Case Study
Patient Demographic: Client Age: 51 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced and single Counseling Setting: Local government mental health agency Type of Counseling: Individual counseling Presenting Problem: The client is experiencing a recent separation from her last partner who was verbally and physically abusive, and she is currently living in a domestic violence home. Diagnosis: Major depressive disorder, recurrent episode, moderate (F33.1) and post-traumatic stress disorder (PTSD) (F43.10)
Mental Status Exam: Mental Status Exam: The client’s affect is flat, and she is hunched over in the chair. The client is oriented to person, place, time, and situation. She reports no hallucinations, paranoia, or depersonalization/dissocia
Presenting Problem: You are a licensed counselor working for a local government mental health agency in the counseling clinic. The client was referred to receive case management and counseling after experiencing homelessness due to leaving a physically and verbally abusive relationship with her last partner. The client is experiencing the following depressive symptoms: sadness more often than not, mental fogginess, suicidal ideation, insomnia, significant weight loss, feelings of worthlessness, and fatigue. The client experiences PTSD symptoms due to having experienced several abusive relationships, including recurrent distressing intrusive thoughts regarding the physical abuse, distressing dreams related to abuse, and physiological reactions (difficulty breathing, heart racing) when she goes near certain places that remind her of the abuse. She also explains that she has been avoiding triggers, believes that no one can be trusted, has an exaggerated startle response, and has had difficulty experiencing positive emotions. The client says that she does not know if therapy can help because she feels like these events have changed her and that she cannot get back to “normal,” but that she would like to make friends so she doesn’t feel so alone.
Other Contexts:    tion. Family History: The client has three adult children: a daughter(age 32), son (age 30), and a second daughter (age 28). The client reports on and off relationships with her children historically because they did not want to be around these men, but that they have rekindled their relationships recently. The client has been married twice, and, in addition to her most recent partner (unmarried), all three men have been physically and verbally abusive toward her

Question: All of the following are appropriate assessment tools to explore differential diagnoses for major depressive disorder and PTSD, EXCEPT:
(A): Adult ADHD Self-Report Scale
(B): Generalized Anxiety Disorder-7 (GAD-7)
(C): Adjustment Disorder-New Module 20
(D): Acute Stress Disorder Scale

Correct Answer: Acute Stress Disorder Scale
Explanation: Acute stress disorder would not be an indicated differential diagnosis; therefore, the Acute Stress Disorder Scale is not indicated here. Although it may be considered upon initial diagnosis, the client has experienced trauma symptoms over her lifetime. Acute stress disorder would not be diagnosed outside the timeframe of 3 to 30 days following the trauma exposure. Adjustment disorder would be appropriate to assess for because the client recently had some major life changes; however, the disturbances are likely a result of continuous exposure to trauma. Anxiety disorders should also be considered because PTSD has some symptoms that involve anxiety and panic. ADHD, though unlikely, could explain concentration issues and other symptoms that may appear in depression and PTSD. Therefore, the correct answer is (D)
Competency: intake, assessment, and diagnosis