Week 3, Assignment:
PLEASE USE THE FOLLOWING TO COMPLETE:
TRANSCRIPT LISTED BELOW
ADDITIONAL PATIENT HISTORY LISTED BELOW
COMPREHENSIVE PSYCHIATRIC EVALUATION TEMPLATE FILE UPLOADED
USE REFERENCES LISTED FOR ALL REFERENCES/CITATIONS LISTED BELOW
“Fear,” according to the DSM-5-TR, “is the emotional response to a real or perceived imminent threat, whereas anxiety is the 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.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
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 (PLEASE SEE TRANSCRIPT FOR TRAINING TITLE # 15 VIDEO BELOW), AND THE (ADDITONAL HISTORY BELOW)The diagnosis for this video should be "Adjustment Disorder with Anxiety".
Please use the transcript for this Assignment. 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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TRANSCRIPT OF VIDEO FILE:
00:00:00
______________________________________________________________________________
00:00:00
BEGIN TRANSCRIPT:
00:00:00
[sil.]
00:00:15
OFF CAMERA So you, you said you were in the reserves? Inactive duty?
00:00:20
PATIENT Well, I was inactive duty. But then I learned that they are using the stop-loss policy to extend our active duties. We have to all return to Iraq for another tour.
00:00:30
OFF CAMERA Was that upsetting?
00:00:30
PATIENT I can’t even begin to describe what I am feeling.
00:00:35
OFF CAMERA Tell me about why you decided to make an appointment with a psychiatrist.
00:00:40
PATIENT Some questions I can answer. Sadness. Fear I guess. But other, other questions I can’t find the answers to.
00:00:55
[sil.]
00:01:00
OFF CAMERA Go ahead.
00:01:05
PATIENT You know how they repealed the "Don’t ask don’t tell" policy? Well, I’m struggling if I should… You don’t have to report what I tell you, do you?
00:01:20
OFF CAMERA Well, it’s similar to civilian life, the military is under the same HIPPA laws. So if somebody, if one wants to look at your record, medical, only medical personnel can look in your record and only with a medical reason. And, no one else is allowed access. Any private, personal issues you have, which don’t break a law or a military rule, those are not reported. Someone could always illegally access your record, but that would be prosecuted.
00:02:00
PATIENT Good. I guess you can figure out, well, I can’t figure out whether I should tell people when I go back.
00:02:15
OFF CAMERA So have you been weighing the pros and cons of, the advantages and disadvantages about telling people about your sexuality?
00:02:25
PATIENT Everyday.
00:02:25
OFF CAMERA What do you feel are the pressures for you to tell people?
00:02:30
PATIENT It’s miserable enough being over there just being a soldier, on top of that you have to listen to all these gay comments: "Oh Johnston, you look a fag when you wear your head gear like that."
00:02:45
OFF CAMERA Uh, huh. Who is Johnston?
00:02:45
PATIENT He’s one of my best friends.
00:02:50
OFF CAMERA Is he gay or someone who has homosexual-type thoughts?
00:02:55
PATIENT Johnston. No. Never.
00:02:55
OFF CAMERA Why do you say that?
00:03:00
PATIENT I don’t know. I can just feel it, sense it, that he’s not gay.
00:03:05
OFF CAMERA Okay. So, if I play, permit me to play the devil’s advocate, maybe there are others feel they know, can already feel whether you are gay or not.
00:03:15
PATIENT No. I hide it. I’m very careful.
00:03:20
OFF CAMERA Uh huh. I see.
00:03:20
PATIENT If I told the other people in my unit, the men and the women, they’d be surprised. I promise.
00:03:30
OFF CAMERA So you think that they all fell for the "lies" as you call it, about your sexuality?
00:03:35
PATIENT Absolutely. Well, I think "absolutely." I mean, I mean they wouldn’t feel free to make all the comments like they do if they thought that I were…
00:04:00
OFF CAMERA Have you ever talked with anyone in your unit about your private, sexual thoughts,
00:04:05
PATIENT No.
00:04:05
OFF CAMERA Private sexual feelings?
00:04:05
PATIENT No. Never.
