Assignment: Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD
“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.
Photo Credit: Hill Street Studios / Blend Images / Getty Images
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.
- 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 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.).
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
DIFERENTIAL DIAGNOSIS (WHAT DO YOU THINK?)
Posttraumatic Stress Disorder (DSM-5) 309.81 (F43.10)
Generalized Anxiety Disorder (DSM-5) 300.02 (F41.1)
Agoraphobia (DSM-5) 300.22 (F40.00)
VIDEO TRANSCRIPT
TRANSCRIPT OF VIDEO FILE:
00:00:00
______________________________________________________________________________
00:00:00
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?
00:02:00
SERGEANT [Sighs] Yeah, scared the… you know, out of me.
00:02:10
OFF CAMERA You didn’t expect the fire works.
00:02:10
SERGEANT 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.
00:02:30
OFF CAMERA Wow.
00:02:35
SERGEANT So I yelled “I’m a combat veteran sir.” Immediately they backed off. They were veterans, understood.
00:02:50
OFF CAMERA They understood that the fireworks sounded like combat fire?
00:02:55
SERGEANT Yeah, exactly sir. God. [Sighs, quivering]. They helped me to my feet, gave me some cold water. I was shaking pretty bad.
00:03:10
OFF CAMERA So they were helpful?
00:03:15
SERGEANT Yeah, absolutely.
00:03:20
OFF CAMERA The explosive sounds took you back in time.
00:03:25
SERGEANT I was… I was right back in the middle of enemy fire, sir.
00:03:35OFF CAMERA What about other loud noises?
00:03:40
SERGEANT The same. 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.
00:04:05
OFF CAMERA Are there any smells that set you off?
00:04:10
SERGEANT Yeah, it’s funny you should ask. Yes sir. 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.
00:04:55
OFF CAMERA What came to mind?
00:05:00
[He pauses, struggling to hold back tears].
00:05:10
SERGEANT Two of my buddies, they got burned when their Humvee was blown and I smelled their… I’d rather not talk about that, sir.
00:05:40
OFF CAMERA Memories are too strong?
00:05:45
SERGEANT Yeah, way too strong.
00:05:50
[sil.]
00:05:55
OFF CAMERA Do you ever dream about these events?
00:06:00
SERGEANT Every night, sir. Yeah, makes me not want to crawl in bed, not close my eyes.
00:06:10
OFF CAMERA So you have nightmares. You startle easily. Are there any other problems that you’ve noticed?
00:06:20
SERGEANT Like what, sir?
00:06:25
OFF CAMERA Other cues that cause flashbacks or make you anxious?
00:06:35
SERGEANT Traffic. I hate real 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.
00:07:05
OFF CAMERA What about traffic is so bad?
00:07:10
SERGEANT Someone could roll an IED under your car. You’re trapped. You can’t get out.
00:07:25
OFF CAMERA That happened overseas?
00:07:25
SERGEANT Yeah. Yeah, to four of my buddies. 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.
00:08:10
[He breathes heavily]
00:08:15
OFF CAMERA You look like you’re breathing heavily right now just talking about it.
00:08:20
[Holding back]
00:08:20
SERGEANT Yeah, sorry, sir. I can’t help it.
00:08:30
OFF CAMERA Any other difficulties?
00:08:40
SERGEANT Sometimes my fiance 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.
00:09:40
OFF CAMERA Have you talked to anyone else about this?
00:09:45
SERGEANT Just you. Just now. I don’t want to remember.
00:09:55
OFF CAMERA You’re very brave for sharing your story with me. I know that must be horribly difficult for you.
00:10:05
SERGEANT Sometimes my stomach muscles get tight. I start getting nauseated.
00:10:15
OFF CAMERA Your body is reacting normally to bad events that you’ve experienced.
00:10:20
SERGEANT I don’t want to be a whiner.
00:10:25
OFF CAMERA You know, talking can actually help your brain to heal. Talking takes it out of the feeling mode and puts it into the thinking mode so that you don’t hear those same stories over and over again. So in a way you feel like you’re in control. We could work on this together.
00:10:55
SERGEANT I would like that, sir. Very much.
00:11:00
OFF CAMERA Good. Let’s get you scheduled for an appointment then.
00:11:05
SERGEANT Thank you, sir. 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.
00:11:40
SymptomMedia Visual Learning for Behavioral Health www.symptommedia.com
00:11:40
END TRANSCRIPT
Training Title 21
0:11 / 11:55
In Test Section Index, Episode 21 (Santa Monica, CA: Symptom
