Description of the Client and Client's Demographics

Ashton is a 42 year old African-American male. He is pleasant, astute, well-groomed, and has average weight and height. During our interview, he was able to maintain an appropriate eye contact and affect. His intelligence was average, engaged in the process of interview; he was relaxed and showed confidence. Ashton was oriented, relaxed, and exhibited good short-term memory, although had some long-term memory problems. He was a sophisticated man who claimed to have travelled to several parts of the world. Moreover, he maintained that he had classic music training and was a guitarist as well. He noted that he was alone at that time, but had been in a stable relationship with his girlfriend he claimed to be a mental health clinician. It is the girlfriend who had come with him to the clinic for the assessment. He noted that he had one friend with whom they were very close, and in fact, he was close to his family as well.


Description of Relevant History

Mr. Ashton reported that he had little emotional connection with his distant parents. During the interview, he stated that he had horrible argument with his father prompting him to leave home when he was a teenager. Besides, he denied knowing any living relatives. His childhood was significant, and his prodigy was evident when he started playing piano at the age of 4. He was also an ardent reader who could read anything by age of 11. He reported that by the time he was 15, he had become the center of attraction. However, his first episode of mania occurred at age 16, when one day he woke up only to find himself in a mental hospital.

A Description of How Ashton’s Relationships Are Impacted by the Challenges He Is Facing

Since his first episode of mania at the age of 16, Ashton has been in the hospital from time to time for 25 years without ability to maintain mood stability, relational constancy, or employment stability. Ashton claimed that he attended a music school, but discontinued during his junior years because of the maniac episode. In fact, he tried to commit a suicide when he took an overdose of Tylenol. His girlfriend of that time, whom he considered as the only person that loved him, put end to their relationship claiming that he was too much of a problem. Even though his was not a detailed history, Ashton noted that he had been through short periods of high functioning, stable employment as well as financial life that were interrupted by episodes of devastating mania, which depleted his financial resources. Besides, at such times, he became combative at work and experienced periods of severe depression.

Client’s Symptoms

Within the last 10 months, Ashton had experienced a hypomanic episode that became a maniac episode, a major depressive disorder, as well as a second hypomanic episode. He was able to achieve partial remission that lasted less than one month. The remission occurred after medication compliance between his recent hypomanic episode and depressive state.

During his first hypomanic episode, the police brought Ashton to the hospital when he was delusional for a 72-hour observation. At that time, he had been prevented from falling off the roof of a five story building. At the time of his release from the hospital, he had been diagnosed with schizophrenia. However, police returned him to the hospital three days later, claiming that he was in a state of full mania after his performance in a symphony orchestra was disrupted. When the mania occurred, he spent all the $ 11,000 savings that he had. He exhibited high grandiosity, racing thoughts, poor judgment, pressured speech, severe agitation, incoherence, and sleeplessness. The attending psychiatrist reported that he was intrusive, expansive, and euphoric. Therefore, the doctor recommended and prescribed lithium treatment. The client lacked insight regarding his behavior during the hearing for competency for his involuntary commitment, but he denied a history of depression, and therefore he requested that he be released.

Within a week, he voluntarily accepted admission to the hospital, especially because he was having severe depression. At the time, he appeared disoriented and without the knowledge about his surroundings, and he was wandering in traffic. He demonstrated psychomotor retardation, despondency, anhedonia, as well as was overwhelmed with weeping and sadness, poorly groomed, disheveled, and could not make his sadness disappear. Physical examinations showed that he had bruises on his torso, but he could not recall how these bruising had appeared.

For the thirty days that he has stayed in the hospital, Mr. Ashton recorded significant progress. Unfortunately, he left the hospital before he could complete his treatment regime after his transfer from the psychiatrist, who had been attending to him, to a new physician, who was in another hospital. Immediately after he left, he also discontinued taking psychotropic medications thus he quickly became hypomanic. When he was located again on the rooftop of the story building, from where he had wanted to jump before, Mr. Ashton acknowledged that he needed treatment and medications to manage the symptoms. He was referred to the clinic by a former psychiatrist for therapy and medication management.

