NRNP 6635 Week 4 Assignment

Week 4: Anxiety Disorders, PTSD, And OCD

Your own experiences might tell you that expectations from family, friends, and work—as well as your own expectations regarding achievement, success, and happiness—can create stress. Stressors are a normal part of life, and stress traditionally has been viewed as an adaptive function with a set of physiological responses to a stressor. In a situation where stress is perceived, the organism is physiologically prepared to attack or flee from the threat.

Those with effective fight or flight responses tended to survive long enough to reproduce, so we are descended from those who are genetically hardwired for self-protection. When you experience stress, your biology, emotions, social support, motivation, environment, attitude, immune function, and wellness all feel the ripple effect.

This stress response is an adaptive response the human body has to threats; however, stress can also be difficult to handle and—depending upon the nature and intensity of the stress—can result in anxiety disorders, obsessive-compulsive disorders, or traumaand stressor-related disorders. This week, you will focus on these disorders and explore strategies to accurately assess and diagnose them.

Learning Objectives

Students will:

  • Apply concepts, theories, and principles related to patient interviewing, diagnostic reasoning, and recording patient information
  • Formulate differential diagnoses using DSM-5 criteria for patients with anxiety disorders, PTSD, and OCD across the lifespan

Learning Resources

  • American Psychiatric Association. (2013). Anxiety disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm05
  • American Psychiatric Association. (2013). Obsessive compulsive and related disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm06
  • American Psychiatric Association. (2013). Trauma- and stressor-related disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm07
  • 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

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.

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 symptomatology 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 15

Name: Mr. David Jackson Gender: male

Age:19 years old

T- 98.8 P- 89 R 18 110/62 Ht 5’7 Wt 133lbs

Background: Lives in Minneapolis, MN with both of his parents, only child. Works part time at Starbucks. Not currently partnered. No previous psychiatric history. Symptoms began in the last

1.5 months when he discovered he was being activated with the Navy Reserves. His MOS is SK1 Storekeeper; no medical illnesses Allergies: NKDA; sleeps 6.5 hrs; appetite good

Symptom Media. (Producer). (2017). Training title 15 [Video].

https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-15

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 Weight 167 lbs

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-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-21

Training Title 37 Name: Mr. Tony Patelli Gender: male

Age:18 years old

T- 98.8 P- 94 R 20 126/88 Ht 5’4 Wt 131 lbs

Background: Lives alone in New York, raised by parents in New Jersey, only child. He is a full- time student at local community college for graphic design. 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 7.5 hrs; appetite eats 3 meals/day, likes to keep a routine schedule.

Symptom Media. (Producer). (2016). Training title 37 [Video].

https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-37

Training Title 40

Name: Ms. Barbara Weidre Gender: female

Age: 56 years old

T- 99.0 P- 99 R 24 132/89 Ht 5’4 Weight 168 lbs

Background: Lives with her husband in Knoxville, TN, has one daughter age 23. She has never worked. Raised by mother, she never knew her father. Mother with hx of anxiety; no substance hx for patient or family. No previous psychiatric treatment. Have one glass of red wine with dinner. Sleep 10-12 hrs; appetite decreased. Has overactive bladder, untreated. Allergic to Phenergan; complains of headaches, takes prn ibuprofen, has diarrhea once weekly, takes OTC Imodium.

Symptom Media. (Producer). (2016). Training title 40 [Video].

https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-40

Training Title 55 Name: Matilda Johnson Gender: female

Age: 9 years old

She refused vitals, ht and wt

Vaccinations are up to date; on target with developmental milestones. Appetite, she is a picky eater per mom. NKDA

Symptom Media. (Producer). (2017). Training title 55 [Video].

https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-55

Training Title 85

Name: Mrs. Carol Holliman Gender: female

Age: 42 years old

T- 98.0 P- 77 R 18 132/72 Ht 5’0 Wt 127 lbs

Background: Born and raised in Northern Ireland, parents brought her and her 5 sisters to the U.S. when she was 15 to go to U.S. university where she met her husband. They live in Charleston, SC. She obtained her bachelor’s degree in education; no history of mental health or substance use treatment, no family history. Her husband reported a recent school shooting nearby 3 weeks ago “flipped a switch” on her. She is watching the news 24/7, barely sleeping, and even when she does, it is only a few hours, Appetite is decreased. Hx of hysterectomy, NKDA, no legal hx.

Symptom Media. (Producer). (2017). Training title 85 [Video].

https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-85

Training Title 95

Name: Ms. Zahara Williams Gender: female

Age: 23 years old

T- 97.5 P- 86 R 18 112/64 Ht 5’2 Weight 130 lbs

Background: Born and raised in Jacksonville, FL with her mother and 2 older brothers; her mother has hx of anxiety, brothers hx of cannabis; no previous mental health treatment, no medications; NKDA; no legal hx; sleeping 7 hrs; Appetite is good.

She has an associate of arts degree and works for Amazon warehouse. She has had DX of diabetes since age 5. She recalls having great difficulty with her medical condition

(uncontrolled blood sugar, fighting with mother over needle sticks, “kids want candy, and I was so different because of my diet”). She recalls having a difficult relationship with her mother who was a nurse and

really worked hard to control her daughter’s diabetes. She is not in a relationship, identifies as lesbian but has not come out to the family. Only her closest co-workers know she is gay, and she doesn’t plan to come out in the near future. She stated, “I don’t see why I would, they wouldn’t understand, and this is not important right now.”

Symptom Media. (Producer). (2018). Training title 95 [Video].

https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-95