Assessing and Diagnosing Patients With Anxiety, PTSD, and OCD

Assessing and Diagnosing Patients With Anxiety, PTSD, and OCD

Subjective:

CC (chief complaint): “I am feeling some sadness and fear. I guess.”

HPI: 19-year-old male presenting with complaints of sadness and fear. The onset of the feeling was two months ago after he learned that his active duties in the Navy were being extended and that he was supposed to return to Iraq for another tour. He feels pressured to tell people about his sexuality but fears that his mates will be uncomfortable when he opens up. He is worried about what his best non-gay friend and other people in his unit would say and is fearful that those around him may reject him.

Past Psychiatric History:

General Statement: No reports of any mental health illness.

• Hospitalizations:Denies any past hospitalization.
• Medication trials: No reports of any medication trial.
• Psychotherapy or Previous Psychiatric Diagnosis: No history of any mental health illness or psychotherapy.

Substance Current Use and History: Denies current and past use of alcohol or any substance of abuse.

Family Psychiatric/Substance Use History: No history of alcohol or substance use among family members.

Psychosocial: The client is a male gay man. He is single and currently serves in the Navy. He is also a part-time construction mechanic. The client lives alone. He has a dog called Chance.

• Legal Hx: No legal history.

Medical History: No known medical illness.

• Current Medications:No history of current medication use.
• Allergies:No known drug allergies.

ROS:

• GENERAL: Denies weight loss, chills, or fever.
• HEENT: Denies head injuries, previous accidents, visual and hearing loss, nasal discharge, or nasal congestion.
• SKIN:  Denies skin color inconsistencies, skin swelling, or scars.
• CARDIOVASCULAR: Denies palpitations or irregular heart rhythms.
• RESPIRATORY: Denies unusual coughs, wheezing, or difficulty breathing.
• GASTROINTESTINAL: No report of bowel movement inconsistencies, abdominal distension, pain, or tenderness.
• GENITOURINARY: No reports of any urinary problems.
• NEUROLOGICAL: No reports of syncope, headaches, or dizziness.
• MUSCULOSKELETAL: No reports of muscle or joint pain or restricted range of motions of the joints.
• HEMATOLOGIC: No reports of unusual bleeding or anemia.
• LYMPHATICS: No reports of lymph node swelling or splenomegaly.
• ENDOCRINOLOGIC: No reports of diabetes, heat, or cold intolerance.

Objective:

Physical exam: The client seems anxious. All other physicals are negative.

Vital Sign: Temp: 97.0 PR: 70 beats per minute. RR:  18 breaths per minute 116/68mmHg. Ht 5’9 Wt:  175lbs

Diagnostic results: Anxiety disorder is a clinical diagnosis made after history taking and assessment. There is no diagnostic test that confirms these illnesses. Notwithstanding, diagnostic scales, such as the social phobia inventory, can guide SAD diagnosis. These scales capture the symptoms of anxiety disorders, guiding the diagnosis. In the patient’s case presented, these diagnostic scales will be used to determine the exact anxiety disorder (Alomari et al., 2022).

Assessment:

Mental Status Examination: The client is alert and responds to the interview questions. He verbalizes the reason for his healthcare seeking. He is oriented to place, time, and event. His reasoning is logical, and his judgment is goal-directed and logical. His speech is also coherent and normative in tone and volume. His mood is sad. He has a history of suicidal ideation and has considered suicide at some point in his life.

Differential Diagnoses:

Social anxiety disorder ICD-10 Code F40.1: SAD is one of the disorders in the anxiety spectrum disorders. It is characterized by a fear of humiliation, embarrassment, or rejection. According to the Fifth Manual for Diagnostic and Statistical Manual for Mental Health Disorders (DSM-V), a diagnosis of SAD is made in the presence of sustained fear or anxiety in one or more social situations where one is exposed to scrutiny. The social situation, in this respect, provokes anxiety, resulting in psychosocial disruptions. The anxiety must be present for six months for a conclusive diagnosis of SAD (Alomari et al., 2022). The client in the case presented the client had complaints of sadness and fear that started when he learned he was being activated into the military. He attributed his feeling to fearing judgment from others once he opened up about his sexuality. These presentations are aligned with those of SAD as defined by DSM-V.

