Review the 3 case studies provided (one for each DSM-V section covered in the module). Determine the correct DSM-V diagnosis including any applicable specifiers. Provide a brief rationale for your specific diagnosis (see example below). Here is an example of a case study and also an example of the DSM-V diagnosis and rationale for the diagnosis which includes the letters and numbers associated with the diagnosis in DSM-V. Example Case Study: “Carl Estel, a 74-year-old right-handed man, was brought for a neuropsychiatric evaluation after a multi-year decline marked by stiffness, forgetfulness, and apathy. His wife had been trying to get him in for an evaluation for years and had finally become desperate enough to enlist his brothers to bring him for the evaluation. Mrs. Estel described her husband’s problems as starting when he retired at age 65. He had seemed “out of sorts” almost immediately, and she had wondered at the time whether he was getting depressed. He became uncharacteristically forgetful, misplacing items and neglecting to pay bills. He had trouble with appointments, medications, and calculations. He had declined to see a physician at her urging until he was involved in a traffic accident a few years prior to this evaluation. While evaluating him for minor injuries, a physician had said that the accident was caused by inattention and diminished depth perception, that Mr. Estel should stop driving, and that he might have early dementia. Over the past year, things had gotten worse. Mr. Estel often could not recall the outcome of sporting events that he had just watched on television, although his memory improved with cues. He resisted activities such as travel and socializing that he had previously enjoyed. A former athlete, he quit taking walks around the neighborhood after several falls. He quit playing cards with neighbors because the rules had become confusing. He looked depressed and acted apathetic but generally said he was fine. His judgment and problem-solving skills were rated as poor. A retired plumbing contractor who had completed 4 years of college, Mr. Estel sometimes seemed unable to operate household appliances. All of these cognitive problems seemed to fluctuate, so that his wife reported that sometimes he was “almost like his old self,” whereas at other times it was “like living with a zombie, a depressed zombie.” She described his excessive daytime drowsiness and frequent staring spells. She also reported that she felt exhausted. When asked specifically about sleep, Mrs. Estel reported that neither of them slept well. Mainly, she said, it was because of her husband “acting out his dreams.” He punched and screamed and would occasionally fall out of bed. She was bruised the morning after these episodes and decided it was safer to sleep on the couch. These episodes occurred several times per month. She recalled that these sleep episodes began just before he retired; she recalled wondering at the time whether he had posttraumatic stress disorder, but she did not think he had suffered any particular trauma. A few years earlier, a friend had offered a “sleeping pill” that had helped her own husband with dementia. Mr. Estel had responded to it with extreme rigidity and confusion, and his wife had nearly taken him to the emergency room in the middle of the night. Mrs. Estel denied that her husband had ever had any psychiatric illness. When asked about psychotic symptoms, she said he often seemed to swat at invisible things in the air. This happened about twice a month. Mr. Estel’s medical history was pertinent for hypercholesterolemia, cardiovascular disease with a stent, and possible transient ischemic attacks. His family history was positive for his mother having developed dementia in her mid-70s. On examination, Mr. Estel was a stooped, stiff man who shuffled into the office. While listening to his wife present the history he often stared into space, seeming to pay no attention to the content of the conversation. His right hand was tremulous. He appeared depressed but when asked, he said he felt fine. His voice was so quiet that words were often unintelligible even when the interviewer leaned close. He drooled at times and did not notice until his wife wiped his chin. When asked to do cognitive testing, he shrugged his shoulders and said, “I don’t know.”” Example Student Response: Diagnosis is Major neurocognitive disorder with Lewy bodies Major neurocognitive disorder with Lewy bodies Diagnostic Criteria A – meeting criteria for major neurocognitive disorder. Major Neurocognitive Disorder Criteria A – Mr. Estel experienced significant cognitive decline (A) since retirement Major Neurocognitive Disorder Criteria B – Cognitive deficits interfere with his independence and he is unable to pay bills and drive Major Neurocognitive Disorder Criteria C – There are no indication of delirium for Mr. Estel. Major Neurocognitive Disorder Criteria D – Mr. Estel has not history of mental illness and symptoms do not seem related to another mental disorder Major neurocognitive disorder with Lewy bodies Diagnostic Criteria B – gradual onset – Mr. Estel has had worsening of symptoms over time. Major neurocognitive disorder with Lewy bodies Diagnostic Criteria C – core diagnostic features and suggestive diagnostic features Major neurocognitive disorder with Lewy bodies Core Diagnostic Features – fluctuating cognition (A)- wife reports he is sometimes a “zombie”, recurrent visual hallucinations (B) – although the specifics are not clear, wife reports he waves in the air, spontaneous features of parkinsonism (C) – sleeping pill caused extreme rigidity and confusion, Major neurocognitive disorder with Lewy bodies Suggestive Diagnostic Features – rapid eye movement sleep behavior disorder (A) – Mr. Estel meets criteria for this disorder which wife describes as “acting out his dreams” and she now sleeps on the couch. It is unclear if the Mr. Estel has severe neuroleptic sensitivity (B), but if the sleeping pill was an antipsychotic like Seroquel, then he would also meet this criteria.

