NRNP 6635 Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD

Subjective:

CC (chief complaint): “ I Can’t even begin to describe what I am feeling, sadness, fear, I guess.”

HPI: Mr. D.J. is a nineteen-year-old male patient who came to the facility for a psychiatric visit after developing symptoms of fear and sadness after he realized that he is being activated with the Navy Reserves through a stop-loss policy. These symptoms have been there for the last one and half months. He confesses to being discontent with having to listen to gay comments while serving as a soldier since he is gay. However, he fears sharing regarding his sexuality with people since he is not sure how they would react. He fears and is scared that some would be surprised and walk away from him and never come back to his side. The patient also indicates that he fears rejection and feels like he wants to die when he thinks about it. He confesses to having suicidal thoughts before but not in recent times. The patient has had delusions related to the men he works with and hopes that he can move away from such delusions.

Past Psychiatric History:

General Statement: The patient is generally healthy but is of late sad and has fear after realizing he has been activated with the Navy Reserves
Caregivers (if applicable): The patient lives with both parents as the only child
Hospitalizations: no cases of hospitalizations recorded
Medication trials: No cases of medical trials reported
Psychotherapy or Previous Psychiatric Diagnosis: No previous psychiatric history.

Substance Current Use and History: The patient has not used or is not using any substances, alcohol, or cigarette

Family Psychiatric/Substance Use History: There is no substance use or family psychiatric history.

Psychosocial History: D.J is a nineteen-year-old patient who lives with both parents in Minneapolis. The patient has no partner currently and works at Starbucks as a part-timer. The patient’s MOS is an SK1 storekeeper

Medical History:

Current Medications: The patient is currently not using any medications
Allergies: No known allergies

Reproductive Hx: The patient has no partner currently. He confirms that he is gay and has known his sexual identity since the age of eight.

ROS:

GENERAL: The patient is calm and cooperative
HEENT: The head is normal. No eye infection, double vision, double vision, or visual loss. No ear infections or hearing loss. No nose congestion or sneezing. No sore throat
SKIN: no rashes, itchiness, or irritation
CARDIOVASCULAR: No chest discomfort, pressure, or pain was reported
RESPIRATORY: NO congestion, no breathing problems
GASTROINTESTINAL: no eating disorders, no abdominal ailments
GENITOURINARY: no pain passing urine, no urge for frequent urination
NEUROLOGICAL: Reports being sad and having fear. He is also scared and anxious
MUSCULOSKELETAL: No glutes, no muscle or back pain
HEMATOLOGIC: No blood infections were reported
LYMPHATICS: No swelling was noted
ENDOCRINOLOGIC: has no abnormal sweating or excessive thirst

Objective:

Vitals: T- 98.8, P- 89, R 18 110/62 Ht 5’7 Wt 133lbs.

Physical exam: if applicable

Diagnostic results: none was conducted

Assessment:

Mental Status Examination:

D.J is a nineteen-year-old male patient who visited the clinic with the claims of fear and sadness. The patient is well-dressed and groomed. He is keen to participate in the psychiatric examination and assessment. He has normal speech with consistent volume and normal tone. The patient confirms delusional thoughts. He confirms to have had suicidal thoughts sometimes back to not anymore. The patient’s thought process is intact. His short-term and long-term memory are both intact. His mood is sad, and he feels scared to be rejected by people.

Differential Diagnoses:

Social Anxiety Disorder: This is a type of anxiety disorder known to make individuals have symptoms such as excessive self-consciousness and anxiety in a social situation. According to the DSM-5 criteria, the diagnosis of a social anxiety disorder includes fear of anxiety unexplainable through substance abuse, medication use or substance use, and distress or anxiety which impairs daily life, avoidaing of anxiety-prodocing situations (Koyuncu et al.,2019). The other symptom is intense fear or anxiety regarding a particular social situation because of fear of being humiliated, embarrassed, or negatively judged (APA, 2022). The patient has displayed all these symptoms. He fears revealing his sexuality to workmates for fear of being judged; he also seems to avoid going to active duties since it is unpleasant to him hearing people make comments regarding gays. Therefore, this is likely to be the primary diagnosis.
Generalized Anxiety disorder (GAD). This is a condition that may make an individual have extreme worry and fear about various aspects of life. A person may have a constant feeling of being overwhelmed, fearful, and excessive worry regarding various things (Sadock, 2015). The implication is that such individuals usually have problems controlling nervousness or worry (Crocq, 2022). The patient in this case study has displayed these symptoms. The patient has feelings of sadness and worry, which have been triggered by realizing that his active service is being extended. He also feels anxious and scared about revealing his sexuality to his workmates and fears that some may leave him, never to return.

