Anxiety Disorders, PTSD, and OCD Essay

Anxiety Disorders, PTSD, and OCD Essay

Anxiety Disorders, PTSD, and OCD Essay

Subjective:

CC (chief complaint): “Sadness and fear.”

HPI: D.J. is a 19-year-old male patient who presented to the psychiatric unit as a result of sadness and fear. The patient is in the U.S Navy, but currently in the reserves. He is however scared of telling people in the Navy about his sexuality.  He is scared of rejection, and the fear that some important people in his life, might not approve of him being gay. He feels that his friend will not see him, the same way they used to. He reports that at some point in his life, the fear of rejection gave him suicidal thoughts. He however denies such thoughts at the moment. His symptoms started about one and a half months ago when he realized that he is being activated with the Navy Reserves.

Past Psychiatric History:

• General Statement: The patient denies previous psychiatric history. He, however, had suicidal thoughts when he realized that he was gay and had the thought of being rejected by people who matter to him the most.
• Caregivers (if applicable): The patient lives in Minneapolis with both his parents as the only child.
• Hospitalizations: No history of hospitalization as a result of the present condition, or any other health complication.
• Medication trials: The patient denies taking any medication as a result of his present symptoms.
• Psychotherapy or Previous Psychiatric Diagnosis: Denies ever talking to anyone about his present situation.

Substance Current Use and History: Denies use of cigarettes, alcohol, or any other drug of abuse. No history of substance use disorders.

Family Psychiatric/Substance Use History: Denies family history of substance use disorder.

Psychosocial History: The patient realized that he was gay years back. He has however been scared ever since to disclose his sexuality to anyone as a result of being rejected or treated differently. He even reports thinking of taking his life at some point. He however denies the suicidal thoughts at the moment.

Medical History: No current medical diagnosis was reported.

• Current Medications: The patient denies using any medication at the moment.
• Allergies: No known drug, food, or seasonal allergies

• Reproductive Hx: The patient is homosexual (gay). He claims to be well sure about his sexual attraction to men. He however denies ever having any sexual encounter with a man before.
  

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ROS:

• GENERAL: No fever, fatigue, general body weakness, nausea, vomiting, changes in appetite, or recent weight changes.
• HEENT: Head: No headache or signs of head injury. Ears: No pain, tinnitus, discharge, hearing loss, or itchiness. Eyes: No blurred vision, excessive tearing, itchiness, double vision, or use of corrective lenses. Nose: No sinus drainage, congestions, redness, pain, inflammation, or nose bleeding. Throat & Mouth: No sore throat, hoarseness, bleeding gums, swallowing difficulties, toothache, or bleeding gums.
• SKIN: Skin complexity consistent with ethnicity. No hives, itchiness, redness, rashes, or lumps.
• CARDIOVASCULAR: No chest pressure, pain, palpitations, cyanosis, edema, or dyspnea.
• RESPIRATORY: No wheezing, sneezing, coughing, shortness of breath, or chest congestions.
• GASTROINTESTINAL: No abdominal distension, tenderness, hernia, changes in bowel movement, or constipation.
• GENITOURINARY: No changes in urine frequency, burning sensation on urination, difficulties in initiating urination, or nocturnal enuresis or dysuria.
• NEUROLOGICAL: No headache, changes in vision, loss of consciousness, or dizziness.
• MUSCULOSKELETAL: No painful joints or muscles. Full range of movement of joints with no difficulties.
• HEMATOLOGIC: No history of hematologic disorders, prolonged healing, or easy bruising.
• LYMPHATICS: No history of lymphadenopathy or enlargement of lymph nodes.
• ENDOCRINOLOGIC: No polyuria, polydipsia, or excessive thirst.

 Objective:

Vitals: T- 98.8 P- 89 R 18 110/62 Ht 5’7 Wt 133lbs

Diagnostic results: Performed routine blood works comprise of complete blood count, red blood cells, and white blood cell count, to assess the presence of infection or any other health complications. Urine and blood drug tests are ordered to rule out substance use disorder as the reason behind the patient’s signs and symptoms. Renal, liver, and thyroid function tests necessary for appropriate diagnosis and determining the right psychotropic agent to use with the patient. CT scan and X-Ray of the patient’s head were ordered to assess for signs of physical trauma (Campbell et al., 2020). Other diagnostic tools utilized include the Profile of Mood States (POMS) depression subscale, the Center for Epidemiological Studies Depression Scale (CES-D), the Hamilton Depression Rating Scale (HAM-D), Beck Depression Inventory (BDI), and Generalized Anxiety Disorder 7 (GAD-7).

