Nurs 686 Two replies Discussion Week 5
Respond to your peers with the following: What are 3 questions you would ask to help determine if the patient meets criteria for one of the differentials? • Rocio Reyes Echemendia One diagnosis that is appropriate for the above scenario is Post-Traumatic Stress Disorder (PTSD).According to the DSM-5 (2013), the criteria for PTSD include exposure to actual or threatened death, serious injury, or sexual violence through direct experience, witnessing, or learning about the traumatic event; intrusive symptoms such as intrusive memories, nightmares, flashbacks, or distressing reactions to reminders of the traumatic event; avoidance of traumarelated stimuli; negative alterations in mood or cognition; and alterations in arousal and reactivity. These symptoms must persist for more than one month and cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.Evidence supporting the criteria for PTSD in the scenario includes: • Exposure to a traumatic event: The patient experienced a serious car accident. • Intrusive symptoms: The patient experiences intense anxiety and fear of driving, which likely involve intrusive memories or flashbacks of the traumatic event. • Avoidance behavior: The patient avoids driving and other activities that remind her of the traumatic event, such as going to the store. • Negative alterations in mood or cognition: The patient’s anxiety is becoming more disruptive and is affecting various aspects of her life, including quitting her job and withdrawing from social activities. • Alterations in arousal and reactivity: The patient’s intense anxiety and fear are evident in her avoidance behavior and the significant impact on her daily life. Two differential diagnoses for this scenario are: • Specific Phobia: This diagnosis involves an intense, irrational fear of a specific object or situation, such as driving a car (American Psychiatric Association, 2013). However, in this case, the fear seems to be directly related to a traumatic event, which is more indicative of PTSD. • Generalized Anxiety Disorder (GAD): GAD involves excessive worry and anxiety about various aspects of life, but it typically lacks the specific traumatic event trigger seen in PTSD (American Psychiatric Association, 2013). While this patient does exhibit intense anxiety, the fear seems to be primarily focused on driving due to the car accident rather than generalized worry about multiple aspects of life. • Oscar Anthony Tan • Based on the case presented, my working diagnosis for the patient would be posttraumatic stress disorder (PTSD). PTSD is a debilitating mental health condition caused by exposure to actual or threatened injury, death, sexual assault, or traumatic events such as military combat, life-threatening incidents, or the unexpected loss of a loved one. It has been associated with both functional and cognitive impairment (Mann & Marwaha, 2023). The diagnostic criteria for the diagnosis of PTSD as per DSM-5 (American Psychiatric Association, 2013) include:Criterion A: Stressor (one required) o The patient must have been exposed to actual or threatened death, serious injury, or sexual violence through direct exposure, witnessing, learning about the traumatic event, or indirect exposure to aversive details of the trauma. Criterion B: Intrusion Symptoms (one required) o The patient experiences intrusion symptoms such as unwanted upsetting memories, nightmares, flashbacks, emotional distress after exposure to traumatic reminders, or physical reactivity after exposure to traumatic reminders. Criterion C: Avoidance (one required) o The patient avoids trauma-related stimuli after the traumatic event, including places, people, thoughts, feelings, or reminders. Criterion D: Negative Alterations in Mood (two required) o The patient experiences negative alterations in mood or cognition, such as persistent negative beliefs about oneself, a persistent negative emotional state (fear, guilt, anger, or shame), diminished interest in activities, feeling detached from others, or inability to experience positive emotions. Criterion E: Alterations in Arousal and Reactivity o The patient experiences symptoms of increased arousal and reactivity, such as irritability or aggressive outbursts, self-destructive behavior, hypervigilance, difficulty concentrating, exaggerated startle response, or sleep disturbances. Criterion F: Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.Criterion G: The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.Criterion H: The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.Based on the scenario, the patient experienced a serious car accident, which is a traumatic experience that supports the criteria for the diagnosis of PTSD. She also exhibits intrusive symptoms such as anxiety and fear and avoidance of driving, decreased interest in her daily activities (e.g., going to the store, job, hanging out with friends), as well as negative alterations in her cognition and mood. The differential diagnoses for the patient will be panic disorder and generalized anxiety disorder (GAD). • •
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