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

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

Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD

This soap note is about a Sergeant who is 27 years old, joined the military right after high school, and has served in battle zones. Having served in the military for eight years, he is now engaged. The paper looks at differentiating between possible illnesses and evaluating a patient’s mental state, focusing on the critical thinking skills needed. The paper thoroughly examines the patient’s symptoms, DSM-5 criteria, and potential ways to improve things. The paper also discusses ethics issues and looks at possible future meetings.

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Subjective:

CC (chief complaint): “My fiancé suggested, well, demanded that I make an appointment.”

HPI: B.S., a 27-year-old white man, asked to see a psychiatrist because he was having anxiety problems after a stressful event at the county fair with his sister and her husband. Heavy fireworks in the sky stopped the show, but B.S. did not know about them. He ran because he feared the police were trying to catch him. He loudly announced that he was a war veteran, and his friends quickly left because they thought the noise of the fireworks sounded like the shooting he had heard in battle. The blasts took B.S. back in time and made him think of his time in the service. The person has never been to treatment for mental health or drug abuse before, and they want to get married and start a family. The patient keeps thinking about what happened, causing dreams, over-the-top startle reactions, and feeling trapped between two cars. He talks about terrible things that happened to him in the military, and any bad sound or smell can make him sick and tense up his stomach muscles.

Past Psychiatric History:

  • General Statement: For twelve months, the person has not gotten help for his mental health problems.
  • Caregivers (if applicable): His fiancé.
  • Hospitalizations: He has never been hospitalized before.
  • Medication trials: He says he has not taken any medicine for his mental illness.
  • Psychotherapy or Previous Psychiatric Diagnosis: he says he has never been diagnosed or treated for mental health issues

Substance Current Use and History: The patient denied using smoke or illicit substances. The father battled drinking and showed indications of neglect.

Family Psychiatric/Substance Use History: When he was drunk, his father behaved harshly. Despite having cirrhosis, Type 2 diabetes, hypertension, and alcoholism, the father continues to be alive but in poor condition. His paternal grandfather had periods of depression while in the armed forces.

Psychosocial History: Due to his fiancée’s job opportunity, the patient and she relocated, and they are now five hours away from their family. He has a younger brother and an older sister. After graduating from high school, he will pursue an online accounting degree. He likes to read and watch television as hobbies. Nevertheless, he avoids music as it might make others uneasy. He had just served eight years in the Marines, three of which were lengthy deployments into war zones.

Medical History:

  • Current Medications: The patient manages his asthma with medicine.
  • Allergies: There is no documented allergy to food or drugs. Confirms that seasonal allergies occur.
  • Reproductive Hx: sexually active with aspirations to be married in the next two years.

ROS:

  • GENERAL: The patient does not complain of a fever, changes in weight, fatigue, or physical weakness.
  • HEENT: No discomfort, altered hair growth patterns, or altered internal structures. The auricular region has no tinnitus, exudate, itching, soreness, or auditory deficiencies. Eyes: No need for glasses, blurry vision, or tears. Nose: No history of previous epistaxis or sinus discomfort or congestion. Mouth and Throat: No dysphagia, bleeding gums, throat discomfort, or dental pain.
  • SKIN: Free of eczema, rashes, itching, or hives.
  • CARDIOVASCULAR: denies chest tightness, palpitations, or cyanosis.
  • RESPIRATORY: denies sneezing, wheezing, coughing, or dyspnea.
  • GASTROINTESTINAL: denies reflux, changed bowel motions, and hernias. There have been reports of stomach strains and nausea.
  • GENITOURINARY: denies any variances in the frequency of urine, burning while urination, dysuria, and nocturia.
  • NEUROLOGICAL: Denies headache, vertigo, lightheadedness, and impaired eyesight.
  • MUSCULOSKELETAL: denies pain or stiffness in their muscles and joints.
  • HAEMATOLOGIC: denies having ever had anemia, bleeding, or ecchymosis that took too long to heal.
  • LYMPHATICS: Lymphadenopathy is denied
  • ENDOCRINOLOGIC: denies experiencing excessive thirst, polydipsia, polyuria, or hair changes.

Objective:

Physical exam:

Vital signs: T: 98.8°F, P: 86 bpm, R: 18 bpm. BP: 122/70 mmHg. Ht: 5’8. Weight: 160 pounds

Diagnostic results: There were no requests for blood tests.

