NRNP 6635 ASSESSING AND DIAGNOSING PATIENTS WITH ANXIETY DISORDERS, PTSD, AND OCD

ASSIGNMENT: NRNP 6635 ASSESSING AND DIAGNOSING PATIENTS WITH ANXIETY DISORDERS, PTSD, AND OCD

ASSIGNMENT: NRNP 6635 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.

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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.

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RESOURCES

 

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

WEEKLY RESOURCES

LEARNING RESOURCES

Required Readings

Required Media

Video Case Selections for Assignment

Select one of the following videos to use for your Assignment this week. Then, access the document “Case History Reports” and review the additional data about the patient in the specific video number you selected.

 

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.).

SUBMISSION INFORMATION

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Rubric

NRNP_6635_Week4_Assignment_Rubric

NRNP_6635_Week4_Assignment_Rubric

Criteria Ratings Pts
This criterion is linked to a Learning OutcomeCreate documentation in the Comprehensive Psychiatric Evaluation Template about the patient you selected. 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
20 to >17.0 ptsExcellent

The response throughly and accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.

17 to >15.0 ptsGood

The response accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.

15 to >13.0 ptsFair

The response describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis, but is somewhat vague or contains minor innacuracies.

13 to >0 ptsPoor

The response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Or, subjective documentation is missing.

20 pts
This criterion is linked to a Learning OutcomeIn 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.
20 to >17.0 ptsExcellent

The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.

17 to >15.0 ptsGood

The response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented.

15 to >13.0 ptsFair

Documentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies.

13 to >0 ptsPoor

The response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing.

20 pts
This criterion is linked to a Learning OutcomeIn 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-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.
25 to >22.0 ptsExcellent

The response thoroughly and accurately documents the results of the mental status exam…. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected.

22 to >19.0 ptsGood

The response accurately documents the results of the mental status exam…. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides an accurate justification for each of the disorders selected.

19 to >17.0 ptsFair

The response documents the results of the mental status exam with some vagueness or innacuracy…. Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vaguess or innacuracy.

17 to >0 ptsPoor

The response provides an incomplete or inaccurate description of the results of the mental status exam and explanation of the differential diagnoses. Or, assessment documentation is missing.

25 pts
This criterion is linked to a Learning OutcomeReflect on this case. 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!), social determinates of health, 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.).
10 to >8.0 ptsExcellent

Reflections are thorough, thoughtful, and demonstrate critical thinking.

8 to >7.0 ptsGood

Reflections demonstrate critical thinking.

7 to >6.0 ptsFair

Reflections are somewhat general or do not demonstrate critical thinking.

6 to >0 ptsPoor

Reflections are incomplete, inaccurate, or missing.

10 pts
This criterion is linked to a Learning OutcomeProvide 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).
15 to >13.0 ptsExcellent

The response provides at least three current, evidence-based resources from the literature to support the assessment and diagnosis of the patient in the assigned case study. The resources reflect the latest clinical guidelines and provide strong justification for decision making.

13 to >11.0 ptsGood

The response provides at least three current, evidence-based resources from the literature that appropriately support the assessment and diagnosis of the patient in the assigned case study.

11 to >10.0 ptsFair

Three evidence-based resources are provided to support assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification.

10 to >0 ptsPoor

Two or fewer resources are provided to support assessment and diagnosis decisions. The resources may not be current or evidence based.

15 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting—Paragraph development and organization:Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.
5 to >4.0 ptsExcellent

A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. …Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

4 to >3.5 ptsGood

Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive. …Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

3.5 to >3.0 ptsFair

Purpose, introduction, and conclusion of the assignment is vague or off topic. … Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%-79% of the time.

3 to >0 ptsPoor

No purpose statement, introduction, or conclusion were provided. … Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.

