“Fear,” according to the DSM-5, “is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat” (APA, 2013). All anxiety disorders contain some degree of fear or anxiety symptoms (often in combination with avoidant behaviors), although their causes and severity differ. Trauma-related disorders may also, but not necessarily, contain fear and anxiety symptoms, but their primary distinguishing criterion is exposure to a traumatic event. Trauma can occur at any point in life. It might not surprise you to discover that traumatic events are likely to have a greater effect on children than on adults. Early-life traumatic experiences, such as childhood sexual abuse, may influence the physiology of the developing brain. Later in life, there is a chronic hyperarousal of the stress response, making the individual vulnerable to further stress and stress-related disease.
For this Assignment, you practice assessing and diagnosing patients with anxiety disorders, PTSD, and OCD. Review the DSM-5 criteria for the disorders within these classifications before you get started, as you will be asked to justify your differential diagnosis with DSM-5 criteria.
Review this week’s Learning Resources and consider the insights they provide about assessing and diagnosing anxiety, obsessive-compulsive, and trauma- and stressor-related disorders..
Consider what history would be necessary to collect from this patient.
Consider what interview questions you would need to ask this patient.
Identify at least three possible differential diagnoses for the patient.
submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis.
Incorporate the following into your responses in the template:
Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
Objective: What observations did you make during the psychiatric assessment?
Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
Reflection notes: What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
INTRODUCTION/ OBSERVATION/ASSESSMENT (CASE STUDY
My fiancé suggested, well demanded that I make an appointment. Three nights ago, we went with her sister and husband to a county fair. Carnival rides, cotton candy, toss balls at bottles, and win big panda bears, all that silly, old-fashioned stuff, but we were having a good enough time. So, all was going well. Then these fireworks go off. No warning. Just big, full sky explosions. Then I took off running. Fast as I could. Tried to find cover. I didn’t expect the fireworks. These two cops saw me running, I guess they thought I pickpocketed someone, maybe tried to rob a poor country person and I was running away. They took me down, tried to cuff me. So, I yelled “I’m a combat veteran sir.” Immediately they backed off. They were veterans, understood. They understood that the fireworks sounded like combat fire, and they helped me to my feet, gave me some cold water. I was shaking pretty bad. The explosive sounds took me back in time. I was right back in the middle of enemy fire, sir. Other noises are triggering to me as well. Last week, a car backfired, I jumped behind a magazine rack. Even a sudden circular saw cutting into wood and I’m… right back there. There are also smells that set me off. Diesel fuel. I hate smelling diesel fuel. Chopper smells. And last week, Charlie, my neighbor, was grilling for Jenna’s birthday and he singed some hair on his arm. No injury but… the smell… I had to leave the party pretty fast. Two of my buddies, they got burned when their Humvee was blown, and I smelled their… (I’d rather not talk about that, sir). These memories are way to strong. I dream of these events every night. It makes me not want to crawl in bed, not close my eyes. Traffic also makes me anxious. I hate really busy, downtown traffic. Stopping at a traffic light, with people in front of you and behind you, on both sides of you. I can’t stand that. I start breaking out in a sweat, I start shaking, and I can’t catch my breath. The reason because someone could roll an IED under your car. You’re trapped. You can’t get out. So, this happened to four of my buddies overseas. Blew’em to hell. And I saw it happen to two other vehicles. I didn’t know the guys but… God several times we’d be stuck in traffic, and people were staring at us. And I knew we were going down. Men, women, children. I mean, any of ’em could ‘a rolled an IED under us. Also, sometimes my fiancé argues with her mother. It used to not matter. Now I can’t handle it. It seems like any negative situation, and I just want to crawl into a hole and hide. I’m a wimp, a freaking coward. I don’t, I don’t want to go anywhere. I don’t want to go out to restaurants, or shopping or even to baseball parks. I just stay in my room all day. Afraid to sleep. It’s bad. I haven’t talked to anyone about this except you (PSYCH NP). I don’t want to be a whiner. Sometimes I feel like it’s never going to end. You know I thought I was going to crazy. Sometimes my mind just sinks back into itself, like I can’t see or hear or move. It’s like I’m numb all over. Lose track of time.
Chief Compliant. ‘I am scared that the anxiety will never end’.
Background: Lives in Minneapolis, MN with both of his parents, only child. Works part time at
Starbucks. Not currently partnered. No previous psychiatric history. Symptoms began in the last
1.5 months when he discovered he is being activated with the Navy Reserves. His MOS is SK1
Storekeeper; no medical illnesses Allergies: NKDA; sleeps 6.5 hrs; appetite good
Symptom Media. (Producer). (2017). Training title 15 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-15