For this Assignment, you practice assessing and diagnosing patients with anxiety disorders, PTSD, and OCD. Review the?DSM-5-TR?criteria for the disorders withi
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.
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.
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 trauma- and 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-TR criteria for patients with anxiety disorders, PTSD, and OCD across the lifespan
Assignment: Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD
“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.
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.
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.
For the assignment
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.).
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, Comprehensive Psychiatric Evaluation Exemplar, Comprehensive Psychiatric Evaluation Template, Patient History Report.
4). Please review and follow the grading rubric details, and include each component in the assignment as required. Also, follow the APA 7 writing rules and style/Format.
Learning Resources
https://www.youtube.com/watch?v=-BwzQF9DTlY
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NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Template
Week (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
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NRNP 6635 Case History Reports
Use these case histories to supplement the information about the patients in the video case studies.
Table of Contents
Week 3: Mood Disorders………………………………………………………………………………………….. 3
Training Title 2 ……………………………………………………………………………………………………………….3
Training Title 8 ……………………………………………………………………………………………………………….3
Training Title 18 ……………………………………………………………………………………………………………..3
Training Title 28 ……………………………………………………………………………………………………………..4
Training Title 38 ……………………………………………………………………………………………………………..4
Training Title 43 ……………………………………………………………………………………………………………..5
Training Title 150 ……………………………………………………………………………………………………………5
Training Title 118 ……………………………………………………………………………………………………………6
Training Title 144 ……………………………………………………………………………………………………………6
Week 4: Anxiety Disorders, PTSD, and OCD …………………………………………………………………. 7
Training Title 15 ……………………………………………………………………………………………………………..7
Training Title 21 ……………………………………………………………………………………………………………..7
Training Title 37 ……………………………………………………………………………………………………………..8
Training Title 40 ……………………………………………………………………………………………………………..8
Training Title 55 ……………………………………………………………………………………………………………..8
Training Title 85 ……………………………………………………………………………………………………………..9
Training Title 95 ……………………………………………………………………………………………………………..9
Week 7 Schizophrenia and Other Psychotic Disorders; Medication-Induced Movement Disorders …………………………………………………………………………………………………………….. 10
Training Title 9 …………………………………………………………………………………………………………….. 10
Training Title 24 …………………………………………………………………………………………………………… 10
Training Title 29 …………………………………………………………………………………………………………… 10
Training Title 134 …………………………………………………………………………………………………………. 11
Week 8 Substance-Related and Addictive Disorders ……………………………………………………. 11
Training Title 82 …………………………………………………………………………………………………………… 11
Training Title 114 …………………………………………………………………………………………………………. 12
Training Title 151 …………………………………………………………………………………………………………. 12
Week 10 Neurocognitive and Neurodevelopmental Disorders ………………………………………. 13
Training Title 48 …………………………………………………………………………………………………………… 13
Training Title 50 …………………………………………………………………………………………………………… 13
Week 3: Mood Disorders
Training Title 2
Name: Ms. Natalie Crew Gender: female Age:17 years old T 97.4 P-82 R-1 20 128/84 Ht 5’2” Wt 192lbs Background: Recently started an accelerated high school business program in Chicago, Illinois after growing up and living in New Orleans her whole life. Grew up with both parents and four brothers. Currently lives in on a specialty high school campus dormitory. Currently a full-time student and works part time in the local coffee shop. Not married, currently single. She has no previous psychiatric history; takes no medications. There is history of depression, denied substance use history for her or family. No legal hx NKDA
Symptom Media. (Producer). (2016). Training title 2 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-2
Training Title 8
Name: Mrs. Abrianna Tilman Gender: female Age: 27 years old T- 98.6 P- 88 R 18 154/92 Ht 5’1 Wt 230lbs Background: Recently had her first child two months ago. Currently married; stay at home mother after working in community library for 5 years. Grew up with her mother after her parents divorced when she was 16; has two sisters in Troy, Alabama. Completed education through bachelor’s level, majoring in English Literature. No previous suicidal gestures. Brother committed suicide via GSW. She denied drugs/alcohol; brother was addicted to methamphetamines. Hx of HTN-prescribed Trandate 100mg twice daily, admits to missing doses due to forgetting. No legal hx. Allergies: PCN Symptom Media. (Producer). (2016). Training title 8 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-8
Training Title 18
Name: Ms. Rosario Campbell Gender: female Age:25 years old T-97.7 P-70 R-18 118/72 Ht 5’3 Wt 123lbs Background: Currently living off-base in El Paso, Texas, active duty in the Army, MOS 92M Mortuary Affairs Specialist. Grew up in McAllen TX with both parents and one brother. Completed education through high school. Currently partnered. No children. Mother history of
depression; brother hx of cannabis use. No medical history. No legal hx; allergy: cipro previous medication trials: sertraline, fluoxetine both with good effects when taking.
