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Philippine Normal University

The National Center for Teacher Education


College of Teacher Development
Faculty of Behavioral Sciences
and Social Sciences

CLINICAL DIAGNOSIS EXERCISES

Cases Diagnosed:
Mr. Stan
Mr. X

Clinical Sections:
Probable Diagnosis
Final Diagnosis
Defense Mechanisms and Dynamisms
Signs and Symptoms, and Predilections

Prepared by:
John ChristopherPerez

Submitted to:
Dr. Peter Howard R. Obias, M.D., Ph.D.

2014

CASE 1: MR. STAN


I. Probable Diagnosis
Dx: Major Depressive Disorder (2ndary) Self- Defeating Personality Disorder (R/o)
Avoidant Personality Disorder
II. Final Diagnosis: Multiaxial Assessment
Axis I: Major Depressive Disorder
Axis II: Avoidant Personality Disorder
Axis III: none known
Axis IV: Primary Support Group: unwanted child, compared to other siblings, usual
parental conflicts
Social Environment: involved with drug usage with peers, expelled from regular
school for fighting
Other Psychosocial problems: recent marriage divorce
Axis V: GAF=57

III. Appendix A: Defense Mechanisms and Dynamisms


Defense Mechanisms
Fixation- Client was observed as fixated in Freuds Oral Stage for usual intake of
alcohol and even drugs.
Denial- Client, although feels not good with women around, claimed having
good connection with female therapist
Projection- The clients description of his fathers character with equivalence to
his is a sign of this defense. However, this may need further
observations to the extent of the clients generalization towards others.
Displacement- The defense may have been present during his fights in regular
school. Excitatory stimulus is assumed to come from his mothers
frustration to him as he had felt anger and hatred.
Regression- Clients recollection of crying to sleep many nights is an indicator of
retreating as a response to an earlier level of development.
Rationalization- Relating self concept the client is assumed having with the
conflicts he have had gone during his childhood may somewhat be
classified as rationalization. This works especially if underlying
symptoms does not correspond to any psychosocial or environmental
problems but as to even more grounds.
Reaction Formation- Client, although fears people, establishes deep interpersonal
relation with others
Substitution- Clients need for self respect and self worth is diverted into his
chosen field in majoring psychology as to better himself.
Sublimation- Clients description of fairly being successful as mechanic may
have sublimed his unconscious conflicts with his parents into the field.
Compensation- Client wanted to do make a change being a psychologist despite
fear with other people around

Dynamisms
Intellectualization- Client pursued majoring psychology to identify how he can
build confidence in himself. However, this is subject for thorough
investigation as the client is on conscious state upon describing his aim.
Camouflage - Consistent rechanneling of fathers weak ego strength to the
individuals self may have had triggered this defense.
Idealization - This splitting defense mechanism made the client overvalue his
mother and his wife as stronger and more dominant.
Devaluation - In contrast with idealization on his significant women, the client
devaluated his father with relatively weak ego strength.
Isolation - Client wanted to be alone and aloof for his fear of people judging him.

IV. Appendix B: Signs/ Symptoms and Predilections

Differences
Probable Diagnosis (Dx)
Major Depressive
Disorder
- depressed mood or
irritable most of the day,
nearly every day
- decreased interest or
pleasure in most
activities, most of each
day
- significant weight
change (5%) or change
in appetite
- change in sleep:
insomnia or
hypersomnia
- change in activity:
psychomotor agitation or
retardation
- fatigue or loss of energy
- diminished ability to
think or concentrate, or
more indecisiveness
- suicidality: thoughts of
death or suicide, or has
suicide plan

Secondary (2ndary)
Self- Defeating Personality
Disorder
- chooses people and
situations that lead to
disappointment, failure, or
mistreatment
- rejects or renders ineffective
the attempts of others to help
him or her
- following positive personal
events, responds with
depression, guilt, or a
behavior that produces pain
- incites angry or rejecting
responses from others and
then feels hurt, defeated, or
humiliated
- fails to accomplish tasks
crucial to his or her personal
objectives despite
demonstrated ability to do so
- is uninterested in or rejects
people who consistently treat
him or her well
- engages in excessive selfsacrifice

Rule out (R/o)


Avoidant Personality
Disorder
- avoids occupational
activities that involve
significant interpersonal
contact, because of fears
of criticism, disapproval,
or rejection
- is unwilling to get
involved with people
unless certain of being
liked
- shows restraint within
intimate relationships
because of the fear of
being shamed or ridiculed
-is preoccupied with being
criticized or rejected in
social situations
- is inhibited in new
interpersonal situations
because of feelings of
inadequacy
-is unusually reluctant to
take personal risks or to
engage in any new
activities because they
may prove embarrassing

Summary:
Although signs and symptoms may appear nearly the same with each
other, major difference between the following diagnoses involves on how the
client entertained problematic situations which are focused into the self. While
the 2ndary diagnosis would serve as a tool to humiliate self, the R/o prevents self
to be embarrassed. The Dx assumes only the result for both. Still, the client,
based on the given background, is consistent with signs and symptoms from
probable diagnoses given above.

