Case 21

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“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. 

 

Here is the link. If you cannot access the video below is the transcript

 

 

https://video.alexanderstreet.com/p/Z8WWO67zw

 

Training Title 21Name: Sergeant Berry Sullivan Gender: maleAge:27 years old T- 98.8 P- 86 R 18 B/P 122/7 Ht 5’8 Wt 160lbsBackground: He entered the military just after high school and did three long tours of duty in war zones. He separated from active duty in the Marines (MOS 0800 Field Artillery) six months ago after eight years of service. He is engaged to be married in 8 months and is using his GIEducation Bill to attend online college for accounting. 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 “abusive when he was drunk.” Father is still alive, unwell (DM, cirrhosis,HTN), still drinking. The paternal grandfather was also a veteran and suffered depression at timesthough he never told anyone except the patient because of their combat connection. He has oneyounger brother and one older sister. He lives in a different state, approximately five hours fromhis parents and siblings. After the military, he and his fiancé moved because she got a much

better opportunity. They want kids someday. Has service-connected asthma, seasonal allergies;no hx of psychiatric or substance use treatment.Symptom Media. (Producer). (2016). Training title 21 [Video].https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-21

 

 

00:00:00TRANSCRIPT OF VIDEO FILE: 

00:00:00______________________________________________________________________________ 

00:00:00BEGIN TRANSCRIPT: 

00:00:00[sil.] 

00:00:15OFF CAMERA Nice to meet you Sergeant. I’m Dr. Schwartz. 

00:00:20SERGEANT Nice to meet you, sir. 

00:00:25OFF CAMERA Can you tell me why you came here today. 

00:00:30SERGEANT My fiance suggested, well demanded that I make an appointment. 

00:00:40OFF CAMERA Why was she concerned? 

00:00:45[Sighs] 

00:00:45SERGEANT 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. 

00:01:15OFF CAMERA So all was going well. 

00:01:20SERGEANT Then these fire works go off. No warning. Just big, full sky explosions. 

00:01:30OFF CAMERA Like county fairs do. 

00:01:35SERGEANT I didn’t know they did that. 

00:01:40OFF CAMERA Then what happened? 

00:01:45SERGEANT I took off running. Fast as I could. Tried to find cover. 

00:01:55OFF CAMERA Frightened? 

00:02:00SERGEANT [Sighs] Yeah, scared the… you know, out of me. 

00:02:10OFF CAMERA You didn’t expect the fire works. 

00:02:10SERGEANT 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. 

00:02:30OFF CAMERA Wow. 

00:02:35SERGEANT So I yelled “I’m a combat veteran sir.” Immediately they backed off. They were veterans, understood. 

00:02:50OFF CAMERA They understood that the fireworks sounded like combat fire? 

00:02:55SERGEANT Yeah, exactly sir. God. [Sighs, quivering]. They helped me to my feet, gave me some cold water. I was shaking pretty bad. 

00:03:10OFF CAMERA So they were helpful? 

00:03:15SERGEANT Yeah, absolutely. 

00:03:20OFF CAMERA The explosive sounds took you back in time. 

00:03:25SERGEANT I was… I was right back in the middle of enemy fire, sir. 

00:03:35OFF CAMERA What about other loud noises? 

00:03:40SERGEANT 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. 

00:04:05OFF CAMERA Are there any smells that set you off? 

00:04:10SERGEANT 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. 

00:04:55OFF CAMERA What came to mind? 

00:05:00[He pauses, struggling to hold back tears]. 

00:05:10SERGEANT Two of my buddies, they got burned when their Humvee was blown and I smelled their… I’d rather not talk about that, sir. 

00:05:40OFF CAMERA Memories are too strong? 

00:05:45SERGEANT Yeah, way too strong. 

 

Citation for video 

 

 Training Title 21. . (2016).[Video/DVD] Symptom Media. Retrieved from https://video.alexanderstreet.com/watch/training-title-21

 

 

 

  • 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.