5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting—English writing standards: Correct grammar, mechanics, and punctuation
5 to >4.0 ptsExcellent

Uses correct grammar, spelling, and punctuation with no errors

4 to >3.0 ptsGood

Contains a few (one or two) grammar, spelling, and punctuation errors

3 to >2.0 ptsFair

Contains several (three or four) grammar, spelling, and punctuation errors

2 to >0 ptsPoor

Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding

5 pts
Total Points: 100

NRNP 6635 ASSESSING AND DIAGNOSING PATIENTS WITH ANXIETY DISORDERS, PTSD, AND OCD

Subjective:

CC (chief complaint): “I fear telling others about my sexuality”

HPI: the patient is Mr. Ralph Newsome, a 19-year-old male that came to the psychiatric clinic for psychiatric assessment. The patient is a former military personnel and currently works part time in construction. The patient reports difficulties in telling others about his sexuality. The patient reports that he has been weighing about the benefits and disadvantages of revealing his sexuality as a gay. He fears the ridicule that he would experience from other soldiers after knowing about his sexuality. The patient reports that he has never told anyone about his sexuality, except the psychiatrist. The patient reports that he fears that others will not be comfortable being around him after he tells them his sexuality. The patient denies sexual thoughts about men but reports interest in close relationship with them as well as women. He also acknowledges fear of rejection from others following his disclosure. He reports suicidal thoughts when he was young but denies any recent thoughts, plans, or intention.

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Past Psychiatric History: The patient denied any history of psychiatric illnesses

  • General Statement: I fear telling others about my sexuality
  • Caregivers (if applicable):none
  • Hospitalizations: the client denies any history of hospitalization
  • Medication trials: The client denies any history of medication trials
  • Psychotherapy or Previous Psychiatric Diagnosis: The client denies any history of psychotherapy or previous psychiatric diagnosis

Substance Current Use and History: The client denies any current or previous use of alcohol, smoking, and other substance use or abuse

Family Psychiatric/Substance Use History: The client denies any history of psychiatric or substance abuse history in the family

Psychosocial History: The client lives alone with his dog. He is the only child in his family. He currently works part time in construction. He has been recalled to Iraq to work as a soldier. The patient reports that his family is his source of social support. He denies any stress. However, he fears telling others about his sexuality.

Medical History: The patient denied any history of hospitalization or surgeries.

  • Current Medications: The patient is not currently using an medications.
  • Allergies: The patient reported that he is allergic to Penicillin. He denied food and environmental allergies.
  • Reproductive Hx: The patient is single. He is not in a relationship. He denies dysuria, frequency and urgency. He also denies any history of sexually transmitted infections or abuse.

ROS:

GENERAL: The patient is dressed appropriately for the occasion. There is no evidence of weight loss, fever, chills, weakness, or fatigue.

HEENT: Eyes: The patient denies visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: He also denies hearing loss, sneezing, congestion, runny nose, or sore throat.

SKIN: The patient denies rash or itching.

CARDIOVASCULAR: The patient denies chest pain, chest pressure, or chest discomfort. He also denies palpitations or edema.

RESPIRATORY: The patient denies shortness of breath, cough, or sputum.

GASTROINTESTINAL: The patient denies anorexia, nausea, vomiting, or diarrhea. He also denies abdominal pain or blood.

GENITOURINARY: The patient denies burning on urination, urgency, hesitancy, odor, odd color

NEUROLOGICAL: The patient denies headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. He also denies change in bowel or bladder control.

MUSCULOSKELETAL: The patient denies muscle, back pain, joint pain, or stiffness.

HEMATOLOGIC: The patient denies anemia, bleeding, or bruising.

LYMPHATICS: The patient denies enlarged nodes. No history of splenectomy.

ENDOCRINOLOGIC: The patient denies reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.

Objective:

Physical exam:

Vital signs: BP 119/76 P 68 T 36.7 SPO2 98% at room air, RR 20 beats per minute, regular

Respiratory: Presence of clear lung sounds and absence of wheezing, cough, and nasal flaring.

Cardiovascular: Presence of S1 and S2 heart sounds. Absence of adventitious heart sounds and body edema.

Diagnostic results: None

Assessment:

Mental Status Examination: The patient is dressed appropriately for the occasion. He appears of the appropriate weight for his age and gender. He denies fever, fatigue, or chills. The patient is alert and oriented to self, others, time, and events. The thought process is intact and future oriented. The patient maintains normal eye contact during the assessment. He demonstrates speech of normal tone and rate. The patient does not demonstrate abnormal mannerism such as tremors and tics. The patient denies illusions, delusions, and hallucinations. His mood is anxious. The patient denies suicidal thoughts, plans, or attempts.

