Clinical Scenarios
Scenario 1 – Grace
Grace is a 33-year-old woman who runs her own business. Grace has had long standing difficulties with her mood. She often finds herself in an emotional state where she feels highly energized and enthusiastic and is able to get a great deal of work done. This usually lasts for about a week and is followed by a 'crash' where she feels listless and depressed and has a very hard time attending to her job. These episodes of feeling either energized or depressed have been something that Grace has experienced for much of her life. Lately, however, Grace has found that her unpredictable mood has started to interfere with both her work and her personal life. Grace began treatment following a significantly depressed episode where she felt particularly hopeless and even considered taking her own life.
Grace was diagnosed with Crohn's disease (a gastro-intestinal disease) when she was in her 20’s. A specialized diet and other treatments have helped to curb the symptoms of this disease, but Grace has found that her unpredictable mood has caused these symptoms to flare up again.
Grace’s father passed away about two months ago following a long illness. Grace has had a hard time coping with her father’s death. She also recently learned that the property tax for her condominium is going to be considerably raised and she is not sure she will be able to keep up with her mortgage payments.
Important information for completing a diagnosis for Grace:
The DSM code for Bipolar I Disorder (single manic episode) is 296.0x.
The DSM code for Bipolar I Disorder (most recent episode mixed) is 296.40.
The DSM code for Bipolar I Disorder (most recent episode manic) is 296.4x.
The DSM code for Bipolar I Disorder (most recent episode depressed) is 296.5x.
The ICD-9 code for Crohn’s Disease is 555.9.
The v-code for bereavement is V62.82.
The v-code for no diagnosis on Axis I is V71.09.
The v-code for no diagnosis on Axis II is also V71.09.
Scenario 2 – Paul
Paul is a 28-year-old man who has had long-standing difficulties with criminal behavior. Paul has spent a number of years in prison for auto theft and burglary. He appears to have little interest in making meaningful connections with others and does not seem to feel any remorse for the people he has hurt in his past.
Recently Paul was arrested after he was caught sneaking around and looking in the windows of a girl’s school dormitory. During a session with a court appointed psychologist, Paul stated that he often feels an uncontrollable urge to watch women who are unaware of him, and that it is now the only way in which he can attain a sense of sexual gratification.
Paul has lost contact with his parents and reported that he was often physically abused when he was a child. Paul has had a few jobs over the years, but he usually ends up quitting or being fired for insubordination.
Paul was born with a cleft lip. Although post-natal surgery was able to repair the cleft lip, it left Paul with a noticeable scar that he is very self conscious of.
Important information for completing a diagnosis for Paul:
The DSM code for Antisocial Personality Disorder is 301.7.
The DSM code for voyeurism is 302.82.
The ICD-9 code for a cleft lip is 749.10.
The coding for physical abuse of a child (when the clinical attention is on
the victim) is 995.5.
The v-code for no diagnosis on Axis I is V71.09.
The v-code for no diagnosis on Axis II is V71.09.
