NRNP 6635 Week 4 Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD Paper

NRNP 6635 Week 4 Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD Paper

Anxiety disorders are some of the most common and debilitating mental illnesses. Their symptoms often overlap, which makes it harder to make an accurate diagnosis. Early identification and treatment are critical to improving outcomes and preventing functional decline. This paper presents a comprehensive psychiatric evaluation of Mr. Luca Esposito, focusing on his presenting symptoms, diagnostic considerations, and psychosocial background to determine an accurate diagnosis and plan of care.

Subjective:

CC (chief complaint): “I felt like I was dying from a heart attack.”

HPI: L.E. is a 21-year-old Caucasian male seeking psychiatric treatment for recurrent episodes of acute terror. He was referred following a visit to the emergency department with symptoms he suspected were cardiac-related. He reports abrupt occurrences of chest constriction, excessive perspiration, dyspnea, and cardiac palpitations lasting roughly 12 to 15 minutes, which disappear spontaneously. He reports that the episodes occur without any obvious triggers and are now happening daily. He recalls his mother experiencing similar symptoms frequently. L.E. denies substance use, recent stressors, or any history of trauma. He expresses concern over the unpredictability of these episodes and states they are interfering with his daily routine. Psychiatric review of symptoms is significant for panic-like symptoms, no hallucinations, no delusions, no suicidal ideation, and no obsessive behaviors.

Past Psychiatric History:

• General Statement: No previous psychiatric diagnosis or treatment.
• Caregivers (if applicable): Raised by parents.
• Hospitalizations: None reported.
• Medication trials: None reported.
• Psychotherapy or Previous Psychiatric Diagnosis: None.

Substance Current Use and History: Denies the use of alcohol, tobacco, or illicit substances; no history of withdrawal.

Family Psychiatric/Substance Use History: Mother experienced frequent panic-like symptoms.

Psychosocial History: Born and grew up in Buffalo, New York, as an only child under the guardianship of both parents. He presently resides independently in Orlando, Florida. He is a full-time college student studying graphic design and works part-time as an Uber driver. He has a long-standing girlfriend. There is no record of legal problems, trauma, or violence. Indicates secure social interactions and a consistent daily schedule.

Medical History:

• Current Medications: None currently prescribed.
• Allergies: No known allergies to medications, food, or environment.

• Reproductive Hx: Not engaged in sexual activity outside of a long-term partnership.

ROS:

• GENERAL: There were no reports of fever, chills, exhaustion, weight loss, or nocturnal sweats.
• HEENT: denies having ever experienced headaches, dizziness, or head trauma. Denies double vision, blurriness, or alterations in vision. Denies tinnitus, ear pain, or hearing loss. Absence of epistaxis, nasal congestion, or discharge. Denies hoarseness or a painful throat.
• SKIN: Free of dryness, irritation, sores, or rashes.
• CARDIOVASCULAR: Denies edema or chronic chest discomfort; reports pressure in the chest and palpitations during bouts.
• RESPIRATORY: Disavows coughing or wheezing; reports dyspnea during episodes.
• GASTROINTESTINAL: Denies experiencing any stomach pain, diarrhea, vomiting, or nausea.
• GENITOURINARY: rejects hematuria, urgency, frequency, and dysuria.
• NEUROLOGICAL: Denies loss of coordination, weakness, numbness, or convulsions.
• MUSCULOSKELETAL: Denies muscle weakness, stiffness, or joint discomfort.
• HEMATOLOGIC: denies signs of anemia, blood, or bruises.
• LYMPHATICS: disputes a history of splenectomy and lymphadenopathy.
• ENDOCRINOLOGICAL: Denies polydipsia, polyuria, cold/heat sensitivity, and sporadic perspiration during panic attacks.

Objective:

Physical exam:

• Vital Signs: Temp: 97.4°F, P: 112 bpm (tachycardic), RR: 22 bpm, BP: 122/68 mmHg, Ht: 6’1”, Wt: 198 lbs.., BMI: 26.
• GENERAL: Patient appears well-groomed, cooperative, and in no acute distress. No tremors, diaphoresis, or abnormal movements were observed during the interview. No signs of intoxication or withdrawal noted. Mild psychomotor agitation was noted during the discussion of symptoms.

Diagnostic results: Emergency Department EKG: Normal sinus rhythm, no arrhythmia or cardiac abnormalities reported. No lab results or imaging studies were provided or available at this time. No toxicology screen performed.

