Complete case study
form that follows, all the way through the treatment plan. Take the time and
explore differential diagnosis, cultural factors, life experience, and
circumstances. There may not be enough information provided within the case to
substantially fill in all of the area of the form, but try to be thorough.
Nancy Ingram, a 33-year old stock analyst and married mother of two children,
was brought to the emergency room (ER) after 10 days of what her husband
described as “another cycle of dark days.” His wife was tearful, then explosive,
and she had almost no sleep.
Ms. Ingram’s husband said he had decided to bring her to the ER after he
discovered that she had recently created a blog entitled Nancy Ingram’s Best Stock
Picks. Such an activity not only was out of character but, given her job as a stock
analyst for a large investment bank, was strictly against company policy.
Mr. Ingram said his wife was working on the stock picks around the clock,
forgoing her own meals as well as her responsibilities at work and with her
children. Ms. Ingram argued with her husband at this time and said, her blog
“would make them rich.”
The patient had first been diagnosed with depression in college, after the death of
her father from suicide. On examination, the patient was pacing angrily in the
exam room. Her eyes appeared glazed and unfocused. She responded to the
examiner’s entrance by sitting down and explaining that this was all a
miscommunication, that she was fine and needed to get home immediately to tend
to her business. She was speaking so rapidly, it was difficult for the examiner to
She denied hallucinations, but admitted with a smile, to a unique ability to predict
the stock market. She refused to be cognitively tested and she said, “I will not be a
trained seal, a guinea pig, or a barking dog, thank you very much, and may I leave
Case Formulation • Presenting problem – What is the client’s problem list? –
What are DSM diagnoses?
• Predisposing factors – Over the person’s lifetime, what factors contributed to the
development of the problem? – Think biopsychosocial
•Precipitants – Why now? – What are triggers or events that exacerbated the
• Perpetuating factors – What factors are likely to maintain the problem? – Are
there issues that the problem will worsen, if not addressed
• Protective/positive factors – What are client strengths that can be drawn upon? –
Are there any social supports or community resources ?