TPC-Journal-V4-Issue3

The Professional Counselor \Volume 4, Issue 3 238 to 4 ( severe and present ), are hallucinations, delusions, disorganized speech, abnormal psychomotor behavior, negative symptoms, impaired cognition, depression and mania. During a presentation on the DSM-5 (Malaspina, 2013), representatives from the schizophrenia spectrum and other psychotic disorders work group explained that symptoms for individuals with schizophrenia can change over time. Therefore, the scale was designed to help clinicians note their detailed observations of the client and track changes in symptoms across time. Case Examples Some of the changes previously described are minor and do not result in revisions to the core diagnoses of clients with these disorders. However, some changes might impact diagnoses, and others might alter the way we describe the disorder or the name of the disorder itself. As with the conversion from the DSM-III-R (APA, 1987) to the DSM-IV (APA, 1994), the process will be ongoing. The cases below illustrate possible changes that counselors, supervisors and counselor educators can make immediately in their practices. Martha: Major Depressive Disorder Martha is a 47-year-old married mother of two. She works part-time as a real estate agent and is active in her Episcopal church. Her husband spends long hours at work and is often required to travel out of town. Her two adult children live nearby. Her father is deceased and her mother’s health is unstable, although she lives at a local assisted living facility. Martha’s depression was first recognized by her family doctor when she was 23. He was not familiar with the DSM ( DSM-III-R at that time), but recognized symptoms of sadness, hopelessness, emptiness and fatigue. He began prescribing her a relatively new drug called Prozac. Martha experienced improvement immediately. For the next 6 years Martha’s family doctor managed her depression with occasional dosage increases and biannual checkups. Just before her 30th birthday, Martha experienced her first severe depressive episode and attempted suicide. She had delivered her second child three weeks prior, and her husband found her after she cut her wrists. Martha was hospitalized and received her first full mental health evaluation. Using the DSM-IV criteria, she was diagnosed with 296.33 major depressive disorder, recurrent, severe without psychotic features, with postpartum onset . Recurrent was given because of her self-reported symptom and treatment history. Her present symptoms far exceeded the minimum required for diagnosis, so the episode was considered severe. Martha was coherent, denied hearing voices or seeing images, and showed no evidence of delusions, so no psychotic features were noted. The suicide attempt occurred 3 weeks after delivery and depressive symptoms had been present for at least a week at that point; therefore, Martha met criteria for the postpartum onset specifier. Martha also experienced anxiety about caring for her children and managing her life but did not meet criteria for an anxiety disorder. Following discharge from the hospital, Martha continued to see the psychiatrist she met while hospitalized and began seeing a licensed professional counselor. Martha worked well in counseling and experienced long periods of remission and several more moderate depressive episodes in the 17 years that followed. She maintained regular appointments with her psychiatrist for medication management and sought counseling at times of increased depression or stress. Presently, Martha has just resumed seeing a licensed professional counselor. She describes sadness, low energy, hopelessness, limited pleasure, insomnia, and stressors related to aging, her family relationships and her mother’s failing health. Her psychiatrist adjusted her medication and suggested that she resume counseling for additional support. Although the counselor has worked with Martha previously, the resumption of services is a great opportunity to revisit her diagnosis.