 

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.).

Week 3 Due 3/16

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Accurately diagnosing depressive disorders can be challenging given their periodic and, at times, cyclic nature. Some of these disorders occur in response to stressors and, depending on the cultural history of the client, may affect their decision to seek treatment. Bipolar disorders can also be difficult to properly diagnose. While clients with bipolar or related disorders will likely have to contend with the disorder indefinitely, many find that the use of medication and evidence-based treatments have favorable outcomes.

 

  • Review this week’s Learning Resources. Consider the insights they provide about assessing and diagnosing mood 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.

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.).

SOME REFERENCES

  • American Psychiatric Association. (2022). Bipolar and related disorders. In Diagnostic and statistical manual of mental disordersLinks to an external site. (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url= https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x03_Bipolar_and_Related_Disorders
  • American Psychiatric Association. (2022). Depressive disorders. In Diagnostic and statistical manual of mental disordersLinks to an external site. (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x04_Depressive_Disorders
  • Boland, R. & Verduin, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.
    • Chapter 2 -only sections 2.9, “Depressive Disorders and Suicide in Children and  Adolescents” 2.10 Early-Onset Bipolar Disorder”, and 2.11 “Disruptive Mood Dysregulation Disorder”
    • Chapter 6 “Bipolar Disorders”
    • Chapter 7 “Depressive Disorders”

 

 

Name: Mr. Elijah Loman Gender: male Age:20 years old T- 97.2 P- 84 R 18 118/68 Ht 5’7 Wt 156 lbs Background: Currently lives with his sister and her husband who are his legal guardians as parents deceased when he was 15 and he was deemed to need a fiduciary and guardian by the court system. Not currently employed. Completed high school, not currently in school. Hx of treatment for mood disorder began age 15, previous trials of Depakote, Quetiapine off and on, side effects of akathisia. Has hx of a multiple hospitalization, last was 4 months ago when he exposed his genitals to girls at the mall. . Not currently partnered. He is currently in hospital admitted one week ago, was initiated on lithium 300mg po three times daily and risperidone 1mg at bedtime. Denies any recent alcohol or substance use. Paternal uncle has history of bipolar disorder. No history of self-harm behaviors, no family suicides. Appetite is decreased. No medical hx; hospital admission labs within normal ranges, UDS negative; Hx of truancy as a juvenile. Has pending court date for indecent exposure. Allergies NKDA 

 

***LINK FOR SELECTED VIDEO***

https://video-alexanderstreet-com.eu1.proxy.openathens.net/watch/training-title-43

Week 2 Discussion

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Assessment tools have two primary purposes: 1) to measure illness and diagnose clients, and 2) to measure a client’s response to treatment. Often, you will find that multiple assessment tools are designed to measure the same condition or response. Not all tools, however, are appropriate for use in all clinical situations. You must consider the strengths and weaknesses of each tool to select the appropriate assessment tool for your client. For this Discussion, as you examine the assessment tool assigned to you by the Course Instructor, consider its use in psychotherapy.

 

  • Review this week’s Learning Resources and reflect on the insights they provide regarding psychiatric assessment and diagnosis.
  • Consider the elements of the psychiatric interview, history, and examination.
  • Consider the assessment tool assigned to you by the Course Instructor.

Post a brief explanation of three important components of the psychiatric interview and why you consider these elements important. Explain the psychometric properties of the rating scale you were assigned. Explain when it is appropriate to use this rating scale with clients during the psychiatric interview and how the scale is helpful to a nurse practitioner’s psychiatric assessment. Support your approach with evidence-based literature.

Upload a copy of your discussion writing to the draft Turnitin for plagiarism check.  Your faculty holds the academic freedom to not accept your work and grade at a zero if your work is not uploaded as a draft submission to Turnitin as instructed.

Read a selection of your colleagues’ responses.