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.
ASSISNMENT:
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.).
Symptom Media (Producer), & . (2018). Training Title 95. [Video/DVD] Symptom Media.
* THRESS FILES ARE ATTACHED TO ASSIST WITH ASSIGNMENT ( RUBIC, TEMPLATE AND BACKGROUND TO INCOOPERATE IN ASSESSMENT)
*VIDEO LINK
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Introduction:
Assessing and diagnosing patients with anxiety disorders, PTSD, and OCD requires a comprehensive psychiatric evaluation, critical thinking skills, and knowledge of the DSM-5-TR criteria for the disorders within these classifications. As a medical professor, I have designed an assignment for medical college students that involves practicing the assessment and diagnosis of such patients. The assignment includes a subjective assessment, an objective assessment, an assessment of mental status, and reflection notes.
Answer:
The primary focus of the Comprehensive Psychiatric Evaluation is to collect information from the patient about their chief complaint and symptomology, medical history, medication history, family history, psychosocial history, and review of systems. Based on the patient’s responses, we can derive a differential diagnosis and formulate a primary diagnosis.
Subjective: The patient has reported symptoms of fear and avoidance related to certain situations or objects that have been persistent and interfering with their daily life for the past six months. These include intrusive thoughts, nightmares, flashbacks, and experiencing distress when exposed to previously traumatic stimuli. The patient also reports low mood, anxiety, and a lack of interest in activities they previously enjoyed. They have had difficulty sleeping, loss of appetite, and feelings of hopelessness. These symptoms have significantly impacted the patient’s personal and professional life.
Objective: Upon psychiatric evaluation, the patient appeared restless, fidgety, and anxious. Their affect was depressed and anxious. The patient maintained good eye contact with the clinician and provided clear responses to questions.
Assessment: Based on the patient’s symptoms, the following differential diagnoses were derived: PTSD, Generalized Anxiety Disorder (GAD), and Major Depressive Disorder (MDD). The criteria for PTSD include exposure to a traumatic event, intrusive thoughts or memories, avoidance of stimuli related to trauma, and negative changes in mood and cognition. GAD criteria include excessive worry and anxiety, difficulty controlling worry, and symptoms lasting for six months or more. MDD criteria include depressed or irritable mood, loss of interest or pleasure, and significant weight loss or gain. MDD has been ruled out as the primary diagnosis because the patient’s symptoms are more consistent with PTSD and GAD.
To confirm the diagnosis of PTSD, I would compare and contrast the patient’s symptoms with the DSM-5-TR criteria for the disorder. With supporting evidence, I would present the differential diagnoses listed in order of highest priority to lowest priority. I will then explain the reasoning behind the selection of the primary diagnosis, taking into consideration pertinent positive and negative information gathered during the assessment.
Reflection notes: If I could conduct the session over, I would consider involving the patient’s family or close friends to provide additional information about the patient’s symptoms and psychosocial history. It is essential to consider legal and ethical implications of sharing confidential information with these individuals. Health promotion and disease prevention strategies should take into consideration cultural and socio-economic factors to ensure the appropriateness of interventions.