Assessment:

Mental Status Examination: The patient is a male young adult who is focused, presentable, and enthusiastic during the interview. However, he sometimes exhibits defensiveness and anxiousness even though he seems to be calm and friendly. His communication is clear and logical, even though it may sometimes be somewhat emotional. In addition to expressing anxiety about flashbacks from his time in the military, he acknowledges the need for coping mechanisms. There was no evidence of any motor deficiencies, and he had well-developed judgment and understanding. In addition to denying having any auditory or visual hallucinations, he also claims that he has not had any suicidal or homicidal impulses.

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Differential Diagnoses:

  1. Posttraumatic Stress Disorder (PTSD): The four types of symptoms that make up PTSD, according to the DSM-5-TR, are as follows: duration, arousal and reactivity, avoidance, negative mood changes, and intrusive symptoms (Blais et al., 2021). The condition may be precipitated by exposure to a traumatic incident, seeing it, learning about it, or indirect exposure. Symptoms of intrusion include persistent thoughts, nightmares, dissociative episodes, significant psychological discomfort, and dramatic physiological responses (Hunt et al., 2022). The principal diagnosis is PTSD, marked by nightmares, nervousness, and terror, indicative of recurrent exposure to traumatic events.
  2. Panic Disorder: As per the DSM-V, Panic disorder is a syndrome marked by persistent, unforeseen panic episodes, often occurring without warning and accompanied by physiological symptoms. These attacks may manifest concurrently with various anxiety, mood, psychotic, drug use, and medical issues. They may exacerbate symptom intensity, induce suicidal thoughts, and diminish therapy efficacy in people with concurrent anxiety and mental illnesses. Precise diagnosis requires a comprehensive comprehension of panic episodes (Barrett et al., 2020). The patient said he was sweating a lot and felt stuck in traffic.
  3. Agoraphobia: The DSM-5 delineates the diagnostic criteria for agoraphobia, necessitating profound dread when confronted with or expecting at least two of five scenarios: public transit, open spaces, confined places, crowds, or being alone at home (Gros et al., 2023). The dread must be disproportionate to the actual stimuli and accompanied by behavioral or cognitive alterations. Symptoms must persist for a minimum of six months, induce considerable distress, and cannot be well accounted for by an alternative mental diagnosis, medical condition, or drug use or withdrawal scenario.

Reflections: Should I have the chance to see this patient again, I would focus on a thorough review of his coping strategies and support network, as well as any regrets he may have about his anxiety. I would stress how important it is to remain anonymous and look into any possible thoughts of hurting oneself or others while taking into account his events. At the same time, active work can make people feel many emotions, such as regret. It is essential to understand how these feelings are affecting his health, especially since stressful events can cause PTSD and have many physical effects (Neilson et al., 2020). I would focus on finding new ways to guide his treatment and help him better take care of his health. To improve the process, I would use an orderly, trauma-informed approach that includes client-centered involvement, informed consent, cultural competence, and explicit professional boundaries (Benedict et al., 2020). I would teach him about support networks for people with PTSD and how to deal with stress. I would tailor my methods to his specific background and situation and ensure we met regularly to check on his progress and make any necessary changes to the treatment plans.

Conclusion

The patient went to see a psychiatrist because he was having anxiety issues after a bad experience at a fair and a flashback to his time in the military. He has never been to care for mental illness or drug abuse before, and he wants to get married and have kids. In his family background, there is a drunken father and a depressed grandpa. An orderly, trauma-informed strategy, psychoeducation, support networks, and ways to deal with stress should all be part of treatment.

References

Barrett, A. J., Taylor, S. L., Kopak, A. M., & Hoffmann, N. G. (2020). PTSD, panic disorder, and alcohol use disorder as a triple threat for violence among male jail detainees. Journal of Criminal Psychology, 11(1), 21–29. https://doi.org/10.1108/jcp-07-2020-0029

Benedict, T. M., Keenan, P. G., Nitz, A. J., & Moeller-Bertram, T. (2020). Post-traumatic stress disorder symptoms contribute to worse pain and health outcomes in veterans with PTSD compared to those without. A Systematic Review with Meta-Analysis. Military Medicine, 185(9–10), e1481–e1491. https://doi.org/10.1093/milmed/usaa052

Blais, R. K., Tirone, V., Orlowska, D., Lofgreen, A., Klassen, B., Held, P., Stevens, N., & Zalta, A. K. (2021). Self-reported PTSD symptoms and social support in U.S. military service members and veterans: a meta-analysis. European Journal of Psychotraumatology, 12(1). https://doi.org/10.1080/20008198.2020.1851078

