QUESTION 1
Case 1A
Sam is a 52 year old married man, who is the father of 3 children. Two of his children are
living on their own and one is currently a senior in high school. Sam has been married for 30
years and describes his marriage as loving and stable. Sam’s two adult children are gainfully
employed and living independently. Sam is college educated and employed in his chosen
vocation in accounting/finance for a large successful company. Sam commutes to work daily by
driving into a large city. Outside of work he has a large circle of close friends and family with
whom he shared much time. He has many interests as well such as golf, gardening, and fishing.
He also described himself as a man of faith and attends church regularly. He denied any alcohol
or drug use, and rarely takes medication of any kind, stating that he is in “very good health
overall.” He grew up in an intact and loving family, met his wife in college, and “married her as
soon as he could.” Up to the date of the accident Sam described his life as nearly perfect.
Sam reported that about 2 weeks ago as he was driving to work he witnessed a “horrible”
accident where in a large dump truck suddenly veered to the right from the middle lane and
collided with a school bus full of children. The impact was such that the school bus was crushed
in the center and traffic came to a sudden stop. In the chaos Sam’s car was struck from behind
pushing him into the back of another vehicle. While he was not hurt seriously by this he was
trapped in his car for about an hour until emergency personnel were able to extricate him.
Sam stated that he is really struggling at this point due to what happened “that day.” He
related that he saw children die, the truck and bus drivers die, kids thrown from the bus onto the
road and into the river (some of whom were never recovered). He vividly recalled the scene of
blood and confusion as people fought to free themselves, help others, and comfort the wounded.
He reported that these images continually “loop” in his mind and keep him awake many nights.
When he does fall asleep he is often beset with nightmares about the accident. This has left Sam
feeling like a “zombie” who wanders around in a “fog” most days. Sam reported that he has
applied for short term disability at work because he “just can’t face driving and especially that
bridge,” and on the few days he did go to work he simply could not concentrate on anything. He
confided that his current state is adversely affecting family relations as he finds himself being
short tempered with his wife and youngest son, and also extremely anxious about going
anywhere or doing anything. Conversely, he stated that all the things he used to enjoy now seem
meaningless to him, like “the joy was sucked out of life on that day.” For these reasons, his wife
and employer strongly suggested he seek help.
Diagnostic Impressions
Acute Stress Disorder 308.3 (F43.0)
V62.29 (Z56.9) Other Problem Related to Employment
V61.10 (Z63.0) Relationship Distress with Spouse or Intimate Partner
Sam is likely coping with acute stress disorder (DSM-5 308.3; ICD-10 F43.0) along with
relationship distress with his spouse (DSM-5 V61.10; ICD-10 Z63.0) and problems related to
employment (DSM-5 V62.29; ICD-10 Z56.9). Sam directly witnessed a deadly car accident two
weeks ago and has been suffering symptoms ever since (criteria A & C). Sam is experiencing
intrusive memories, nightmares of the event, and extreme anxiety when he considers going
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, somewhere (criteria B1, B2, B4). Sam states that he no longer enjoys the things he used to
because “joy was sucked out of his life” the day of the accident (criteria B5). Sam describes
feeling like a “zombie” or walking in a “fog” most days (criteria B6). A desire to avoid driving,
especially near the location of the accident, has caused Sam to take a leave of absence from work
(criteria B9, D, & V62.29/Z56.9). Sam also reports having significant trouble concentrating on
the days he did try to work (criteria B13). Sam’s sleep has been suffering due to persistent
thoughts and nightmares (criteria B10). Finally, Sam has been feeling short tempered with his
wife and son (criteria B11, D, & V61.10/Z63.0). The case study notes indicate Sam does not
have a substance use disorder; he has no prior psychotic disorders, he was not seriously hurt in
the accident, nor does he have any other medical conditions (criteria E.)
Sam fully meets the criteria for acute stress disorder therefore adjustment disorder is not
the appropriate diagnosis. The traumatizing event was just two weeks ago therefore Sam does not
meet the time threshold for posttraumatic stress disorder (PTSD). If his symptoms continue for
longer than a month his diagnosis should be changed to PTSD. Sam’s intrusive thoughts are not
described at hallucinations or as perceptual disturbances therefore it is not likely that he is
suffering from a psychotic disorder. There was no indication for panic disorder or dissociative
disorders based on information in the case study. Also, as mentioned above, Sam was not
seriously injured in the accident therefore it is not likely that he is experiencing symptoms as a
result of traumatic brain injury.
