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.
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.).
PLEASE FOLLOW THE INSTRUCTIONS AS INDICATED BELOW:
1). ZERO (0) PLAGIARISM
2). AT LEAST 5 REFERENCES, NO MORE THAN 5 YEARS (WITHIN 5YRS, OR LESS THAN 5YRS)
3). PLEASE SEE THE ATTACHED RUBRIC DETAILS, Exemplar & Template, week4 anxiety disorder, PTSD and OCD Comprehensive Psychiatric evaluation Template, and the video transcripts.
Rubric Detail
Select Grid View or List View to change the rubric’s layout.
Content
Name: NRNP_6635_Week4_Assignment_Rubric
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Create documentation in the Comprehensive Psychiatric Evaluation Template about the patient you selected.
In the Subjective section, provide: |
Points: Points Range: 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. Feedback: |
Points: Points Range: 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. Feedback: |
Points: Points Range: 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. Feedback: |
Points: Points Range: The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history o ______________________________________________________________________________ 00:00:00 BEGIN TRANSCRIPT: TRAINING TITLE 15 00:00:15 OFF CAMERA So you, you said you were in the reserves? Inactive duty? 00:00:20 PATIENT Well, I was inactive duty. But then I learned that they are using the stop-loss policy to extend our active duties. We have to all return to Iraq for another tour. 00:00:30 OFF CAMERA Was that upsetting? 00:00:30 PATIENT I can’t even begin to describe what I am feeling. 00:00:35 OFF CAMERA Tell me about why you decided to make an appointment with a psychiatrist. 00:00:40PATIENT Some questions I can answer. Sadness. Fear I guess. But other, other questions I can’t find the answers to. 00:00:55[sil.] 00:01:00 OFF CAMERA Go ahead. 00:01:05 PATIENT You know how they repealed the “Don’t ask don’t tell” policy? Well, I’m struggling if I should… You don’t have to report what I tell you, do you? 00:01:20 OFF CAMERA Well, it’s similar to civilian life, the military is under the same HIPPA laws. So if somebody, if one wants to look at your record, medical, only medical personnel can look in your record and only with a medical reason. And, no one else is allowed access. Any private, personal issues you have, which don’t break a law or a military rule, those are not reported. Someone could always illegally access your record, but that would be prosecuted. 00:02:00 PATIENT Good. I guess you can figure out, well, I can’t figure out whether I should tell people when I go back. 00:02:15 OFF CAMERA So have you been weighing the pros and cons of, the advantages and disadvantages about telling people about your sexuality? 00:02:25 PATIENT Everyday. 00:02:25 OFF CAMERA What do you feel are the pressures for you to tell people? 00:02:30 PATIENT It’s miserable enough being over there just being a soldier, on top of that you have to listen to all these gay comments: “Oh Johnston, you look a fag when you wear your head gear like that.” 00:02:45 OFF CAMERA Uh, huh. Who is Johnston? 00:02:45 PATIENT He’s one of my best friends. 00:02:50 OFF CAMERA Is he gay or someone who has homosexual-type thoughts? 00:02:55 PATIENT Johnston. No. Never. 00:02:55 OFF CAMERA Why do you say that? 00:03:00 PATIENT I don’t know. I can just feel it, sense it, that he’s not gay. 00:03:05 OFF CAMERA Okay. So, if I play, permit me to play the devil’s advocate, maybe there are others feel they know, can already feel whether you are gay or not. 00:03:15 PATIENT No. I hide it. I’m very careful. 00:03:20 OFF CAMERA Uh huh. I see. 00:03:20 PATIENT If I told the other people in my unit, the men and the women, they’d be surprised. I promise. 