Gros, D. F., Pavlacic, J. M., Wray, J. M., & Szafranski, D. D. (2023). Investigating Relations Between the Symptoms of Panic, Agoraphobia, and Suicidal Ideation: The Significance of Comorbid Depressive Symptoms in Veterans with Panic Disorder. Journal of Psychopathology and Behavioral Assessment, 45(4), 1154–1162. https://doi.org/10.1007/s10862-023-10082-4

Hunt, C., Krauss, A., Hiatt, E., & Teng, E. J. (2022). Predictors of symptom reduction following intensive weekend treatment for panic disorder: An exploratory study of veterans. Journal of Affective Disorders, 308, 298–304. https://doi.org/10.1016/j.jad.2022.04.053

Neilson, E. C., Singh, R. S., Harper, K. L., & Teng, E. J. (2020). Traditional masculinity ideology, posttraumatic stress disorder (PTSD) symptom severity, and treatment in service members and veterans: A systematic review. Psychology of Men & Masculinity, 21(4), 578–592. https://doi.org/10.1037/men0000257

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Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD

“Fear,” according to the DSM-5-TR, “is the emotional response to real or perceived imminent threat, whereas anxiety is 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.

Resources

 

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

Learning Resources

Required Readings

Required Media

Video Case Selections for Assignment

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.

 

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.
  • By Day 1 of this week, select a specific video 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.

By Day 7 of Week 4

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-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR 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.).

submission information

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.

  1. To submit your completed assignment, save your Assignment as WK4Assgn_LastName_Firstinitial
  2. Then, click on Start Assignment near the top of the page.
  3. Next, click on Upload File and select Submit Assignment for review.

Rubric

NRNP_6635_Week4_Assignment_Rubric

NRNP_6635_Week4_Assignment_Rubric
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeCreate 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
20 to >17.0 ptsExcellent

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.

 17 to >15.0 ptsGood

The response 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.

 15 to >13.0 ptsFair

The response 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, but is somewhat vague or contains minor innacuracies.

 13 to >0 ptsPoor

The response provides an incomplete or inaccurate description of 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. Or, subjective documentation is missing.
20 pts
This criterion is linked to a Learning OutcomeIn 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.
20 to >17.0 ptsExcellent

The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.

 17 to >15.0 ptsGood

The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented.

 15 to >13.0 ptsFair

Documentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies.

 13 to >0 ptsPoor

The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing.
20 pts
This criterion is linked to a Learning OutcomeIn 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-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR 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.
25 to >22.0 ptsExcellent

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.

 22 to >19.0 ptsGood

The response 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 an accurate justification for each of the disorders selected.

 19 to >17.0 ptsFair

The response documents the results of the mental status exam with some vagueness or innacuracy…. Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vaguess or innacuracy.

 17 to >0 ptsPoor

The response provides an incomplete or inaccurate description of the results of the mental status exam and explanation of the differential diagnoses. Or, assessment documentation is missing.
25 pts
This criterion is linked to a Learning OutcomeReflect 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!), social determinates of health, 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.).
10 to >8.0 ptsExcellent

Reflections are thorough, thoughtful, and demonstrate critical thinking.

 8 to >7.0 ptsGood

Reflections demonstrate critical thinking.

 7 to >6.0 ptsFair

Reflections are somewhat general or do not demonstrate critical thinking.

 6 to >0 ptsPoor

Reflections are incomplete, inaccurate, or missing.
10 pts
This criterion is linked to a Learning OutcomeProvide 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).
15 to >13.0 ptsExcellent

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.

 13 to >11.0 ptsGood

The response provides at least three current, evidence-based resources from the literature that appropriately support the assessment and diagnosis of the patient in the assigned case study.

 11 to >10.0 ptsFair

Three evidence-based resources are provided to support assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification.

 10 to >0 ptsPoor

Two or fewer resources are provided to support assessment and diagnosis decisions. The resources may not be current or evidence based.
15 pts
This criterion is linked to a Learning OutcomeWritten 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 to >4.0 ptsExcellent

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.

 4 to >3.5 ptsGood

Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive. …Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

 3.5 to >3.0 ptsFair

Purpose, introduction, and conclusion of the assignment is vague or off topic. … Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%-79% of the time.

 3 to >0 ptsPoor

No purpose statement, introduction, or conclusion were provided. … Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.
5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting—English writing standards: Correct grammar, mechanics, and punctuation
5 to >4.0 ptsExcellent

Uses correct grammar, spelling, and punctuation with no errors

 4 to >3.0 ptsGood

Contains a few (one or two) grammar, spelling, and punctuation errors

 3 to >2.0 ptsFair

Contains several (three or four) grammar, spelling, and punctuation errors

 2 to >0 ptsPoor

Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
5 pts
Total Points: 100

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