Assessment:

Mental Status Examination: L.E. is a 21-year-old Caucasian male who presents as his given age and is suitably groomed and attired. He exhibited alertness, was oriented to person, place, time, and situation, and showed cooperation throughout the session. Eye contact was adequate, and no atypical motions or mannerisms were seen. Speech was unpremeditated, intelligible, and exhibited a regular tempo and volume. His mood was characterized as “stressed” and apprehensive, exhibiting a constrained yet suitable affect. Cognitive processes were rational and purpose-driven. The thought content was devoid of delusions, obsessions, or phobias. He refuted any thoughts of suicide or homicide. No perceptual disturbances, such as hallucinations or illusions, were reported. Cognition appeared intact with standard memory, attention, and concentration. Insight and judgment were fair, as he is aware of his symptoms and their impact, but unsure of their cause.

Differential Diagnoses:

• Panic Disorder (F41.0): L.E. experiences frequent, unforeseen panic attacks marked by profound dread, palpitations, chest constriction, dyspnea, and diaphoresis. Episodes last approximately 15 minutes and are not linked to specific triggers. Per DSM-5-TR, this supports a diagnosis of panic disorder (Ziffra, 2021). No substance use, medical cause, or other mental disorders better explain the symptoms.
• Generalized Anxiety Disorder (GAD) (F41.1): L.E. exhibits anxiety but does not fulfill DSM-5-TR criteria for excessive worry happening more days than not for a minimum of six months across various domains. His anxiety is intense and intermittent rather than persistent and widespread, which assists in excluding this possibility (Shah et al., 2023).
• Substance-Induced Anxiety Disorder (F41.8): Despite the possibility that anxiety and panic symptoms may arise from substance use or withdrawal, L.E. refutes any consumption of alcohol, caffeine, nicotine, or narcotics. No indications of recent intoxication or withdrawal were observed. The criteria for this diagnosis, as outlined in the DSM-5-TR, are not satisfied (Kivlichan et al., 2024).

Reflections: Should the opportunity arise to facilitate this session anew, I would integrate a standardized anxiety screening instrument, such as the Panic Disorder Severity Scale (PDSS), to quantitatively evaluate symptom severity and monitor progress (Ziffra, 2021). It is ethically imperative to account for cultural sensitivity when elucidating mental health to a young adult without a psychiatric background and possibly possessing poor mental health literacy. Considering his age and Italian-American heritage, psychoeducation regarding anxiety and its physiological symptoms may diminish stigma and enhance treatment adherence. Health promotion programs must encompass the instruction of stress management skills and the advocacy of lifestyle factors, including consistent sleep and physical activity. Preventive interventions may entail early intervention to mitigate the progression of additional anxiety or mood disorders (Wang et al., 2023). Legal considerations encompass the evaluation and documentation of safety and decisional competence, despite his current denial of any harm to himself or others.

Conclusion: Mr. Luca Esposito exhibits symptoms indicative of panic disorder, characterized by recurring, spontaneous panic attacks and physiological arousal absent recognizable triggers. A primary diagnosis of panic disorder was established following the exclusion of medical and substance-induced factors. Timely intervention utilizing pharmacological and non-pharmacological methods, psychoeducation, and consistent follow-up will be essential for enhancing his functioning and averting persistent impairment.

References

Kivlichan, A. E., Praecht, A., Wang, C., & George, T. P. (2024). Substance-Induced Mood Disorders: A Scoping Review. Current Addiction Reports, 11(1), 1–18. https://doi.org/10.1007/s40429-023-00533-z

Shah, A. Q., Prasad, D., Caropreso, L., Frey, B. N., & De Azevedo Cardoso, T. (2023). The comorbidity between borderline personality disorder (BPD) and generalized anxiety disorder (GAD): A systematic review and meta-analysis. Journal of Psychiatric Research, 164, 304–314. https://doi.org/10.1016/j.jpsychires.2023.06.009

Wang, Z., Luo, Y., Zhang, Y., Chen, L., Zou, Y., Xiao, J., Min, W., Yuan, C., Ye, Y., Li, M., Tu, M., Hu, J., & Zou, Z. (2023). Heart rate variability in generalized anxiety disorder, major depressive disorder, and panic disorder: A network meta-analysis and systematic review. Journal of Affective Disorders, 330, 259–266. https://doi.org/10.1016/j.jad.2023.03.018

Ziffra, M. (2021). Panic disorder: A review of treatment options. Annals of Clinical Psychiatry, Volume 33, No. 2, e22–e31. https://doi.org/10.12788/acp.0014

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