Symptom Media. (Producer). (2017). Training title 18 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-18 Training Title 28
Name: Mrs. Ada Carson Gender: female Age: 54 years old T- 97.6 P- 94 R 22 162/84 Ht 5’5 Wt 144lbs Background: Currently living in Sioux Falls, South Dakota, working full-time as a contract negotiator in a financial company. Has an MBA. Lives with her husband and two teenage twin sons. Born and raised in Trenton, NJ, with her father and two brothers, her mother deceased when she in MVA when she was 12 years old. Brother has depression; mother has history of being a “functioning alcoholic”. Recently informed by her PCP she has a “fatty liver.” Allergies: codeine Symptom Media. (Producer). (2016). Training title 28 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-28
Training Title 38 Name: Mr. Elijah Loman Gender: male Age:18 years old T- 98.3 P- 93 R 22 118/68 Ht 5’7 Wt 149lbs Background: Currently lives with his sister and two parents in Durham, NC. Not currently employed. Completed high school, not currently in school. Hx of treatment for mood disorder began age 15, previous trials of risperidone, quetiapine off and on, side effects of wt. gain. Has hx of a six-day hospitalization one year ago after found wandering at night in the mall parking lot without clothes. He refused medication due to previous experiences. Not currently partnered. He has been sexually inappropriate with comments to female neighbors; pulled his pants down in the mall. Denies any recent alcohol or substance use. Father has history of bipolar disorder. No history of self-harm behaviors, no family suicides. Mother reports he has slept 4-5 hours in past week, up spending money buying and playing new video games and says he is writing a book on how others can be a video game master. Appetite is decreased. No medical hx; Hx of vandalism as a juvenile. Has pending court date for indecent exposure. Allergies: latex Symptom Media. (Producer). (2016). Training title 38 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-38
Training Title 43 Name: Mr. Elijah Loman Gender: male Age:20 years old T- 97.2 P- 84 R 18 118/68 Ht 5’7 Wt 156lbs Background: Currently lives with his sister and her husband who are his legal guardians as parents deceased when he was 15 and he was deemed to need a fiduciary and guardian by the court system. Not currently employed. Completed high school, not currently in school. Hx of treatment for mood disorder began age 15, previous trials of Depakote, Quetiapine off and on, side effects of akathisia. Has hx of a multiple hospitalization, last was 4 months ago when he exposed his genitals to girls at the mall. . Not currently partnered. He is currently in hospital admitted one week ago, was initiated on lithium 300mg po three times daily and risperidone 1mg at bedtime. Denies any recent alcohol or substance use. Paternal uncle has history of bipolar disorder. No history of self-harm behaviors, no family suicides. Appetite is decreased. No medical hx; hospital admission labs within normal ranges, UDS negative; Hx of truancy as a juvenile. Has pending court date for indecent exposure. Allergies NKDA Symptom Media. (Producer). (2016). Training title 43 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-43
Training Title 150
Name: Ms. Cheyenne Lisenbe Gender: female Age:18 years old T- 97.4 P- 94 R 22 136/86 Ht 5’2 Wt 121 Background: Currently living with her parents in Locust Grove, Oklahoma along with two younger sisters and 1 older brother. She is a senior in high school, not currently partnered, reports she is bisexual, lately hyper-sexual reporting increase of unprotected sex. She has been stealing money out of her grandmother’s purse to buy clothes, shoes, purses, “and just other things. She has history of treatment since age 9 for conduct disorder, depression, history of taking citalopram which worsened her irritability, aggression, impulsivity. She has been in a 90- day teen residential mental health facility discharged three months ago with lithium 300mg in am and 600mg at bedtime, aripiprazole 2.5mg in the morning. When discharged, her labs were within normal ranges and urine toxicology negative. She was positive for cannabis