Understanding Chief Symptomatology for Diagnosis of Anxiety Obsessive-Compulsive and Trauma and Stressor-Related Disorders

Understanding Chief Symptomatology for Diagnosis of Anxiety Obsessive-Compulsive and Trauma and Stressor-Related Disorders

Subjective:

CC (chief complaint): The case is of a seven-year-old male child presenting with extreme worry. He worries about everything most of the time.

HPI: D.C is a seven-year-old male child brought to the clinic by his mother. The child has been worrying a lot about getting lost and losing his mother and brother. His worries seem to affect his schooling, as he always has trouble at school. Collaborative history from the mother revealed that he is anxious and worried all the time about her mother dying and not being able to pick him up from school. Additionally, he has difficulty getting to sleep and often wants the doors open and lights on as he goes to sleep. He also wakes up from sleep frequently. He also wants to return home from school, citing complaints of stomach aches and headaches. His mother also reported that he doesn’t eat and has lost three pounds in the past three weeks. The client still wets his bed and doesn’t bathe regularly. This has made him be called names at school.

Substance Current Use: The client has a negative history of substance abuse.

Medical History: 

The client has a negative history of hospitalization, head accidents, or injuries.

Current Medications: The client is currently not on any medications and has never used any psychotropic agents.

Allergies: The client has no known allergies.

Reproductive Hx: No reports of maternal pregnancy and birthing complications, as well as drugs and substance use during maternal pregnancy.

ROS:

GENERAL: The client is a seven-year-old male child. He has lost three pounds in the last three weeks.

HEENT: The client has a negative history of head injuries and eye or ear disorders. He denies using any visual and hearing aids. He also has no eye or ear discharge. His vision is intact. He denies having any nasal discharge, congestion, or swelling. Also, no sneezing, discharge, sore throat, or pain during swallowing was reported.

SKIN: No skin lesion, swelling, tenderness, or inflammation reported.

CARDIOVASCULAR: No reports of palpitations, chest pain, chest discomfort, and edema on the extremities.

RESPIRATORY: No reports of shortness of breath, sputum production on cough, and coughing.

GASTROINTESTINAL: No bowel movement inconsistencies were reported. Additionally, there were no reports of melena stool or abdominal pain.

GENITOURINARY: No urinary frequency, urgency, or pain during urination was reported. There were also no reports of urinary discoloration, odor, hesitancy, or polyuria.

NEUROLOGICAL: There were negative reports of syncope, changes in bladder and bowel control, and ataxia. There was also no report of dizziness, seizures, tremors, or weakness in the extremities.

MUSCULOSKELETAL: No reports of joint swelling, tenderness, or limited range of motion on the joints. There were also no reports of joint stiffness and pain.

HEMATOLOGIC: No reports of use of any blood thinners. There were also no reports of bruising, clotting issues, or anemia.

LYMPHATICS: The client has a negative history of lymphatic glandular swelling or splenectomy.

ENDOCRINOLOGIC: There were no reports of excessive sweating or heat and cold intolerance.

Objective:

 Diagnostic results: The clients in the case presented with symptoms suggestive of generalized anxiety disorders. The generalized anxiety disorder 7-item tool (GAD-7) is a self-report diagnostic equipment for screening and assessing the severity of anxiety disorder. These findings can inform the initiation of therapy, the choice of therapy, and how the disorder is responding to medications.

Assessment:

Mental Status Examination:

The client is a seven-year-old male child. He is alert and oriented to the place, time, and event. He is cooperative and responds well to the questions asked. His speech is coherent, clear, and normative intonation and volume. His judgment is intact, logical, and appropriate for his age. He denied having thoughts of self-harm.

Diagnostic Impression: 

The client in the case had generalized anxiety disorder. Generalized anxiety disorder is a mental health disorder prominent in children and adolescents. Pediatric generalized anxiety disorders occur in 10 % of children and adolescents (Mohammadi et al., 2020). It is characterized by symptoms of extreme and uncontrollable worry about diverse events that are often not considered high risk. This manifestation is often accompanied by physical symptoms such as gastrointestinal distress, headaches, and palpitations. As per the fifth edition of the Diagnostic and Statistical Manual for Mental Health Disorders (DSM-V), a positive diagnosis for pediatric generalized anxiety disorder is made in the presence of excessive and uncontrollable worry that impairs social and schooling functioning. These symptoms must have been present for multiple days, not less than six months.

As evident in the case presented, the client’s presentations were consistent with those detailed in DSM-V. He was a seven-year-old male. He had extreme and uncontrollable worry about everything. Additionally, his anxiety affected his social and school functioning. Several other manifestations were supportive of the GAD diagnosis. These included the presence of physical symptoms of GAD, such as headaches and GI distress. :

Differentials

The differentials, in this case, were panic disorder and bipolar disorder. Panic disorder is characterized by sudden and repetitive panic attacks. These attacks are of intense fear of anxiety that often last a minute or an hour. This diagnosis was ruled out because the anxiety seen in the child lacked spontaneity and surrounded every aspect of the child’s life. Bipolar disorder was also a probable diagnosis in the case. Its inclusion was also warranted because of the anxiety. Anxiety episodes are a common feature of the manic or hypomanic phase of bipolar disorders. The impulsivity seen in the manic and hypomanic phases of bipolar disorder was, however, lacking in this case. Additionally, there were no manifestations of depressive episodes in the child’s history. These findings helped in ruling out bipolar disorder.