Generalized anxiety disorder (GAD) ICD-10 Code F41.1:  GAD is characterized by a persistent feeling of fear or worry about things. Patients with GAD will often present with excessive fear or worry that lasts for at least six months and results in significant impairment in the social functioning of the individual. Patients often have difficulty controlling these worries. Additionally, the anxiety symptoms is usually accompanied by other somatic symptoms, such as restlessness, irritability, sleep disturbances, muscle tension, and fatiguability, among others (Mishra & Varma, 2023). This diagnosis is probable due to the presence of sustained anxiety in the patient case presented. However, the absence of other somatic symptoms suggestive of GAD ruled out the diagnosis.

Agoraphobia ICD-10 Code: F40.0 Agoraphobia is characterized by anxiety that manifests in crowded places where the possibility of escape is limited. As per the DSM-V definitions, agoraphobia is marked by sustained fear of an actual or expected exposure to a public or social space (Shin et al., 2020). The patient in the case presented had anxiety. The anxiety was a result of the client’s anticipated return to the clinic. This resembled the manifestation of agoraphobia, warranting the inclusion of this differential. However, assessment findings fell short of detailing the presence of fear in public spaces, ruling out the diagnosis.

Reflections:

The interview detailed diverse assessment aspects of psychiatric illnesses. I agree with the assessment and subsequent diagnosis of the case. Assessment findings and the history revealed features consistent with those of SAD. However, one thing I would have done differently is to perform a thorough physical exam on the client. This would have given insight into somatic presentations and helped diagnose the case. In this case, a legal consideration borders on access to mental healthcare as proclaimed in the Mental Healthcare Act. This act requires that mental healthcare services are provided equally and fairly among all population groups and discourages discriminatory behavior against LGBTQ communities (Malhotra, 2023). An ethical consideration in this case is justice. This principle requires fair and equal distribution of care services across communities. Caregivers, in this respect, should not discriminate against the sexuality of the client. Access to mental healthcare is also a social determinant of health that plays a role in the case (Zabelski et al., 2024). This means that mental healthcare providers should be diligent in providing mental healthcare and refrain from discriminatory behaviors such as bias and labeling. As a point of health prevention and promotion for the client, it is important to educate the client on an appropriate coping strategy and how to disclose information on their sexuality to diverse groups.

 References

Alomari, N. A., Bedaiwi, S. K., Ghasib, A. M., Kabbarah, A. J., Alnefaie, S. A., Hariri, N., Altammar, M. A., Fadhel, A. M., & Altowairqi, F. M. (2022). Social anxiety disorder: Associated conditions and therapeutic approaches. Cureus. https://doi.org/10.7759/cureus.32687

Malhotra, S. (2023). Mental Health Care Act 2017 at five years of its existence. Indian Journal of Psychiatry, 65(9), 971–973. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_538_23

Mishra, A. K., & Varma, A. R. (2023). A comprehensive review of the Generalized Anxiety Disorder. Cureus. https://doi.org/10.7759/cureus.46115

Shin, J., Park, D.-H., Ryu, S.-H., Ha, J. H., Kim, S. M., & Jeon, H. J. (2020). Clinical implications of agoraphobia in patients with panic disorder. Medicine, 99(30). https://doi.org/10.1097/md.0000000000021414

Zabelski, S., Hollander, M., & Alexander, A. (2024). Addressing inequities in access to Mental Healthcare: A policy analysis of community mental health systems serving minoritized populations in North Carolina. Administration and Policy in Mental Health and Mental Health Services Research, 51(4), 543–553. https://doi.org/10.1007/s10488-024-01344-8

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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.

Assessing and Diagnosing Patients With Anxiety, PTSD, and OCD

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.

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

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-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.).