Assessment:

Mental Status Examination: This 19-year-old male client was casually dressed in age-appropriate clothing. He was very cooperative throughout the interview and regarded as a reliable historian. His speech volume was normal, but at a pressured rate with the tendency to focus on the negative outcome of disclosing his sexuality to his friends and family. Affect constricted, with dysphoric mood. His mood was congruent with content. He seemed sad and extremely worried about people finding out that he is gay. He admits to having suicidal ideation in the past, which is not the case at the moment. Orientation, in person, place, and time is intact. He displays appropriate short and long-term memory. Fund of knowledge is adequate. Denies auditory or visual hallucination and delirium.

Differential Diagnoses:

1. Social Anxiety Disorder (Social Phobia): According to DSM-V, social anxiety disorder is characterized by persistent and intense anxiety or fear related to a given social situation, as a result of believing that you may be judged negatively, humiliated, or embarrassed (Leichsenring, & Leweke, 2017). Additionally, to qualify for this diagnosis, the patient must display signs of avoidance of the situation provoking the anxiety symptoms, or signs of enduring intense fear. The fear and anxiety must compromise the patient’s quality of life, and not result from any other medical condition. The patient in the provided case study was really scared of his colleagues in the Navy finding out that he is gay. He thus presented with extreme fear and sadness, claiming that they will treat him differently once they found out. As such, the patient qualifies for the diagnosis of social phobia.
2. Generalized Anxiety Disorder (GAD): This condition, together with panic disorder is the most common mental disorder among homosexual individuals especially those in the military. GAD is characterized by excessive worry or fear, even with no specific trigger. According to the DSM-5 diagnostic criteria, a patient can only qualify for this diagnosis when they present with excessive worry and fear about various things or situations for not less than 6 months. The state of worry must be very troublesome to manage (Averill et al., 2019). Additionally, the patient must display at least 3 of the following symptoms in addition to the extreme worry, such as sleeping difficulties, body weakness, irritability, impaired concentration, easily fatigued, and restlessness. The patient in the provided case study displayed fear and sadness of disclosing his sexuality to his colleagues once activated in the Navy.
3. Major Depressive Disorder (MDD): Patients diagnosed with MDD normally present with persistent feelings of hopelessness and sadness, in addition to the loss of interest in routine daily activities which previously seemed enjoyable (Arbanas, 2021). According to the DSM-V diagnostic criteria, patients with this disorder must display at least five of the following symptoms within the past two weeks such as, depressed mood, markedly diminished interest in daily activities, significant weight loss, slowed thought process, diminished ability to think properly, feeling of worthlessness, and recurrent thoughts of death. The patient in the provided case study displayed some of these symptoms, such as a sad mood, and lack of interest in being activated in the Navy. However, he does not qualify for this diagnosis.

Reflections: The provided case study displays a good illustration of a patient suffering from social phobia. The patient displays symptoms of sad feelings and fear but seems not to clearly understand why these symptoms present. He confirms that he knows that he is gay, but is scared of people finding out, once he is back in the Navy. The psychiatrist has demonstrated great engagement skills with the patient, giving a clear picture of the diagnosis and how the patient can benefit from therapy among other therapeutic interventions (Fisher et al., 2021). Consequently, with consideration of the ethical and legal obligations, the patient has the right to privacy and confidentiality which has been adequately addressed by the psychiatrist.

 References

Campbell, J. K., Poage, S. M., Godley, S., & Rothman, E. F. (2020). Social anxiety as a consequence of non-consensually disseminated sexually explicit media victimization. Journal of interpersonal violence, 0886260520967150. https://doi.org/10.1177/0886260520967150

Arbanas, G. (2021). Anxiety and Somatoform Disorders. In Psychiatry and Sexual Medicine (pp. 261-276). Springer, Cham. https://doi.org/10.1007/978-3-030-52298-8_18

Averill, L. A., Smith, N. B., Holens, P. L., Sippel, L. M., Bellmore, A. R., Mota, N. P., … & Pietrzak, R. H. (2019). Sex differences in correlates of risk and resilience associated with military sexual trauma. Journal of Aggression, Maltreatment & Trauma, 28(10), 1199-1215. https://doi.org/10.1080/10926771.2018.1522408

Fisher, K., Seidler, Z. E., King, K., Oliffe, J. L., & Rice, S. M. (2021). Men’s anxiety: A systematic review. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2021.08.136

Leichsenring, F., & Leweke, F. (2017). Social anxiety disorder. New England Journal of Medicine, 376(23), 2255-2264. DOI: 10.1056/NEJMcp1614701

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€œFear,” 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.
To Prepare:
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.
Download the Comprehensive Psychiatric Evaluation Template, which you will use to complete this Assignment. Also review the Comprehensive Psychiatric Evaluation Exemplar to see an example of a completed evaluation document.
Select a specific video ( Video transcribe is below) case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.
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.
Complete and 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.).