00:04:05
OFF CAMERA Do others talk with you about their sexual thoughts and feelings?
00:04:10
PATIENT Like 59 minutes out of every hour, every day.
00:04:15
OFF CAMERA Ah. Everyone?
00:04:20
PATIENT Well, almost everyone. I mean some people are more private, stand offish.
00:04:25
OFF CAMERA Yeah. So what do you fear could happen if you talk wit them?
00:04:30
PATIENT They wouldn’t feel comfortable around me. In the showers. Patting me on the back. Guy hugs. Sleeping in close quarters.
00:04:45
OFF CAMERA So some people, men and women, if they knew you were gay, they’d treat you differently. But hard it’s know in advance the exact gains and losses. All you know is that it would be different.
00:05:05
PATIENT That it would feel lousy for somebody to get up and move away from me because they thought that I would… do something with them.
00:05:15
OFF CAMERA Some may very well feel that way. Do you ever have sexual thoughts about any of the men in your unit?
00:05:25
PATIENT Mild curiosity maybe about what you know someone looks like or something, undressed. But not actually having sex kinds of thoughts. I have thoughts of wanting to be close, but that’s, that’s not sexual. I mean with women, too. I enjoy close friendships.
00:05:55
OFF CAMERA Sounds like… your own feelings are just a little bit confused separating out friendship and sexual feelings.
00:06:05
PATIENT Well, I’ve never been in an on-going relationship. I mean a few times fooling around. A couple years back.
00:06:20
OFF CAMERA Do you have doubts about whether you prefer women or if you prefer men?
00:06:25
PATIENT No. No doubts. I’ve known since I was 8 what kind of… nude photos, later internet pics, videos, I like to look at. Just no real-life experiences.
00:06:45
OFF CAMERA So it sounds like you feel pretty confident about your sexuality?
00:06:50
PATIENT I’m gay. I know I’m gay.
00:06:55
OFF CAMERA So who else, other than me just now, have you ever said those words to?
00:07:00
PATIENT "I’m gay?"
00:07:00
OFF CAMERA Yes.
00:07:05
PATIENT Just you. Just now.
00:07:05
OFF CAMERA So you don’t have experience in telling people. You haven’t practiced that skill.
00:07:15
PATIENT I never thought about that as a skill.
00:07:20
OFF CAMERA Well you have the skill, it sounds like of thinking whether or not you are gay, which many people don’t even have that skill, But you are lacking in two skills. You have a little difficulty, little confusion about, thinking about separating friendships from sexual relations and then your lacking in that skill of telling people that you are gay. And not having those two skills, sometimes that scares people.
00:07:50
PATIENT Try terrifies.
00:07:55
OFF CAMERA Terrifies. Well, over the years, listening to people like I do with similar concerns, it’s, it’s clear to me that there are several skills in talking about one’s own sexuality. There are bad ways, bad timing for telling people about your sexuality. And there are good ways, better timing.
00:08:20
PATIENT Guess that makes sense.
00:08:25
OFF CAMERA And then another skill is recognizing that there are people who won’t want to learn directly from you about your sexuality, and there are people who do not want to learn it directly from you. Maybe because of their religious beliefs, or their cultural backgrounds, or even their lack of thinking about sexuality. So it’s a skill to look at people, talk to people and learn to sense their attitudes. So you don’t confront them and surprise them or alarm them.
00:09:00
PATIENT But these people, they’re supposed to be learning about sexuality in workshops and all, right?
00:09:05
OFF CAMERA How many times have you gone to class, learning, only to later discover it was more difficult to apply what you learned?
00:09:15
PATIENT Lots of times.
00:09:20
OFF CAMERA Yeah. So maybe one day, people will come into the military and talk open about sexuality and early in their meeting people, but not now. We’re not there now. I think we have to be realistic.
00:09:35
[sil.]
00:09:40
OFF CAMERA You look confused. Maybe confusion’s okay. It’s a confusing topic at this point in our history.
00:09:55
PATIENT What other "skills" am I missing?
00:10:00
OFF CAMERA Well… What about dealing with rejection?
00:10:05
PATIENT Rejection? Damn.
