Explain the differences and similarities in your choice of criteria used to determine diagnosis, including Z codes (other conditions that may be a focus of clinical attention). Explain whether or not you agree with your colleague’s treatment recommendations. Leticia Cortez Cornell Diagnosis COLLAPSE F32.1               Major Depressive Disorder, single episode, moderate  Z63.5               Disruption of Family by Separation  or Divorce Z59.6               Low Income  Cornell met criteria A1, A2, A4, A6, A7, and A8 and criteria B and C for Major Depressive in correlation to his current separation.  A1: Cornell expressed feeling “sad mood, fearfulness, and passive suicidal ideation”. A2:Decreased in motivation and low interest in chores at home engages in “sitting around”  A4:Sleep pattern length of 3 to 4 hours, over several years.   A6:When sleeping little time frames he then becomes tired and oversleeps.  A7: Cornell reported feeling more irritable, decreased self-esteem, and feelings of guilt/self-blame A8: He reported, “experienced increasingly withdrawn/non-communicative”. Criteria B: Cornell's current behaviors have caused the strain in his relationship with his kids and family.  Criteria C: No other medical condition was reported.  Z codes have been given due to unstable income and inability to pay the debt accumulated with therapeutic stays and other expenses. His divorce has influence his current emotional state for which has impacted his life.  OR  F43.23             Adjustment Disorder, with mixed anxiety and depressive mode Cornell met criteria A, B, C, D, and E.  Criteria A: Cornell has been married for 13 years and has been separated from his wife for the past three months. Criteria B1:  The official physical separation when his wife moved out and he moved in with his family.  Criteria B2: The major problem for Cornell is "learn to deal with my wife wanting a divorce." He has engaged in comments of suicide and shown no interest in spending time with kids. Criteria C: The current behaviors have increased due to the wife and kids moving out. His previous diagnosis was given based on problems with his wife.  Criteria D: Cornell is not grieving the loss of a deceased (bereavement) but rather a separation from his wife of many years. Criteria E: With the time of his current situation Cornell has expressed wanting to learn how to deal with the separation.  Scale & Intervention  Depression is commonly underdiagnosed for African American’s and does not seek help for symptoms, this causes severe and disabling symptoms compared to white peers (Walton, & Payne, 2016). The scale that would be used to measure Cornell’s self-esteem is the Interpersonal Support Evaluation List (ISEL). This scale would measure the “belonging-, self-esteem-, and appraisal-based social support”  in his current situation by the measure of 40-items (Odafe, Salami, & Walker, 2017). With the measure of ISEL, the Beck Hopelessness Scal.

1. Explain the differences and similarities in your choice of
criteria used to determine diagnosis, including Z codes (other
conditions that may be a focus of clinical attention).
Explain whether or not you agree with your colleague’s
treatment recommendations.
Leticia Cortez
Cornell Diagnosis
COLLAPSE
F32.1 Major Depressive Disorder, single episode,
moderate
Z63.5 Disruption of Family by Separation or Divorce
Z59.6 Low Income
Cornell met criteria A1, A2, A4, A6, A7, and A8 and criteria B
and C for Major Depressive in correlation to his current
separation.
A1: Cornell expressed feeling “sad mood, fearfulness, and
passive suicidal ideation”.
A2:Decreased in motivation and low interest in chores at home
engages in “sitting around”
A4:Sleep pattern length of 3 to 4 hours, over several years.
A6:When sleeping little time frames he then becomes tired and

2. oversleeps.
A7: Cornell reported feeling more irritable, decreased self-
esteem, and feelings of guilt/self-blame
A8: He reported, “experienced increasingly withdrawn/non-
communicative”.
Criteria B: Cornell's current behaviors have caused the strain in
his relationship with his kids and family.
Criteria C: No other medical condition was reported.
Z codes have been given due to unstable income and inability to
pay the debt accumulated with therapeutic stays and other
expenses. His divorce has influence his current emotional state
for which has impacted his life.
OR
F43.23 Adjustment Disorder, with mixed anxiety and
depressive mode
Cornell met criteria A, B, C, D, and E.
Criteria A:
Cornell has been married for 13 years and has been separated
from his wife for the past three months.
Criteria B1:
The official physical separation when his wife moved out and
he moved in with his family.
Criteria B2:
The major problem for Cornell is "learn to deal with my wife
wanting a divorce." He has engaged in comments of suicide and