Similarities:
- feelings of worthlessness
- excessive or inappropriate guilt
- feelings of inadequacy
- views self as socially inept personally unappealing, or inferior to others
- rejects opportunities for pleasure, or is reluctant to acknowledge enjoying
himself or herself

Summary:
Similar signs and symptoms are in nature, focused on weak ego strength.
This could be essential factors to drive the individual in depressive episodes.
Boosting the self- confidence and trust to own abilities is therefore necessary to
aid the client.

CASE 2: MR. X
I. Probable Diagnosis
Dx: Major Depressive Disorder (2ndary) Bipolar Disorder (R/o) Bipolar II Disorder
II. Final Diagnosis: Multiaxial Assessment
Axis I: Bipolar II Disorder
Axis II: Schizoid Personality Disorder
Axis III: none known
Axis IV: Other Psychosocial problems: recent marriage separation with wife
Axis V: GAF= 59

III. Appendix A: Defense Mechanisms and Dynamisms


Defense Mechanisms
Fixation-Clients habitual use of oral-accompanied products (e.g. smoking
cigarette, drinking alcohol) suggests being fixated on Freuds Oral Stage
Denial- Clients rationalizing behaviour on arguments with his wife may indicate
presence of this defense. No particular event described.

Projection-Logical rationalization for his defense as soon as he argues with his


wife was been used to project personal faults to the latter
Displacement-Client became ambivalent and apathetic over the staff due to
current marriage separation.
Regression- Manifestation of an oral- fixated individual was been evident with
his continual use of drugs and alcohol.
Rationalization-Logical and analytical reasoning described on clients past
history on his usual arguments with his wife suggests repetitive use of
the defense mechanism.
Reaction Formation-Despite earlier marriage separation, client was seen often
having extravagant sprees, going to first class hotels, etc.
Substitution-Client may have had substituted the unattainable goal of having his
wife again by participating in extravagant sprees, going to first class
hotels, etc.
Sublimation- Client at 7 months prior to admission spends his time drawing and
sketching nature.
Compensation- Client may have had compensated his weak trait to maintain a
relationship into being a successful businessman. Likewise his past
history of being apathetic with his argumentative defeats with his wife
describes a compensating behaviour.
Dynamisms
Isolation- Client at 7 months prior to admission tends not to socialize with others.
Selective Inattention- As the mental status of the client describes present
condition to refuse answering questions, client is assumed using this
defense.
Resistance - Usual changes in the clients day to day activities, which were done
extensively, could have been an avoidance to marriage anxieties.
Creativity- Creative thinking functioning was been evident as the client spends
most of his time with artistic hobbies.
Intellectualization Clients usual argument with his wife may have triggered his
proceedings with this defense.

III. Appendix B: Signs/ Symptoms and Predilections

Differentiation of Signs and Symptoms (S/S)


Probable Diagnosis (Dx)
Major Depressive Disorder
- depressed mood or irritable
most of the day, nearly
every day
- decreased interest or
pleasure in most activities,
most of each day
- significant weight change
(5%) or change in appetite

Secondary (2ndary)
Bipolar Disorder
- occurrence of one or
more manic episodes
- elevated, expansive, or
irritable mood
- talkativeness
- inflated self- esteem
- distractibility
- reckless behavior

Rule out (R/o)


Bipolar II Disorder
- occurrence of one or major
depressive episodes
accompanied by at least one
hypomanic episode
Hypomanic Episodes
- inflated self esteem or
grandiosity

- fatigue or loss of energy


- guilt/worthlessness:
feelings of worthlessness or
excessive or inappropriate
guilt
- concentration: diminished
ability to think or
concentrate, or more
indecisiveness
- suicidality: thoughts of
death or suicide, or has
suicide plan

- more talkative than usual


- distractibility
- excessive involvement in
pleasurable activities that
have a high potential for
painful consequences (e.g.,
the person engages in
unrestrained buying sprees,
or foolish business
investments)

Summary:
Major difference is mostly associated with the vigor given by the client
into day to day activities. While the Dx presents decreased interest or pleasure in
most activities, the 2ndary and R/o suggest or more energetic individual.
Presence of psychomotor agitation and hypersomnia would only be the similar
signs and symptoms of the Dx to the other diagnoses.

Similarity:
- psychomotor agitation
- sleeplessness
- hypersomnia
- decreased need for sleep
- hyperactivity
- increased goal-directed activity
- flight of ideas
Summary:
Signs and symptoms with similar influence on the client are of mostly
natured on the excess of energy throughout activities done as mentioned earlier.
This could have been the compensation or avoidance the individual would most
likely use after a distressing event, perhaps, the recent marriage separation. The
client therefore posses a relatively higher coping mechanism than the average
which the latter, preferable.