Reason of Visiting the Clinic

At his presentation in the clinic, Mr. Ashton claimed that he suffered from Bipolar I Disorder. Besides, he acknowledged the difficulties he had in complying with the medication. He believed that he would manage his symptoms if he got enough support and medical regime that accorded him added emotional range. He came to the clinic with the support of his girlfriend and noted that he was willing to do whatever is necessary to remove his self-destructive cycle. Importantly, the client noted that he wanted to stop the sadness as a result of deep depression as well as put an end to the out-of-control maniac behavior so that he could proceed with his music career.

Preliminary Diagnosis including DSM-5 Code for the Diagnosis

Bipolar I disorder, Current or most recent episode hypomanic, in partial remission (F 31.71) (American Psychiatric Association, 2014)

Sociocultural Factors Affecting the Diagnosis Process

Personality profiles can affect the course of symptoms. Among bipolar disorder persons with comorbid personality disorder, the course of mood disorder can become worse. Importantly, individual temperamental differences or affectivity can also influence life events as well as interpersonal relationships that bipolar disorder patients experience (McCormick, Murray, & McNew, 2015).

Life events, such as negative, goal-attainment, and social-rhythm disrupting ones, also affect the process of diagnosis. Such life events can be associated with depressive symptoms and negative cognitive styles. Life events that disrupt social rhythm, such as sleep, that trigger manic symptoms. These manic or hypomanic symptoms due to bipolar depression after sleep deprivation are also the notable example of factors affecting the diagnosis (McCormick et al., 2015).

In cases of the uneasy family relationships, it has been shown that low social support can cause higher levels of depression over time among bipolar disorder people. Marital and family functioning is critical to social support. Studying family functioning is particularly important in cases where a patient has periods of remission. Family factors are also significant in the curse of onset of childhood bipolar disorder, depending on how parents solve the conflicts (Price & Marzani-Nissen, 2012).

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Evaluation of the Client’s Sociocultural Background, Personal History, Current Events, and Family Relationships in Expressing and Presenting Symptoms

The factors affecting the diagnosis process include unemployment, economic problems, and having emotionally distant relationship with the family. Ashton’s social isolation could be a factor in his diagnosis process. He noted that he had only one friend and it was also the family of this friend who he closely related with. Since he did not have many friends, no one ever came to his rescue whenever he had health problems (Culpepper, 2014). It is noteworthy that the police had to take him to hospital on more than one occasion. If he had many friends, then they would realize whenever he has problems and take him to the hospital.

Similarly, Ashton has very limited emotional relationship with his family. After disagreeing with his father during the teenage years, he sought to start his life elsewhere, and this type of detachment from the family could also be a possible factor affecting his diagnosis. Furthermore, Ashton has been unstable financially after spending all his savings to treat mania. Without the finances needed for treatment, particularly now that he has depleted his savings, the process of diagnosis cannot proceed with ease. It could be that in Ashton’s culture, once an individual has left his family home, he has to fend for himself. Otherwise, Ashton could have received financial and social support when his condition deteriorated. It appears that the family is not bothered by his problems, so he always feels abandoned, which could be contributing to his depression.

Limitations on Using Current Diagnostic Systems Such as DSM-5 in Multicultural Society

Systems such as the DSM-5 are complex, inconsistent, and incoherent with research. Thus, users need to be cautious, particularly with the controversial diagnostic categories. For instance, in the case of mood disruption order tempers can turn into disorders, and major depressive disorder can be confused with normal grief. Furthermore, rating disorders needs to be done carefully when diagnosing people with mild conditions, because of the thin line between normal functioning and mild conditions.

The Impact that Potential Diagnostic Labels May Have on Mr. Ashton

Diagnostic labels may present Mr. Ashton as suffering from major depressive disorder when he is actually having a normal grief. In this case, it would be argued that there was a misdiagnosis. Apparently, with misdiagnosis, wrong treatment is bound to be against the patient.

How the Process of Diagnosis or Labeling the Client Might Impact the Relationship You Form with the Client as well as the Therapeutic Process

A diagnosis process conducted respectfully and with value for human life and dignity can create trust in the caregiver and the therapeutic process. Therefore, the assessment needs to be conducted in a manner that makes the patient honored and valued. In this way, he may stick to the treatment regime as recommended during the evaluation.

Review the Ethical Codes for a Professional Counseling Association

According to the American Counseling Association (2014), the counselor has a responsibility of creating counseling relationship, ensuring confidentiality and privacy of patient information, and ensuring professional responsibility when performing duties. Besides, a counselor must maintain professional responsibility with others, evaluate, assess, and interpret client’s data appropriately.

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