upon admission. Her parents believe she is hiding her medication as she has made comments “they slow me down; they make me not think fast” She has hx of domestic violence toward her older brother with juvenile assault charge. No current legal issues. Her grandmother has hx of bipolar disorder; her mother and her maternal aunt have anxiety. She is sleeping 2-3hrs/24 hrs. Reports her appetite “ravishing.” She has no medical issues; has Nexplanon implant; hx of self-harm with cutting, last engaged in the behavior 6 months ago. Symptom Media. (Producer). (2018). Training title 150 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-150
Training Title 118 Name: Mr. Connor Walsh Gender: male Age: 57 years old T- 97.2 P- 94 R 20 156/88 Ht 5’8 Wt 163lbs Background: Born and raised in Peru Indiana Is staying at a shelter after being homeless in MacArthur Park for 1 year in Los Angeles. He lost his apartment and his job working part-time at Home Depot. Enjoys playing music. He has long hx of mental health treatment since age 19. Previous medication trials include lithium (was effective), Depakote (gastric upset), aripiprazole (akathisia), risperidone (hyperprolactinemia), haloperidol (dystonia), quetiapine (didn't give a fair trial), Poor historian. divorced once, reports being gay, no children; estranged from only living sister, parents deceased. He is not sure of his family mental health or substance use history but feels like he is most like his aunt, she has history of mental health treatment “but I’m not sure for what.” States that he got a master’s degree in music theory at Stanford. Admits to 3-6 drinks of alcohol when “playing music in the clubs”, denied illicit drugs, has history of intentional drug overdose at age 22, history of 8 inpatient psychiatric hospitalization, most recent was 8 months ago. hx of one detox admission 15 years ago Allergies: bee stings Symptom Media. (Producer). (2018). Training title 118 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-118
Training Title 144 Name: Ms. Amy Hartford Gender: female Age: 26 years old T- 98.2 P- 70 R 18 128/76 Ht 5’0 Wt 152lbs Background: Currently lives in Scottsdale, AZ, divorced with two children a daughter age 8 and son age 4. Born and raised in Mesa, AZ with her mother and two sisters Works as paralegal, has an associate degree; no legal hx; allergic to dicyclomine; history of rosacea Symptom Media. (Producer). (2018). Training title 144 [Video]. https://video-alexanderstreet- com.ezp.waldenulibrary.org/watch/training-title-144
Week 4: Anxiety Disorders, PTSD, and OCD Training Title 15
Name: Mr. Ralph Newsome Gender: male Age:19 years old T- 97.0 P- 70 R 18 116/68 Ht 5’9 Wt 175lbs Background: Lives in Columbus, OH with his dog Chance, only child. Parents live locally. Works part time in Construction. Not currently partnered. No previous psychiatric history. Symptoms began in the last 2 months when he discovered he is being activated with the Navy Reserves. His MOS is CM3 Construction Mechanic; no medical illnesses, no legal hx. Allergies: NKDA; sleeps 8hrs; 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 Berry Sullivan Gender: male Age:27 years old T- 98.8 P- 86 R 18 B/P 122/7 Ht 5’8 Wt 160lbs 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) six months ago after eight years of service. He is engaged to be married in 8 months and is using his GI Education Bill to attend online college for accounting. 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 “abusive when he was drunk.” Father is still alive, unwell (DM, cirrhosis, 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. He has one younger brother 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. 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. Luca Esposito Gender: male Age:21 years old T- 97.4 P- 112 R 22 122/68 Ht 6'1Wt 198lbs Background: Lives alone in Orlando, FL raised by parents in Buffalo, NY, only child. He is a full- time student obtaining a degree for graphic design. works part-time as Uber driver. Has a girlfriend from high school. No previous psychiatric history. No medical illnesses; no history of psychiatric treatment; denied drug
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