NRNP 6635: Psychopathology and Diagnostic Reasoning Essay

NRNP 6635: Psychopathology and Diagnostic Reasoning Essay

NRNP 6635: Psychopathology and Diagnostic Reasoning Essay

Subjective
CC (chief complaint): “I have some questions that I can answer. Sadness. Fear, I guess. But other, other questions I can’t find the answers to”.
HPI:
D.J., a 19-year-old male, came to a psychiatrist’s office after experiencing depression and anxiety for six weeks after learning that he would be activated with the Navy reserves and sent off to Iraq for another tour. There are specific issues he did not have explanations for, and he expressed feeling unhappy and guessing that his fears were justified. He acknowledged having trouble deciding whether to disclose his sexual orientation when he returns. He said he did not want his coworkers to treat him differently because of his sexual orientation, so he kept it a secret. He said he is worried they will not feel safe being comfortable with him in the shower, on the bed, or even patting him on the back. He feels hopeless because he constantly worries about the worst-case scenarios that could result from coming out as gay. He had suicidal ideations, low self-esteem, confusion, and a sleep schedule of roughly 8 hours per night. However, he claims he does not suffer from poor attention, sleeplessness, aggression, or disruptive behaviors.

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Past Psychiatric History: No past psychiatric history.
General Statement: The patient visited the psychiatrist at the clinic since he cannot disclose his sexual orientation to everyone.
• Caregivers (if applicable): None
• Hospitalizations: Although he has no history of being hospitalized or engaging in self-harm acts, he has a history of suicidal thoughts.
• Medication trials: He has no history of psychiatric medication use.
• Psychotherapy or Previous Psychiatric Diagnosis: There is no history of previous psychiatric illnesses.
Substance Current Use and History: He claims that he has no history of using alcohol, smoking, caffeinated beverages, or using illegal drugs.
Family Psychiatric/Substance Use History: There is no history of mental illness in either parent’s family, nor is there any evidence that either parent abused drugs in the past.
Psychosocial History: He was born in Columbus, Ohio, and was raised by both parents as an only child. He is not currently partnered. A portion of his time is spent working in the construction industry. His hobbies include mountain climbing and fishing; he has never been in trouble with the law, claims to have no history of traumatic experiences, and has a history of being involved in violent incidents while serving in Iraq.
Medical History: He says he has not suffered from any long-term problems or injuries but had surgery to remove a bullet stuck in his left thigh.
Current Medications: Currently, he is not taking any medications.
Allergies: NKDA
Reproductive Hx: He has been sexually active, engaging intimately with females and males.
ROS
• GENERAL: He claims he has no symptoms, such as profuse perspiration, sudden weight gain or loss, intolerance to cold or heat, pyrexia, chills, headache, disorientation, or lack of appetite.
• HEENT:
 Head- He claims he has not had any head injury or experiencing headaches, photophobia, dizziness, or syncope.
 Eyes- He asserts that his eyes are healthy and that he has not experienced any problems with his vision, including pain, blurry eyesight, loss of sight, or yellowing of the sclera.
 Ears- He says he is not experiencing any ear issues, including pain, discharge, infection, deafness, or tinnitus.
 Nose- He denies experiencing epistaxis, nose stuffiness, loss of sense of smell, or runny nose.
 Throat- No sore throat or pain on swallowing was reported.
• SKIN: No skin rashes, color changes, or itchiness reported.
• CARDIOVASCULAR: No history of shortness of breath, palpitations, easy fatiguability, limb edema, orthopnea, or chest pains reported.
• RESPIRATORY: No history of chronic cough, sputum production, or breathing difficulties. Lungs produce a resonant sound on percussion.
• GASTROINTESTINAL: No history of nausea, loss of appetite, constipation, diarrhea, heartburn, or abdominal pains reported.
• GENITOURINARY: No history of hematuria, painful sensation on urination, incontinence, increased urgency, or sexually transmitted infections reported.
• NEUROLOGICAL: No history of numbness, headache, dizziness, photophobia, or paralysis was reported.
• MUSCULOSKELETAL: No history of stiffness of the joints, muscle pains, back pain, or joint pain reported.
• HEMATOLOGIC: No history of bleeding, anemia, or bruising tendencies reported.
• LYMPHATICS: No history of painful lymph nodes was reported or observed on examination.
• ENDOCRINOLOGIC: No history of intolerance to cold or heat, excessive sweating, polyuria, or polydipsia.
Objective:
Vital signs: T- 97.0 P- 70 R 18 116/68 Ht 5’9 Wt 175lbs
Physical exam: This patient does not require any physical examination.
Assessment
Mental Status Examination:
D.J., now 19, is a single male born and raised in Columbus, Ohio and raised by his parents. There is nothing abnormal about his appearance or movement; he is well-groomed, dressed appropriately, and appears in good health. He is conscious, aware, and oriented to time, person, and place. His eye contact is poor during the evaluation, but his thought process is logical. His voice volume and pitch are appropriate, and his sentences make sense. His short- and long-term memories are unimpaired, he can focus for extended periods without distraction, and he was generally upbeat throughout the evaluation. Although he possesses sound judgment and judgment, he has a history of suicidal ideation.
Diagnostic results:
The history of the patient, as well as his family history, a mental status examination, a psychiatric evaluation, and the use of DSM 5 criteria, are all required to arrive at a diagnosis of adjustment disorder with anxiety.
Differential Diagnosis
Adjustment disorder with anxiety
This is a psychiatric ailment in which the patient feels anxious, worried, or fearful long after experiencing a traumatic event (Morgan et al., 2021). The onset of symptoms occurs after experiencing stressful events, such as money, marriage, and losing a relationship. While the exact etiology is unknown, it is speculated that an imbalance of the neurotransmitters in the brain that regulate cognition, emotion, and behavior may be at the root of the problem. Mental diseases, experiencing substantial stress in childhood, and stressful events such as divorce or near-death experiences are risk factors for this condition (Morgan et al., 2021). Those suffering from this illness may experience anxiety, apprehension, hopelessness, and a sense of being completely unable to cope.
Adjustment disorder
Adjustment disorders, as defined by O’Donnell et al. (2019), manifest themselves during the process of responding to a significant change or stressful event in one’s life by causing an individual to experience subjective distress and emotional disturbance, which can have adverse effects on one’s ability to function socially and academically. The typical onset of symptoms occurs within three months of the stressful incident, and resolution occurs within six months as the individual adjusts to the new normal (American Psychiatric Association, 2022). Adolescents with adjustment problems often exhibit symptoms including depression, worry, anxiety, uncertainty in their capacity to handle stressful situations, a noticeable impairment in day-to-day activities, and even dramatic or violent outbursts. Genetics, preexisting personality, personal history, developmental stage, psychological traits, and overall health all play a role in the etiology of the illness.
Generalized anxiety disorder
Individuals with this disorder worry excessively about everyday things, even those that do not warrant such concern (Showraki et al., 2020). Genetic predisposition, elevated levels of stress, history of trauma (physical or psychological), substance abuse, unemployment, and medical conditions or disabilities all enhance the likelihood that an individual would develop a generalized anxiety disorder. Constant worry, a sense that the anxiety is out of regulation, intrusive ideas about things that cause anxiety, an inability to tolerate uncertainty, a failure to relax, difficulty focusing, avoiding things that cause anxiety, procrastination because of feelings of being overwhelmed, nausea, diarrhea, and sleeplessness, are some of the symptoms of this condition.
Reflection
What I Would do Differently
If I had the chance to conduct the evaluation, I would briefly introduce myself to the patient, make him feel comfortable, and welcome him into the room. At the outset of the assessment, I would extend a warm welcome, initiate small talk to put him at ease and request an introduction. I would also ensure that he is assured of the confidentiality of the assessment’s contents before we begin and that he understands that he must consent for any assessment-related materials to be made public. He must feel safe talking to me during the evaluation, and if I can show him empathy, I can make sure that happens. However, the assessment was fruitful because I could collect all the necessary information in as little time as possible, and the patient agreed to schedule a follow-up session.
Ethical Consideration
Ethical difficulties that must be addressed are obtaining informed consent, deceit, confidentiality, debriefing, withdrawal, and patient safety. Adjustment disorder with an anxiety diagnosis requires a thorough evaluation, detailed health history, and mental status exam. Moreover, the DSM-5 criteria are used to assist with validating the diagnosis.
Health Promotion
The adjustment disorder with anxiety patients’ health promotion comprises a visit to a counselor following exposure to psychological pressures. Moreover, the patient and families should be assured that traumatic events’ psychological and physiological repercussions are temporary and self-limited. They should provide emotional support to the patient to promote fast recuperation.
Cultural Considerations
It has been demonstrated that cultural elements play an essential part in the process since a client’s cultural background can influence their feelings and how they express them.
Collaborative resources
There will also be communication with his parents, who will be asked to provide unwavering emotional and material support for their son psychologically. He will be directed toward a local community support group for those with anxiety, where he can feel safe opening up about his struggles without fear of reprimand or criticism.

