Anxiety Disorders
Anxiety disorders.Required reading
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
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 blow
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
AND
the Rubric as your guide. It is also helpful to review the rubric in detail in order not to lose points unnecessarily because you missed something required. Below highlights by category are taken directly from the grading rubric for the assignment in Weeks 4–10. After reviewing the full details of the rubric, you can use it as a guide.
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,
presented in paragraph form.
· 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.
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
.
· 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 (
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.).
(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
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 trauma- and stressor-related disorders. This week, you will focus on these disorders and explore strategies to accurately assess and diagnose them.
Objectives
· 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
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:
· select a specific video case study to use for this Assignme
1
6
Assignment template
Subjective Section
Chief complainant
The patient starts by saying, “I can’t stop crying, all the time.” The patient complains that since she gave birth to her child two months ago, she has been experiencing mood disorders and difficulties falling asleep even after the baby is already asleep. She complains that especially when the baby cries, she loses her appetite and is not comfortable with her new body shape and size. She says nothing interests her, even writing, which was one of the things she loved before she gave birth. She does not want to contact her friends, and everything seems to be upsetting her.
History of present illness (HPI)
L.T is a 32-year-old black female who resents for psychiatric evaluation due to mood depression. The patient has not been prescribed any psychotropic drugs recently.
Past psychiatric history
The patient has never been examined or treated for any mental disorders in the past. Recently she was hospitalized for a standard childbirth procedure.
Medication trials and current medication
She has not tried any medications in the past, neither is she under any medication currently.
Psychotherapy or previous psychiatric diagnosis
The patient has no history of psychiatric illness and has not been diagnosed or treated with any mental health disorder.
Pertinent substance use, social, and medical history
The patient denies any use of alcohol or cases of drug abuse in the family. Although she says that her uncle was not an opioid abuser, he committed suicide using GSW. She is married and currently lives with her husband with their two kids. She has been working in the retail business for the past five years, but currently, she is a housewife. The patient grew up with her sister together with her both parents. She has been diagnosed with hypertension recently, and she is taking drugs labelled as labetalol 100mg for HTN, which she says that she sometimes forgets to take them. The patient has no legal history or any issues related to violence.
Allergies
L.T is allergic to codeine. She gave birth two months ago, which automatically means that she is lactating. Currently, she is not using any form of contraceptive, and she has had no desire for sex since she gave birth.
ROS
General: No weight loss, fatigue or chills experienced by the patient.
HEET: Her vision is the same no issues of double vision or jaundice. Her ears, nose and throat are okay.
Skin: Her skin has not changed either is she having rashes.
Cardiovascular: No chest discomfort or pains.
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