NRNP_6635_Week4_Assignment_Rubric
Create documentation in the Comprehensive Psychiatric Evaluation Template about the patient you selected.
In the Subjective section, provide:
• Chief complaint
• History of present illness (HPI)
• Past psychiatric history
• Medication trials and current medications
• Psychotherapy or previous psychiatric diagnosis
• Pertinent substance use, family psychiatric/substance use, social, and medical history
• Allergies
• ROS
18 (18%) – 20 (20%). The response throughly and accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.
In the Objective section, provide:
• Physical exam documentation of systems pertinent to the chief complaint, HPI, and history
• Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.
18 (18%) – 20 (20%). The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.
In the Assessment section, provide:
• Results of the mental status examination, presented in paragraph form.
• At least three differentials with supporting evidence. List them from top priority to least 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.
23 (23%) – 25 (25%). The response thoroughly and accurately documents the results of the mental status exam. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected.
Reflect on this case. Discuss what you learned and what you might do differently. 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.).
9 (9%) – 10 (10%). Reflections are thorough, thoughtful, and demonstrate critical thinking.
Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).
14 (14%) – 15 (15%). The response provides at least three current, evidence-based resources from the literature to support the assessment and diagnosis of the patient in the assigned case study. The resources reflect the latest clinical guidelines and provide strong justification for decision making.
Written Expression and Formatting—Paragraph development and organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.
5 (5%) – 5 (5%). A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
Written Expression and Formatting—English writing standards:
Correct grammar, mechanics, and punctuation
5 (5%) – 5 (5%). Uses correct grammar, spelling, and punctuation with no errors
Video Transcribe
Training Title 21
0:00:00 BEGIN TRANSCRIPT:
00:00:00 [sil.]
00:00:15 OFF CAMERA Nice to meet you Sergeant. I’m Dr. Schwartz.
00:00:20 SERGEANT Nice to meet you, sir.
00:00:25 OFF CAMERA Can you tell me why you came here today.
00:00:30 SERGEANT My fiance suggested, well demanded that I make an appointment.
00:00:40 OFF CAMERA Why was she concerned?
00:00:45 [Sighs]
00:00:45 SERGEANT 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.
00:01:15 OFF CAMERA So all was going well.
00:01:20 SERGEANT Then these fire works go off. No warning. Just big, full sky explosions.
00:01:30 OFF CAMERA Like county fairs do.
00:01:35 SERGEANT I didn’t know they did that.
00:01:40 OFF CAMERA Then what happened?
00:01:45 SERGEANT I took off running. Fast as I could. Tried to find cover.
00:01:55 OFF CAMERA Frightened?

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Training Title 21
Name: Sergeant Patrick Flanrey
Gender: male
Age:27 years old
T- 97.4 P- 84 R 18 B/P134/88 Ht 5’8 Wt 167lbs
Background: He entered the military just after high school and did three long tours of duty in
warzones. He separated from active duty in the Marines (MOS 0800 Field Artillery) less than a
year ago after eight years of service. He is engaged to be married (no date set) and is currently
working as a furniture salesman. He said he grew up poor and would not do much else if
he didn’t go into the military. He denies ever using any drugs and avoids alcohol because his
father was “sloppy drunk.” Father is still alive, unwell (DM, liver disease, HTN), still
drinking. Paternal grandfather was also a veteran and suffered depression at times though he
never told anyone except the patient because of their combat connection. Mother is alive and
well, still “caring for dad.” He has one younger and one older sister. He lives in a different state,
approximately five hours from his parents and siblings. After the military, he and his fiancé
moved because she got a much better opportunity. They want kids someday and hope to marry
in a year or two. Has service-connected asthma, seasonal allergies; no hx of psychiatric or
substance use treatment.
Symptom Media. (Producer). (2016). Training title 21 [Video]. https://video alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-21