Assessing and diagnosing patients with anxiety disorders, ptsd, and

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“Fear,” according to the DSM-5-TR, “is the emotional response to a real or perceived imminent threat, whereas anxiety is the anticipation of future threat” (APA, 2022). 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-TR criteria for the disorders within these classifications before you get started, as you will be asked to justify your differential diagnosis with DSM-5-TR 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. 
  • 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.

Select 
one 
of the following videos to use for your Assignment this week. Then, access the document “Case History Reports” and review the additional data about the patient in the specific video number you selected. 

Selected Patient Video:

Symptom Media. (Producer). (2016). Training title 37 [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-37

Selected Patient History:

The Transcript of the patient interview video

PATIENT:  I went to the emergency department last week, because I was feeling like I was dying from a heart attack, and they did one of those, what do you call it? Ah, an EKG. And it was normal. But I was sweating and I was having trouble like catching my own breath. And my heart was pounding really, really hard. And I, and I just felt like my, my heart was just going to explode out of my chest. It almost felt like, um, like when your… I don’t know, when you’re in the woods. Uh, alone and, and you… you, feel like someone is, is following or, or chasing you. Or something like that. I, I just, I just my heart felt like it was about to leap out of my chest. I… And uh… I don’t know, probably twelve, fifteen minutes went by and, and the feeling just went away. It just passed. But then… the next day, it was the very same thing and I, for no reason at all. Just all of a sudden, I was making coffee and then WAM, that, that, that tightness in my chest came back and I was sweating and my heart was pounding, same exact feeling. Twelve, fifteen minutes, and then it just went away. It was like… almost it was almost like my mother, I remember she would get the same thing, probably three to four times a week. It’s just sheer panic for no particular reason at all. 

Training Title 37

Name: Mr. Luca Esposito Gender: male Age:21 years old T- 97.4 P- 112 R 22 122/68 Ht 6’1Wt 198lbs

Background: Lives alone in Orlando, FL raised by parents in Buffalo, NY, only child. He is a full- time student obtaining a degree for graphic design. works part-time as Uber driver. Has a girlfriend from high school. No previous psychiatric history. No medical illnesses; no history of psychiatric treatment; denied drugs or alcohol; Allergies: NKDA; sleeps 6 hrs.; appetite eats 3 meals/day, likes to keep a routine schedule.

Symptom Media. (Producer). (2016). Training title 37 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-37

THE QUESTION

Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate a 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-TR 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.).

Learning Resources

American Psychiatric Association. (2022). Anxiety disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url= https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x05_Anxiety_Disorders

American Psychiatric Association. (2022). Obsessive compulsive and related disorders In Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url= https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x06_Obsessive_Compulsive_and_Related_Disorders

American Psychiatric Association. (2022). Trauma- and stressor-related disorders.. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url= https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x07_Trauma_and_Stressor_Related_Disorders

Sadock, B. J., Sadock, V. A., and Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

· Chapter 9, Anxiety Disorders

· Chapter 10, Obsessive-Compulsive and Related Disorders

· Chapter 11, Trauma- and Stressor-Related Disorders

· Chapter 31.11 Trauma-Stressor Related Disorders in Children

· Chapter 31.13 Anxiety Disorders in Infancy, Childhood, and Adolescence

· Chapter 31.14 Obsessive-Compulsive Disorder in Childhood and Adolescence

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