COUNSELING OLDER CLIENTS
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Therapy with Older Adults
The primary diagnosis for this client is major depressive disorder (MDD). It is a DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Ed.) diagnosis assigned to individuals who feel down and have lost interest in activities they previously enjoyed. This depressed feeling must occur daily for at least 2 weeks for a diagnosis to be given. Those who suffer from depression experience persistent feelings of sadness and hopelessness and lose interest in activities they once enjoyed. Aside from the emotional problems caused by depression, individuals can also present with a physical symptom such as chronic pain or digestive issues.
DSM-V Coding for MDD
MDD diagnosed as having either single or recurrent episodes. The severity level, such as mild, moderate, severe and with psychotic features, is also specified to note the unique aspects of the course of the disorder. The coding for single episode include 296.21 (F32.0) Mild 296.22 (F32.0) Moderate, 296.23 (F32.2) Severe, 296.24 (F32.0) In Partial Remission, 296.26 In full Remission, 296.20 (F32.9) Unspecified. The coding for recurrent episode include 296.31 (F33.0) Mild, 296.32 (F33.1) Moderate, 296.33 (F33.2) Severe, 296.34 (F33.3) With Psychotic Features, 296.35 (F33.41) In Partial Remission, 296.36 (F33.42) In Full Remission, 296.30 (F33.9) Unspecified (American Psychiatric Association, 2013).
The rationale for the Diagnosis
The DSM-5 outlines the following criterion to make a diagnosis of depression. The individual must be experiencing five or more symptoms during the same 2-week period, and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure (American Psychiatric Association, 2013). Some of these symptoms include feelings of sadness and hopelessness, loss of interest or pleasure in activities, Loss of weight or weight gain, difficulties sleeping or excessive sleepiness, noticeable restlessness or slowness, lack of energy, troubles concentrating and indecisiveness, feeling of worthless and excessive guilt, continued thoughts of wanting to die (Wheeler, 2014). The presence of anxiety in patients may affect prognosis, treatment options, and the patient’s response to clinicians
Based on the symptoms presented in the case study, the client met the criteria for DSM-5 in several ways. First, the client reported that he experienced symptoms of depression and anxiety for few months including sleeping problems, feeling tired all the time, moving in slow motion, and stopped attending the volunteer job at the nursing home. Some of the risk factors associated with the depression reported by the client include the loose of his father who he mentions as the primary source of support and his diagnoses for prostate cancer this year (American Psychiatric Association, 2013). Besides, conditions such as hypertension and hyperlipidemia are associated with some level of depression. Depression is also considered as an inherited condition, and since mother had the condition, there is a possibility he has the condition too (Wheeler, 2014).
