Sam is a 26 year old white, single, college-educated, unemployed male who came i

Question

Sam is a 26 year old white, single, college-educated, unemployed male who came into the clinic at the insistence of his mother. His mother drove him to the clinic, since his vehicle was not working and he had no money to fix it. He has been living with his parents for the past year after he lost his job at Intel in Rio Rancho, New Mexico. He stated his job was working with computers.

His chief complaint was “my mother is worried about me;” he then added, “she thinks I am sad all the time and she thinks I drink too much.” He was dressed in jeans and a t-shirt. His eyes were red, his forehead had a little perspiration on it, and he appeared tired. He was evasive and his answers were rather short. His affect was blunted. He spoke softly at times; the interviewer had to ask him to speak up.

During the interview he gave the following information. After college he had found a good job and was making good money until the layoffs occurred at Intel. Since the layoffs, he has been drinking nearly every day. He now drinks about one six pack a day, and drinks only cheap beer since he doesn’t have much money. He drank six beers the night before the interview. He also drank a couple of shots later because he was unable to sleep.

He has been drinking since high school and had one DUI which occurred several years ago while he was in college. He went to a party and was stopped by the Rio Rancho police just before he got home. He did say he was in detox at one time in his life when he thought about quitting but left after a day because he thought the other clients there were weird. He started drinking when he was around 15. He proudly described how he never drank at work. He did say he would occasionally call in sick when he had a really bad hangover.

When asked if he used any other drugs he stated he “smokes a little bit of weed,” maybe “one or two joints a day,” stating it helps him to relax. He doesn’t ever smoke at work but sometimes would “take a couple of tokes” while he was getting ready for work. He stated the drinking may be a problem; he’s a little worried because he gets shaky when he doesn’t drink in the morning. He doesn’t see the marijuana use as a problem indicating “it is almost legal here.”

He also has tried cocaine, but it is outside of his money range and states since he has been laid off he can’t afford it. He denied any other substance use. When asked about his mother’s concern about his feeling sad, he stated he has been sad as far back as he could remember. He revealed he has had problems sleeping since he was a child. He described himself as being underweight and as a picky eater. He stated, “If it wasn’t for the weed I’d never be hungry”. He feels tired all the time and becomes easily irritated with other people. Nothing ever seems particularly fun. He denied any current suicidal ideation, but states throughout his life he has thought about it at times although he would never do it because it would hurt his parents. He denied any psychotic symptoms and there was no indication in the mental status exam he was experiencing any hallucinations. He denied ever feeling really energetic or particularly happy. His thinking was logical, and at times circumstantial.

He hasn’t had a romantic relationship since high school, stating it is “too much work to have a girlfriend.” He has a few friends but usually hangs out by himself. “People are tiring, they get on my nerves.”

He stated his father had problems with alcohol, but quit drinking after he went to work with alcohol on his breath and his supervisor sent him home. His mother does not drink or use any substances. He has one sister who lives in California. He and his sister are not close and only talk when she comes to visit their parents. He did not give permission to interview his mother who was in the waiting room.

Based on the above vignette for Case #2, list the principal diagnosis/diagnoses (including any and all appropriate subtypes and specifiers)

Explanation / Answer

The principal diagnosis is substance abuse disorder.

Substance abuse disorder along with psychological disorders are found in the patients who are drug and alcohol dependent like Sam. Psychological disorders like anxiety, depression, anti social personality disorder.

'He smokes weed to relax and drinks too much' indicating anxiety. 'He is sad all the time and appears tired and has less amount of energy' indicating symptoms of depression.

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