3. shown no interest in spending time with kids.
Criteria C:
The current behaviors have increased due to the wife and kids
moving out. His previous diagnosis was given based on
problems with his wife.
Criteria D:
Cornell is not grieving the loss of a deceased (bereavement) but
rather a separation from his wife of many years.
Criteria E:
With the time of his current situation Cornell has expressed
wanting to learn how to deal with the separation.
Scale & Intervention
Depression is commonly underdiagnosed for African
American’s and does not seek help for symptoms, this causes
severe and disabling symptoms compared to white peers
(Walton, & Payne, 2016). The scale that would be used to
measure Cornell’s self-esteem is the Interpersonal Support
Evaluation List (ISEL). This scale would measure the
“belonging-, self-esteem-, and appraisal-based social support”
in his current situation by the measure of 40-items (Odafe,
Salami, & Walker, 2017). With the measure of ISEL, the Beck
Hopelessness Scale (BHS) would be used to measure the
improvement while he engages in support groups with other
male divorced fathers (Odafe, Salami, & Walker, 2017).
Monitoring the current support Cornell has with his sister and
parents as well as support from friends or other community
members facing a separation. Intervention includes a social
support group with goal setting and cognitive-behavioral
interventions. As they explore setting goals to help gain focus
and becoming more aware of their thought process as they
continue to cope with symptoms (Odafe, Salami, & Walker,

4. 2017).
Reference
American Psychiatric Association. (2013). Anxiety disorders. In
Diagnostic and statistical manual of mental disorders
(5th ed.). Arlington, VA: Author.
doi:10.1176/appi.books.9780890425596.dsm05
Diagnostic and statistical manual of mental disorders: DSM-5
. (2017). Arlington, VA: American Psychiatric Association.
Odafe, M. O., Salami, T. K., & Walker, R. L. (2017). Race-
related stress and hopelessness in community-based African
American adults: Moderating role of social support.
Cultural Diversity and Ethnic Minority Psychology
,
23
(4), 561–569. https://doi-
org.ezp.waldenulibrary.org/10.1037/cdp0000167
Walton, Q. L., & Payne, J. S. (2016). Missing the mark:
Cultural expressions of depressive symptoms among African-
American women and men. Social Work in Mental Health,
14(6), 637–657. doi:10.1080/15332985.2015.1133470
Torri Weese
Wk 6 Depressive Disorder
COLLAPSE
F32.2 Major Depressive Disorder, severe, with melancholic
features
Z63.0 Relationship distress with spouse or intimate partner

5. Z63.5 Disruption of family by separation or divorce
Demographics Data
Cornell is a 32 year old black male. He received counseling
services two months prior to voluntary admitting himself to the
hospital due to concerns of self harm. Cornell has been married
for 13 years, has three children with his wife and has been
separated from his wife the last three months. Cornell
completed technical college following high school and has held
a job for the past three years at a print shop. Cornells’ religious
identification is Baptist. Cornell grew up in a two parent home
and the father had some history of drinking. Typically Cornell
enjoys activities like softball, skiing, reading, and watching
football. Cornell having a drinking problem but stated he
previously would binge drink in 2009. Medical history indicated
a car accident with loss of memory of the accident. Cornell
smokes two packs of cigarettes a day.
Note: Areas in () indicate responses from Cornell or his wife.
Diagnostic criteria for Major Depressive disorder, severe, with
melancholic features is characterized and qualified by meeting
the following diagnostic criteria; 1. Cornell has met the
diagnostic criteria of 2 weeks or more as (1) for depressed mood
and (2) for loss of interest of pleasure, in addition to meeting 5
or more symptoms; 1. Cornell has exhibited a generally
depressed mood most of the day and every day identified by
himself
(sad, hopeless)
and his wife's observation
(extremely depressed)
2. Cornell has lost interest in activities most of every day (
chores, hanging with friends, spending time with his kids)
3. Experiences both insomnia and hypersomnia 4. Psychomotor

