Case #4: Mr. E: Mr. E is a 57-year-old divorced man who has 3 adult children (no

Question

Case #4: Mr. E:

Mr. E is a 57-year-old divorced man who has 3 adult children (not in the home) and a history of compulsive and depressive symptoms since childhood. His symptoms have been worsening since his early 20s and after his divorce 5 years ago he has become unable to discard his possessions. Mr. E is in good health and does not present with symptoms of a substance use disorder. Mr. E is an auto-mechanic and strives to be the best mechanic in Los Lunas, where he lives on a 5 acre, rural property. Mr. E. thoroughly enjoys collecting engines, car parts and related magazines, such as “Popular Mechanics” and “Car Mechanics”.

Three of his 5 acres are filled with old cars and various parts. Mr. E. often will sleep in one of the cars as his 2 bedroom home is filled with magazines, to the point he has a difficult time entering and moving about his home. Neighbors have complained about the disarray. Mr. E does not see his collection of autos and parts to be a problem. He is significantly distressed over the situation. Yet, he maintains he owns the property and is free to do whatever he sees fit. Family history reveals his mother and sister, who reside together, also struggle with indecisiveness and perfectionism. They currently own 25 cats and 10 small dogs.

A neighbor called Adult Protective Services. After visiting Mr. E. and his property, they concluded his home is unsafe and uninhabitable. The City has ordered Mr. E. to clean up his home and property. Since he refuses to comply, they have ordered him to see you for a mental health evaluation.

Mr. E. reveals to you he has also felt significantly sad and depressed over the past two years. Sometimes the depression lifts, yet usually returns within 2 months. He complains of not having any energy, a loss of appetite, a desire to sleep all day and a pervasive sense of hopelessness. He finds pleasure in collecting his autos and magazines and in nothing else. He is very indecisive and sees this negatively affecting his work. While assessing him you have determined he has never had a manic or hypomanic episode and clearly does not meet the criteria for cyclothymic or schizophrenia spectrum disorders.

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Based on the above vignette for Case #4, list the principal diagnosis/diagnoses (including any and all appropriate subtypes and specifiers)

Explanation / Answer

This start of depression. This depression is arising out of lonliness experienced by Mr. E. He finds his joy or feels positive only with his automobilesvor magazines. Hence he does not finds a reason to throw them. The society or neighborhood are. not able to empathize what he is going through. Just like any other western country, they don't find reason to speak about it.

This may also fall under biopolar disorder, where a person experiences symptoms but returns to normal condition after a certain period.

But loss of appetite, feeling low, hopeless are all the symptoms of depression.

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