Review the 3 case studies provided (one for each DSM-V section covered in the module). Determine the correct DSM-V diagnosis including any applicable specifiers. Provide a brief rationale for your specific diagnosis (see example below). Here is an example of a case study and also an example of the DSM-V diagnosis and rationale for the diagnosis which includes the letters and numbers associated with the diagnosis in DSM-V. Example Case Study: “Carl Estel, a 74-year-old right-handed man, was brought for a neuropsychiatric evaluation after a multi-year decline marked by stiffness, forgetfulness, and apathy. His wife had been trying to get him in for an evaluation for years and had finally become desperate enough to enlist his brothers to bring him for the evaluation. Mrs. Estel described her husband’s problems as starting when he retired at age 65. He had seemed “out of sorts” almost immediately, and she had wondered at the time whether he was getting depressed. He became uncharacteristically forgetful, misplacing items and neglecting to pay bills. He had trouble with appointments, medications, and calculations. He had declined to see a physician at her urging until he was involved in a traffic accident a few years prior to this evaluation. While evaluating him for minor injuries, a physician had said that the accident was caused by inattention and diminished depth perception, that Mr. Estel should stop driving, and that he might have early dementia. Over the past year, things had gotten worse. Mr. Estel often could not recall the outcome of sporting events that he had just watched on television, although his memory improved with cues. He resisted activities such as travel and socializing that he had previously enjoyed. A former athlete, he quit taking walks around the neighborhood after several falls. He quit playing cards with neighbors because the rules had become confusing. He looked depressed and acted apathetic but generally said he was fine. His judgment and problem-solving skills were rated as poor. A retired plumbing contractor who had completed 4 years of college, Mr. Estel sometimes seemed unable to operate household appliances. All of these cognitive problems seemed to fluctuate, so that his wife reported that sometimes he was “almost like his old self,” whereas at other times it was “like living with a zombie, a depressed zombie.” She described his excessive daytime drowsiness and frequent staring spells. She also reported that she felt exhausted. When asked specifically about sleep, Mrs. Estel reported that neither of them slept well. Mainly, she said, it was because of her husband “acting out his dreams.” He punched and screamed and would occasionally fall out of bed. She was bruised the morning after these episodes and decided it was safer to sleep on the couch. These episodes occurred several times per month. She recalled that these sleep episodes began just before he retired; she recalled wondering at the time whether he had posttraumatic stress disorder, but she did not think he had suffered any particular trauma. A few years earlier, a friend had offered a “sleeping pill” that had helped her own husband with dementia. Mr. Estel had responded to it with extreme rigidity and confusion, and his wife had nearly taken him to the emergency room in the middle of the night. Mrs. Estel denied that her husband had ever had any psychiatric illness. When asked about psychotic symptoms, she said he often seemed to swat at invisible things in the air. This happened about twice a month. Mr. Estel’s medical history was pertinent for hypercholesterolemia, cardiovascular disease with a stent, and possible transient ischemic attacks. His family history was positive for his mother having developed dementia in her mid-70s. On examination, Mr. Estel was a stooped, stiff man who shuffled into the office. While listening to his wife present the history he often stared into space, seeming to pay no attention to the content of the conversation. His right hand was tremulous. He appeared depressed but when asked, he said he felt fine. His voice was so quiet that words were often unintelligible even when the interviewer leaned close. He drooled at times and did not notice until his wife wiped his chin. When asked to do cognitive testing, he shrugged his shoulders and said, “I don’t know.”” Example Student Response: Diagnosis is Major neurocognitive disorder with Lewy bodies Major neurocognitive disorder with Lewy bodies Diagnostic Criteria A – meeting criteria for major neurocognitive disorder. Major Neurocognitive Disorder Criteria A – Mr. Estel experienced significant cognitive decline (A) since retirement Major Neurocognitive Disorder Criteria B – Cognitive deficits interfere with his independence and he is unable to pay bills and drive Major Neurocognitive Disorder Criteria C – There are no indication of delirium for Mr. Estel. Major Neurocognitive Disorder Criteria D – Mr. Estel has not history of mental illness and symptoms do not seem related to another mental disorder Major neurocognitive disorder with Lewy bodies Diagnostic Criteria B – gradual onset – Mr. Estel has had worsening of symptoms over time. Major neurocognitive disorder with Lewy bodies Diagnostic Criteria C – core diagnostic features and suggestive diagnostic features Major neurocognitive disorder with Lewy bodies Core Diagnostic Features – fluctuating cognition (A)- wife reports he is sometimes a “zombie”, recurrent visual hallucinations (B) – although the specifics are not clear, wife reports he waves in the air, spontaneous features of parkinsonism (C) – sleeping pill caused extreme rigidity and confusion, Major neurocognitive disorder with Lewy bodies Suggestive Diagnostic Features – rapid eye movement sleep behavior disorder (A) – Mr. Estel meets criteria for this disorder which wife describes as “acting out his dreams” and she now sleeps on the couch. It is unclear if the Mr. Estel has severe neuroleptic sensitivity (B), but if the sleeping pill was an antipsychotic like Seroquel, then he would also meet this criteria.