Differential Diagnoses:

Social anxiety disorder: Social anxiety disorder is the client’s primary diagnosis. Social anxiety disorder is a mental health disorder that is characterized by significant anxiety or fear about social situations that a patient is exposed to potential scrutiny by others. Patients may have fear or anxiety in talking about or being observed in social situations involving others. The social situation or encounter often results in fear or anxiety, which are beyond the actual threat associated with the situation and to its sociocultural context. The fear and anxiety results in avoidance of situations that predispose the patient to the problem. There is also the impairment in social or occupational functioning and distress. The symptoms persist for at least six months and cannot be attributed to causes such as medications use, mental health problems, or substance use and abuse (Koyuncu et al., 2019; Rose & Tadi, 2023). The patient in the case study has significant fear and anxiety towards revealing his sexuality. He fears rejection and the unknown reaction by his colleagues. The fear affects his interaction with others in his work as a soldier. Therefore, social anxiety disorder qualifies as the primary diagnosis.

Generalized anxiety disorder: Generalized anxiety disorder is the client’s secondary diagnosis. Generalized anxiety disorder is a mental disorder that is characterized by excessive fear or worrying about things or events. The fear and worry are beyond the patient’s control. Patients may also report accompanying symptoms such as restlessness, fatigue, and difficulty in concentrating among others. The patient in the case study demonstrates excessive fear towards revealing his sexuality. He fears the repercussions associated with his decision to inform others about his sexualty. The fear the patient has cannot be attributed to medication use, a medical condition or substance abuse (DeMartini et al., 2019). However, the client does not have the accompanying symptoms such as restlessness, making generalized anxiety disorder a secondary diagnosis.

Post-traumatic stress disorder: Post-traumatic stress disorder is the other differential diagnosis that may be considered for the patient. Patients with this disorder experience avoidance, fear, and anxiety symptoms (Lewis et al., 2020). However, it is the least likely cause of the client’s problem since the client does not have any related traumatic experiences or exposures.

Obsessive compulsive disorder: The other secondary diagnosis to be considered for the patient is obsessive compulsive disorder. Patients diagnosed with obsessive compulsive disorders often experience obsessive thoughts that result in compulsions and repetitive behaviors (Goodman et al., 2021). However, this is a least likely cause of the patient’s problem because of the lack of obsessions, compulsions, and repetitive behaviors.

Panic disorder: Panic disorder is the last potential diagnosis that should be considered for the patient. Panic disorder is a mental health disorder characterized by experiences of intense panic or fear towards situations. Panic disorder is the least likely cause of the client’s problem because of the lack of sudden, intense fear or panic and associated symptoms such as shortness or breath or palpitations (Breilmann et al., 2019).

Reflections:I agree with the nurse preceptor’s diagnosis. The symptoms the client has are similar to those seen among patients diagnosed with social anxiety disorder. One of the things that I would do differently should I experience a similar situation is initiating a patient with social anxiety disorder on treatments such as group or individual posychotherapy. Psychotherapy would help the patient to develop effective coping strategies against the triggers of the disorder. I am interested in researching more about the effect of sociocultural factors on the decisions of the patients to reveal their sexuality.

References

Breilmann, J., Girlanda, F., Guaiana, G., Barbui, C., Cipriani, A., Castellazzi, M., Bighelli, I., Davies, S. J., Furukawa, T. A., & Koesters, M. (2019). Benzodiazepines versus placebo for panic disorder in adults. Cochrane Database of Systematic Reviews, 3. https://doi.org/10.1002/14651858.CD010677.pub2

DeMartini, J., Patel, G., & Fancher, T. L. (2019). Generalized Anxiety Disorder. Annals of Internal Medicine, 170(7), ITC49–ITC64. https://doi.org/10.7326/AITC201904020

Goodman, W. K., Storch, E. A., & Sheth, S. A. (2021). Harmonizing the Neurobiology and Treatment of Obsessive-Compulsive Disorder. American Journal of Psychiatry, 178(1), 17–29. https://doi.org/10.1176/appi.ajp.2020.20111601

Koyuncu, A., İnce, E., Ertekin, E., & Tükel, R. (2019). Comorbidity in social anxiety disorder: Diagnostic and therapeutic challenges. Drugs in Context, 8, 212573. https://doi.org/10.7573/dic.212573

Lewis, C., Roberts, N. P., Andrew, M., Starling, E., & Bisson, J. I. (2020). Psychological therapies for post-traumatic stress disorder in adults: Systematic review and meta-analysis. European Journal of Psychotraumatology, 11(1), 1729633. https://doi.org/10.1080/20008198.2020.1729633

Rose, G. M., & Tadi, P. (2023). Social Anxiety Disorder. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK555890/

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