 Reflections:

The case presented was of a seven-year-old child. His manifestations were consistent with those of pediatric generalized anxiety disorders as detailed in DSM-V. I, therefore, agree with the preceptor’s assessment and diagnostic impression of the child. The case gave me insight into pediatric GAD. It helped me contextualize how to prioritize differential diagnoses and utilize subjective findings to make the best prediction on a diagnosis. In this case, there is nothing that I would have done differently.

When caring for the child, there are several ethical and legal considerations. Competency during care is essential. Per the standards of competence, caregivers must maintain tolerance to their clients’ emotions and, at the same time, not allow themselves to be affected by the anxiety or fear that their clients present with (Disla de Jesus et al., 2022). In this case, the burden lies on the caregivers to determine whether they have emotional tolerance before proceeding with the care process.

Consistently, the ethical principle of beneficence and non-maleficence implores caregivers to maximize the benefits of therapy while minimizing risk to the clients. In this case, caregivers are obligated to initiate therapeutic programs that optimize the child’s school and social functioning while alleviating his intense and uncontrollable worry. In the spirit of beneficence and non-maleficence, caregivers reserve the obligation to protect patients with mental health disorders from traditional barriers to mental healthcare, such as stigmatization and neglect. This is especially important if the client comes from ethnic minority groups. According to Eylem et al. (2020), ethnic minority groups are disproportionately affected by mental health illnesses. This is attributed, in part, to the differences in their perception of these illnesses. The caregiver’s role, in this regard, is to educate the client and their families on these illnesses, enhance their understanding of these disorders, and prevent them from stigmatizing these illnesses. They should also educate these communities on the risk factors for these illnesses, such as history of these illnesses and substance abuse. These interventions may help in lessening the stigma against mental health disorders and lessening disparities associated with socioeconomic classes and cultural backgrounds.

Case Formulation and Treatment Plan:

The client was diagnosed with pediatric GAD. He can benefit from psychotherapy using cognitive behavioral therapy (CBT) and pharmacotherapy. CBT maintains effectiveness in the management of GAD (Cybulski et al., 2022). In this case, the client will be scheduled for CBT sessions. If CBT fails to alleviate the client’s suffering, he will be treated using anti-anxiety medications. These include antidepressants such as selective serotonin reuptake inhibitors (SSRIs), anti-psychotic medications, benzodiazepines, or buspirone. The child will be reviewed after two weeks of CBT therapy sessions.

References

Cybulski, L., Ashcroft, D. M., Carr, M. J., Garg, S., Chew-Graham, C. A., Kapur, N., & Webb, R. T. (2022). Management of Anxiety Disorders among children and adolescents in UK primary care: A cohort study. Journal of Affective Disorders, 313, 270–277. https://doi.org/10.1016/j.jad.2022.07.002

Disla de Jesus, V., Liem, A., Borra, D., & Appel, J. M. (2022). Who’s the boss? Ethical dilemmas in the treatment of children and adolescents. FOCUS, 20(2), 215–219. https://doi.org/10.1176/appi.focus.20210037

Eylem, O., de Wit, L., van Straten, A., Steubl, L., Melissourgaki, Z., Danışman, G. T., de Vries, R., Kerkhof, A. J., Bhui, K., & Cuijpers, P. (2020). Stigma for common mental disorders in racial minorities and majorities a systematic review and meta-analysis. BMC Public Health, 20(1). https://doi.org/10.1186/s12889-020-08964-3

Mohammadi, M. R., Pourdehghan, P., Mostafavi, S.-A., Hooshyari, Z., Ahmadi, N., & Khaleghi, A. (2020). Generalized anxiety disorder: Prevalence, predictors, and comorbidity in children and adolescents. Journal of Anxiety Disorders, 73, 102234. https://doi.org/10.1016/

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WK 3 FOCUSED SOAP NOTES FOR ANXIETY, PTSD, AND OCD
In assessing patients with anxiety, obsessive-compulsive, trauma, and stressor-related disorders, you will continue the practice of looking to understand chief symptomology in order to develop a diagnosis. With a differential diagnosis in mind, you can then move to a treatment and follow-up plan that may involve both psychopharmacologic and psychotherapeutic approaches.

In this Assignment, you use a case study to develop a focused SOAP note based on evidence-based approaches.
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TO PREPARE
Review this week’s Learning Resources. Consider the insights they provide about assessing and diagnosing anxiety, obsessive-compulsive, and trauma-related disorders.
Review the Focused SOAP Note template, which you will use to complete this Assignment. There is also a Focused SOAP Note Exemplar provided as a guide for Assignment expectations.
Review the video, Case Study: Dev Cordoba. You will use this case as the basis of this Assignment. In this video, a Walden faculty member is assessing a mock patient. The patient will be represented onscreen as an avatar.
Consider what history would be necessary to collect from this patient.
Consider what interview questions you would need to ask this patient.
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THE ASSIGNMENT
Develop a Focused SOAP Note, 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-TR criteria rule 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.
Plan: What is your plan for psychotherapy? What is your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan. Also, one health promotion activity and one patient education strategy should be incorporated.
Reflection notes: What would you do differently with this patient if you could conduct the session again? Discuss what your next intervention would be if you could follow up with this patient. 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.).
Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).