The general medical conditions can be described in three ways. First, conditions that are related directly to mental disorders. Second, conditions that are essential to the whole diagnostic picture. Finally, the conditions that do not have enough relationship with disorder being diagnosed (Lobbestael, Leurgans, & Arntz, 2011). Gary has experienced a weight gain of 20lb, which is a physical problem relevant in treating the disorder of increased appetite.

The DMS Axis IV is used to report environmental and psychosocial stressors affecting prognosis, diagnosis, and treatment of mental disorders. Axis IV is easy to comprehend, primarily, it is used to record life events such as work or marriage affecting the mental health treatment and diagnosis of a patient (Lobbestael, Leurgans, & Arntz, 2011). Gary is complaining about embarking on his private venture as a cause of strain in his marriage. Gary is experiencing a personal, professional, emotional, and physical decline due to the deteriorating health of his wife the financial trouble he is facing.

DMS Axis V is applied for Global Assessment of Functioning (GAF) which is a reflection to evaluate the judgment of a physician regarding the ability of a patient to work in daily life. The Global Assessment of Functioning is a 100 point scale that measures occupational, social, and psychological functioning. The main role of the GAF is to take a practical view of the mental health of a patient from a diagnostic perspective (Lobbestael, Leurgans, & Arntz, 2011). Gary’s condition can be assessed using the Global Assessment of Functioning (GAF) tool and rated basing on the 100 point tool.

Treatment Goals

After the initial evaluation and diagnosis are complete, I will collaborate with my colleagues to develop a treatment plan. In developing the treatment plan I will focus on important factors such as the nature of the disorder, Gary’s characteristics, and a treatment approach to adopt. Creating a treatment plan and goals is essential for the treatment outcome and the health of the patient. The main treatment goal for Gary is to change his current situation and regain his normal life. Using the DMS-IV multi-axial diagnostic system, I will treat Gary’s condition in five parts. First, I will ask Gary to visit a physician who will treat all the symptoms of the clinical disorders in Axis I of the DSM-IV diagnostic system. The other symptoms on each axis will be treated in a sequential manner.

The treatment planning process will entail various processes. First, the problems and most important issues will be identified and noted. The specific issues concerning Gary’s health will be defined. The goals will be divided into long-term and short-term treatment goals. I will create interventions that will assist to reach the set goals. In the treatment plans and goals, guiding concepts will be used. The guiding concepts include an overview of the current situation of Gary, a vision of what Gary wants, and a creation of a method of helping Gary to achieve what he need. The goals for success will address behaviors, feelings, and thoughts. These goals should incorporate specific types of therapy and strategies, including the medications.

Gary’s Strengths

Gary despite having numerous psychological disorders he has many strengths that make him succeed in his family life. Gary mentioned being in a happy and intact marriage for more than 12 years. Gary has also succeeded in education having a master’s degree from Johns Hopkins University. He has used his MBA to venture a business with a full-time employee. Gary has also managed to have a virtual accounting office that prompts his clients to pay their debts in time. Gary praises his children for being well behaved, obedient, fun, smart, and healthy. This is an indication of good parenting and is part of Gary’s strengths.

Homework Assignments

Homework assignments are essential for improving the outcomes of a patient’s cognitive behavioral therapy. Engaging a patient in homework assignments is a difficult task because the patient has different beliefs and needs that can interfere with the assignment (Lidya and Jana, 2008). I will negotiate with Gary on the type of the assignment that he will be comfortable with. Physical exercise is the most appropriate assignment for Gary because it will keep him busy from his depression and will reduce the symptoms associated with it such as weight gain, loss of appetite and anxiety. The second assignment to Gary will be to take his family for a one day tour. The one day tour will be an opportunity for Gary and his family to bond with his family. This will make Gary and his wife share out the problems and find ways of solving them. From the Gary’s complains, he feels like his wife’s bad health and troubles arise because he is irresponsible in the family.

In our next appointment with Gary, we will focus on Gary’s professional goals, his relationship with his family and his economic situation. Gary is facing an economic decline which has adversely affected his overall personal, professional, emotional, and physical state. He is mainly affected by the health condition of his wife because he depended on his wife in all aspects including taking care of their two children and their business. For instance, his private business is financed by his wife, who also pays for their medical health. Gary cannot afford to pay the healthcare premium of over $1000 for his family alone without the assistance of his wife who is currently ill.

The essential professional goal for Gary is to advance his business ventures. Gary should maintain a consistent cash flow that will enable him to meet family obligations, pay bills, and pay his employees, without depending on his wife. I will help Gary to create a bill-paying system and a budget. People who face a financial crisis like Gary are often not aware how they spend their money. I will explain to him how my budget and bill helps me in making my financial decisions. By creating a budget, Gary will realize the areas that they can cut back their expenses to meet their financial obligations. Another way of helping Gary to achieve his professional goals is by finding him a professional assistance. Local professionals such as employment agencies, career counselor, and welfare agencies can help Gary and his family manage their financial situation.

The relationship of Gary and his wife seems to be on the rocks as Gary is worried about his wife’s resentment on him. Gary needs advice on how to manage his marriage; his fears are that his wife is overworking to make their family better and that is the reason behind his chronic illness. I will connect Gary and his wife to a common counselor who will advise them on how to share responsibilities in their marriage. Gary should reduce his working hours and increase the amount of time he spent with his family (Yasin and Dzulkifli, 2010).

Gary has so many areas that can be improved after a successful psychological assessment process. The clinical disorders in the DSM-IV multi-axial diagnosis system such as insomnia and decreased libido can be treated through a visit to a physician. These disorders are physical and temporary in nature. Thus, when the conditions causing them are reversed, they can be eradicated. When Gary takes his assignment with seriousness, his situation will improve. Although Axis II disorders seem difficult to pinpoint and untreatable, they can be controlled and suppressed. Axis II disorders are often accompanied by social stigma as a result of failing to adapt well to the society which is a condition that can be reversed through a proper mental treatment plan. The disorders characterized under Axis III such as weight gain can be improved through physical activities like exercising and swimming which are part of the assignments I recommended for Gary.

References

Kendler, K. S., Aggen, S. H., Knudsen, G. P., Røysamb, E., Neale, M. C., & Reichborn-Kjennerud, T. (2011). The structure of genetic and environmental risk factors for syndromal and subsyndromal common DSM-IV axis I and all axis II disorders. American Journal of Psychiatry, 168(1), 29-39.

Lidya Fehm and Jana M. (2008). Patients' Perspective on Homework Assignments in Cognitive–Behavioural Therapy. Clinical Psychology & Psychotherapy. Volume 15, Issue 5

Lobbestael, J., Leurgans, M., & Arntz, A. (2011). Inter‐rater reliability of the Structured Clinical Interview for DSM‐IV Axis I disorders (SCID I) and Axis II disorders (SCID II). Clinical psychology & psychotherapy, 18(1), 75-79.

Røysamb, E., Kendler, K. S., Tambs, K., Ørstavik, R. E., Neale, M. C., Aggen, S. H., ... & Reichborn-Kjennerud, T. (2011). The joint structure of DSM-IV Axis I and Axis II disorders. Journal of abnormal psychology, 120(1), 198.

Yasin, A. S., & Dzulkifli, M. A. (2010). The relationship between social support and psychological problems among students. International Journal of Business and Social Science, 1(3).