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Case 1A
Sam is a 52 year old married man, who is the father of 3 children. Two of his children are
living on their own and one is currently a senior in high school. Sam has been married for 30
years and describes his marriage as loving and stable. Sam’s two adult children are gainfully
employed and living independently. Sam is college educated and employed in his chosen
vocation in accounting/finance for a large successful company. Sam commutes to work daily by
driving into a large city. Outside of work he has a large circle of close friends and family with
whom he shared much time. He has many interests as well such as golf, gardening, and fishing.
He also described himself as a man of faith and attends church regularly. He denied any alcohol
or drug use, and rarely takes medication of any kind, stating that he is in “very good health
overall.” He grew up in an intact and loving family, met his wife in college, and “married her as
soon as he could.” Up to the date of the accident Sam described his life as nearly perfect.
Sam reported that about 2 weeks ago as he was driving to work he witnessed a “horrible”
accident where in a large dump truck suddenly veered to the right from the middle lane and
collided with a school bus full of children. The impact was such that the school bus was crushed
in the center and traffic came to a sudden stop. In the chaos Sam’s car was struck from behind
pushing him into the back of another vehicle. While he was not hurt seriously by this he was
trapped in his car for about an hour until emergency personnel were able to extricate him.
Sam stated that he is really struggling at this point due to what happened “that day.” He
related that he saw children die, the truck and bus drivers die, kids thrown from the bus onto the
road and into the river (some of whom were never recovered). He vividly recalled the scene of
blood and confusion as people fought to free themselves, help others, and comfort the wounded.
He reported that these images continually “loop” in his mind and keep him awake many nights.
When he does fall asleep he is often beset with nightmares about the accident. This has left Sam
feeling like a “zombie” who wanders around in a “fog” most days. Sam reported that he has
applied for short term disability at work because he “just can’t face driving and especially that
bridge,” and on the few days he did go to work he simply could not concentrate on anything. He
confided that his current state is adversely affecting family relations as he finds himself being
short tempered with his wife and youngest son, and also extremely anxious about going
anywhere or doing anything. Conversely, he stated that all the things he used to enjoy now seem
meaningless to him, like “the joy was sucked out of life on that day.” For these reasons, his wife
and employer strongly suggested he seek help.
Diagnostic Impressions
Acute Stress Disorder 308.3 (F43.0)
V62.29 (Z56.9) Other Problem Related to Employment
V61.10 (Z63.0) Relationship Distress with Spouse or Intimate Partner
Sam is likely coping with acute stress disorder (DSM-5 308.3; ICD-10 F43.0) along with
relationship distress with his spouse (DSM-5 V61.10; ICD-10 Z63.0) and problems related to
employment (DSM-5 V62.29; ICD-10 Z56.9). Sam directly witnessed a deadly car accident two
weeks ago and has been suffering symptoms ever since (criteria A & C). Sam is experiencing
intrusive memories, nightmares of the event, and extreme anxiety when he considers going
This study source was downloaded by 100000806176105 from CourseHero.com on 01-23-2022 22:28:41 GMT -06:00
https://www.coursehero.com/file/66593232/COUC-667-FINAL-EXAM-Case-Studiesdocx/
, somewhere (criteria B1, B2, B4). Sam states that he no longer enjoys the things he used to
because “joy was sucked out of his life” the day of the accident (criteria B5). Sam describes
feeling like a “zombie” or walking in a “fog” most days (criteria B6). A desire to avoid driving,
especially near the location of the accident, has caused Sam to take a leave of absence from work
(criteria B9, D, & V62.29/Z56.9). Sam also reports having significant trouble concentrating on
the days he did try to work (criteria B13). Sam’s sleep has been suffering due to persistent
thoughts and nightmares (criteria B10). Finally, Sam has been feeling short tempered with his
wife and son (criteria B11, D, & V61.10/Z63.0). The case study notes indicate Sam does not
have a substance use disorder; he has no prior psychotic disorders, he was not seriously hurt in
the accident, nor does he have any other medical conditions (criteria E.)
Sam fully meets the criteria for acute stress disorder therefore adjustment disorder is not
the appropriate diagnosis. The traumatizing event was just two weeks ago therefore Sam does not
meet the time threshold for posttraumatic stress disorder (PTSD). If his symptoms continue for
longer than a month his diagnosis should be changed to PTSD. Sam’s intrusive thoughts are not
described at hallucinations or as perceptual disturbances therefore it is not likely that he is
suffering from a psychotic disorder. There was no indication for panic disorder or dissociative
disorders based on information in the case study. Also, as mentioned above, Sam was not
seriously injured in the accident therefore it is not likely that he is experiencing symptoms as a
result of traumatic brain injury.
This study source was downloaded by 100000806176105 from CourseHero.com on 01-23-2022 22:28:41 GMT -06:00
https://www.coursehero.com/file/66593232/COUC-667-FINAL-EXAM-Case-Studiesdocx/