Conclusion
Anxiety and other mood and psychiatric symptoms often reveal themselves in people with adjustment disorder anxiety after they have gone through a traumatic life event. Men are more likely than women to suffer from this condition. Patients are sometimes encouraged to talk to a psychiatrist or confide in close friends and family about their struggles to lessen or prevent future episodes. Furthermore, the patient’s loved ones should be informed about the illness and taught to provide the client with both emotional and psychological support as they cope.
 
References
Morgan, A., Kelber, S., Workman, E., Beech, H., Garvey Wilson, L., Edwards-Stewart, A., Belsher, E., Evatt, P., Otto, J., Skopp, A., Bush, E., & Campbell, M. (2021). Adjustment disorders: A research gaps analysis. Psychological Services. https://doi.org/10.1037/ser0000517
O’Donnell, L., Agathos, A., Metcalf, O., Gibson, K., & Lau, W. (2019). Adjustment disorder: Current developments and future directions. International Journal of Environmental Research and Public Health, 16(14), 2537. https://doi.org/10.3390/ijerph16142537
Showraki, M., Showraki, T., & Brown, K. (2020). Generalized anxiety disorder: Revisited. Psychiatric Quarterly. https://doi.org/10.1007/s11126-020-09747-0
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

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WEEK 4 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.

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.).

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Template, Case Study, Rubric and resources Attached.

NRNP_6635_Week4_Assignment_Rubric