00:10:10
OFF CAMERA Yep. That’s a skill. Think about it. Lots of celebrities and politicians, they have to be really superb at dealing with rejection. That’s a skill. If you tell people you are gay, there are people who will walk away from you. Those people may need time to go think about it. About what you shared with them. You’ve had lots of time to think about sexuality. Maybe they have not. You can expect that some of those people will come around and later be accepting. Other people who walk away from you, may feel deceived, and they may never, never come back to your side.
00:10:55
PATIENT That what scares me.
00:10:55
OFF CAMERA And you have to plan ahead for that. Rehearse it in your head, maybe rehearse with accepting friends, or counselors, people, about how you are going to deal with those moments. That’s, that’s a skill.
00:11:15
[sil.]
00:11:20
OFF CAMERA You look sad about that.
00:11:25
PATIENT I used to worry about rejection. And it just made me want to die.
00:11:35
OFF CAMERA Kill yourself?
00:11:35
[Shakes head "Yes"]
00:11:40
OFF CAMERA Any thoughts like that now?
00:11:40
PATIENT Not for years. I’ve seen too many people come out of the closet and do fine. I mean not so much people I know, but from TV, internet, hearing their stories.
00:12:00
OFF CAMERA In your unit, if you tell people, do you feel people may threaten your safety? Not watch your back when you’re in danger?
00:12:15
PATIENT Naw. The people in my unit are amazing. It’s more the small, the subtle looks, the… Feeling like I wasn’t with them I mean I don’t mean to sound like a pussy, but… These men, they’re all I have. Day after day. They’re right there, and I don’t… I don’t want to feel like I’m on the outside.
00:13:00
[sil.]
00:13:05
OFF CAMERA So back when you were with the unit, did you feel like they were with you, when you were not truthful with them?
00:13:20
PATIENT I guess not. They couldn’t be with me. I wasn’t being real. I used to dream that what I had was real. I want that to end. Not being real.
00:13:50
[sil.]
00:13:55
OFF CAMERA What are you thinking?
00:14:05
PATIENT That I still don’t have my answer. I have lots more weighing of pros and cons to do. Maybe that’s okay. Brush up on the skills, as you call them, while I prepare to… To tell them. How do I start? I wish I could use stop loss and take you with me.
00:14:35
OFF CAMERA [Laugh] Thank you for inviting me.
00:14:40
PATIENT You’re welcome.
00:14:45
OFF CAMERA I’ll tell you what, let me talk to a few people. See if… If I can identify someone with whom you can talk with overseas. But in the meantime… Let’s, you and me… At least have a session or two before you leave. Okay?
00:15:05
PATIENT Sure.
00:15:10
[sil.]
00:15:10
END TRANSCRIPT
ADDITIONAL PATIENT HISTORY:
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://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/wa
tch/training-title-15
VIDEO REFERENCE:
Symptom Media. (Producer). (2017). Training title 15Links to an external site. [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/training-title-15
READING REFERENCES:
American Psychiatric Association. (2022). Anxiety disorders. In Diagnostic and statistical manual of mental disordersLinks to an external site. (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url= https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x05_Anxiety_Disorders
American Psychiatric Association. (2022). Obsessive compulsive and related disorders In Diagnostic and statistical manual of mental disordersLinks to an external site. (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url= https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x06_Obsessive_Compulsive_and_Related_Disorders
American Psychiatric Association. (2022). Trauma- and stressor-related disorders.. In Diagnostic and statistical manual of mental disordersLinks to an external site. (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url= https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425787.x07_Trauma_and_Stressor_Related_Disorders
Boland, R. & Verduin, M. L. & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.
Chapter 8, “Anxiety Disorders”
Chapter 9, “Obsessive-Compulsive and Related Disorders”
Chapter 10, “Trauma- and Stressor-Related Disorders”
Chapter 2- only sections 2.13, “Anxiety Disorders of Infancy, Childhood, and Adolescence: Separation Anxiety Disorder, Generalized Anxiety Disorder, and Social Anxiety Disorder (Social Phobia)”; 2.14 “Selective Mutism” and 2.15 “Obsessive-Compulsive Disorder in Children and Adolescence”
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