00:03:30 OFF CAMERA So you think that they all fell for the “lies” as you call it, about your sexu NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Template Week 4 (enter week #): (Enter assignment title) Student Name College of Nursing-PMHNP, Walden University NRNP 6635: Psychopathology and Diagnostic Reasoning Faculty Name Assignment Due Date Subjective: CC (chief complaint): HPI: Past Psychiatric History: · General Statement: · Caregivers (if applicable): · Hospitalizations: · Medication trials: · Psychotherapy or Previous Psychiatric Diagnosis: Substance Current Use and History: Family Psychiatric/Substance Use History: Psychosocial History: Medical History: · Current Medications: · Allergies: · Reproductive Hx: ROS: · GENERAL: · HEENT: · SKIN: · CARDIOVASCULAR: · RESPIRATORY: · GASTROINTESTINAL: · GENITOURINARY: · NEUROLOGICAL: · MUSCULOSKELETAL: · HEMATOLOGIC: · LYMPHATICS: · ENDOCRINOLOGIC: Objective: Physical exam: if applicable Diagnostic results: Assessment: Mental Status Examination: Differential Diagnoses: Reflections: References © 2021 Walden University Page 1 of 3 Training Title 2 In BEGIN TRANSCRIPT: 00:00:00[sil.] 00:00:15OFF CAMERA Why did your mom feel you should come in and talk with me today? 00:00:20MRS HOUSTON She was worried. Mom says I get moody this time of year, every year. I don’t know. Maybe. 00:00:40OFF CAMERA How are you feeling, when? 00:00:45PATIENT Not great. 00:00:45OFF CAMERA What’s not great? 00:00:50PATIENT Huh. Just down. I’m not doing so well. 00:01:05OFF CAMERA How’s school? 00:01:05PATIENT Ok. 00:01:10OFF CAMERA Just ok? 00:01:15PATIENT Yeah. I left the program at school. I mean I did and… I’m not doing so well. 00:01:25OFF CAMERA Are the courses difficult? 00:01:30[sil.] 00:01:35PATIENT I understand everything. The teachers are getting to be a bit of a pain. The classes aren’t lustrous (Sighs). I’m in this special business program, where you have to come up with a mock company. I just… I just can’t seem to get it done. That, and all my other projects. I’m already late on two of them. 00:02:25OFF CAMERA Are you having difficult concentrating? 00:02:30PATIENT Yeah. I’ll read the headlines in the newspaper and like, five seconds later, I can’t remember what I read. And my classes, when I leave the room, I don’t what we were learning about. 00:02:55OFF CAMERA Are you having any irregular sleeping or eating patterns? 00:03:05PATIENT (Sighs) I’ve gained ten pounds. Umm… I’ve slept through five of my classes this month if that answers your question. 00:03:20OFF CAMERA Have you been able to make any friends? 00:03:25PATIENT [Shrugs] Yeah. Almost immediately. The people are a lot of fun. 00:03:30OFF CAMERA What do you do with them? 00:03:35PATIENT Lately, not so much of anything. 00:03:45OFF CAMERA What happened? 00:03:50PATIENT Well, it was a blast when I arrived in August. I made friends almost immediately. We went to concerts and shows, we hung out. And we had a lot of fun. 00:04:15OFF CAMERA You don’t do any of that now? 00:04:20PATIENT They kind of annoy me a little bit. I mean nothing I can’t get over. They got really dull. They suddenly started playing board games… and then, things also got busy and with the weather, I don’t want to go outside. 00:04:45OFF CAMERA Do you particularly dislike the cold weather? 00:04:50PATIENT It’s not like I have a burning passionate hatred for the cold. I’ve always fretted fall and winter. I’m a summer girl. I like t NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar INSTRUCTIONS ON HOW TO USE EXEMPLAR AND TEMPLATE—READ CAREFULLY If you are struggling with the format or remembering what to include, follow the Comprehensive Psychiatric Evaluation Template 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 · Read rating descriptions to see the grading standards! In 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. · Read rating descriptions to see the grading standards! In the Assessment section, provide: · Results of the mental status examination, · At least three differentials with supporting evidence. List them from top priority to least 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. · Read rating descriptions to see the grading standards! Reflect on this case. Include: Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations ( (The comprehensive evaluation is typically the initial new patient evaluation. You will practice writing this type of note in this course. You will be ruling out other mental illnesses so often you will write up what symptoms are present and what symptoms are not present from illnesses to demonstrat 
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