6. retardation
(sitting around)
5. Feelings of worthlessness or guilt
(feeling ashamed and guilty)
6. Diminished ability to think or concentrate daily
(increased distractibility)
7. Recurrent thoughts of death
(suicidal ideation, passive
) (APA, 2013).
Cornell meets the criteria for Major depressive disorder,
severe
due to the intensity of his depressive symptoms and his
inability to manage his symptoms
(indicated by voluntarily checking into the hospital
). Further, his diagnostic criteria for
melancholic features
as he meets the diagnostic criteria as follows; A. Loss of
pleasure in all or almost all activities and B. meeting up to
three
of the following; 1. a quality of depressed mood and feeling
empty (
sad mood, fearful, guilt, self blame)
2. Psychomotor retardation
(sitting around)
3. Excessive or inappropriate guilt
(feelings of guilt, self blame)
(APA, 2013).
Morrison (2014) discusses the importance of clinicians
identifying major depressive disorder and the many subtypes
and specifiers as mood disorders can be difficult and
challenging to diagnose.
Rating scales help to validate the diagnosis and help access the
appropriate treatment outcomes. In the 17-Item Hamilton

7. Depression Scale (HDRS17) a measurement is taken to help
determine the baseline and help identify two factors; vegatative
worry and retardation-agitation and further negative item
loading measured over twelve month period (Nixon, Guo,
Garland, Kaylor-Hughes, Nixon & Morriss, 2020). The scoring
system is using a scale of 0-7 as normal, 8-16 as mild
depression and 17-23 as moderate depression and 24 or higher
representative of severe depression (Nixon, 2020). This type of
scale is currently utilized by both the Federal Drug
Administration in the US and the National Institute for Care
Excellence and due to having over 1500 randomized controlled
trials (Nixon, 2020).
Treatment for Cornell would be effective by applying
mindfulness-based cognitive therapy approach (MBCT)
(Barnhofer, Crane, Hargus, Amarasinghe, Winder & Williams,
2009). Using a mindful approach with meditation interventions
with cognitive therapy to address recurrent depression and
suicidal ideation can decrease the severity of symptoms from
severe to mild using MBCT (Barnhofer, 2009). MBCT is a
useful treatment tool in reducing depressive symptoms and if
patients identify as meeting the full criteria for depression,
MBCT has been shown to successfully decrease depression
(Barnhofer, 2009). Due to Cornell's intense feelings of SI and
checking himself into the hospital, he will likely need to be
prescribed psychotropic medications. Until Cornell is released
from the hospital and his SI can better be managed,
psychotropic medications will likely be necessary for
stabilization and should be reassessed as treatment is provided
following his hospitalization.
Depressions opposite, according to Andrew Soloman, is not
happiness, but vitality (TED, 2013).
References

8. American Psychiatric Association. (2013).
Diagnostic and statistical manual of mental disorders
(5th ed.). Arlington, VA: Author.
Barnhofer, T., Crane, C., Hargus, E., Amarasinghe, M., Winder,
R., & Williams, J. M. G. (2009). Mindfulness-based cognitive
therapy as a treatment for chronic depression: A preliminary
study.
Behaviour Research and Therapy
,
47
(5), 366–373. https://doi-
org.ezp.waldenulibrary.org/10.1016/j.brat.2009.01.019
Morrison, J. (2014).
Diagnosis made easier
(2nd ed.). New York, NY: Guilford Press.
Nixon, N., Guo, B., Garland, A., Kaylor-Hughes, C., Nixon, E.,
& Morriss, R. (2020). The bi-factor structure of the 17-item
Hamilton Depression Rating Scale in persistent major
depression; dimensional measurement of outcome.
PloS One
,
15
(10), e0241370.
https://doi-
org.ezp.waldenulibrary.org/10.1371/journal.pone.0241370
TED Conferences, LLC (Producer). (2013).
Depression, the secret we share
[Video file]. Retrieved from
https://www.ted.com/talks/andrew_solomon_depression_the_sec
ret_we_share