Major Depressive Disorder: This is a type of depression where an individual displays intense depressive symptoms for more than a fortnight, hence interfering with normal functionality or everyday life (Mullen, 2018). The feelings may include hopelessness, being anxious, and feeling sad. According to the DSM-V criteria, an individual is diagnosed with a major depressive disorder when the individual displays symptoms such as feelings of worthlessness, low or sad most of the time for at least a fortnight, change in appetite, loss of interest in activities and sleep problems (Zimmerman et al.,2019). Even though the patient has shown symptoms such as anxiety and sadness, he sleeps well, eats well since he has a good appetite, and has not reported losing interest in activities. Therefore, this condition looks less likely, though it is considered a differential diagnosis.

Reflections:

This case study presented an opportunity to learn more about mental health conditions. This patient presented with fear and sadness resulting largely from his sexual identity. He finds it difficult to go back for active duties, which he has associated with unpleasant comments regarding being gay as he is also gay. The anxiety and fear regarding his sexual identity extend to the other workplace, where he is skeptical about telling others about his sexual identity for fear of being judged or left by others. If I was in the same position as the healthcare professional, there are various things I would have done differently. For example, I would have inquired more about his daily life and how he feels regarding his functionality. This would have led to a better insight into the physical impacts of the condition. The patient is so sensitive about his secrets being shared with other people; as such, I will endeavor to keep the information confidential (Sussman, N., & DeJong, 2018). One of the social determinants of health that is applicable in this case is social support. The patient is sad and has a fear of the extended active duty, as well as worries and fear concerning how to reveal his sexual identity. Therefore, the patient needs adequate social support to help him through the difficulties he is facing (Wang et al.,2018).

References

American Psychiatric Association. (2022). Trauma- and stressor-related disorders. In the Diagnostic and statistical manual of mental disorders

Crocq, M. A. (2022). The history of generalized anxiety disorder as a diagnostic category. Dialogues in Clinical Neuroscience. https://doi.org/10.31887/DCNS.2017.19.2/macrocq

Koyuncu, A., İnce, E., Ertekin, E., & Tükel, R. (2019). Comorbidity in social anxiety disorder: diagnostic and therapeutic challenges. Drugs In Context, 8. https://doi.org/10.7573%2Fdic.212573

Mullen, S. (2018). Major depressive disorder in children and adolescents. Mental Health Clinician, 8(6), 275–283. https://doi.org/10.9740/mhc.2018.11.275

Sadock, B. J. (2015). Sadock’s synopsis of psychiatry: behavioral sciences. Rezaee F.(Persian translator). 11th ed. Tehran: Arjmand pub, 399-410.

Sussman, N., & DeJong, S. M. (2018). Ethical considerations for mental health clinicians working with adolescents in the digital age. Current Psychiatry Reports, 20(12), 1-8. https://doi.org/10.1007/s11920-018-0974-z

Wang, J., Mann, F., Lloyd-Evans, B., Ma, R., & Johnson, S. (2018). Associations between loneliness and perceived social support and outcomes of mental health problems: a systematic review. BMC Psychiatry, 18(1), 1–16. https://doi.org/10.1186/s12888-018-1736-5

Zimmerman, M., Martin, J., McGonigal, P., Harris, L., Kerr, S., Balling, C., … & Dalrymple, K. (2019). Validity of the DSM‐5 anxious distress specifier for major depressive disorder. Depression and Anxiety, 36(1), 31–38. https://doi.org/10.1002/da.22837

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Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

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Important information on Writing a Discussion Question

Your response needs to be a minimum of 150 words (not including your list of references)
There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
Include in-text citations in your response
Do not include quotes—instead summarize and paraphrase the information
Follow APA-7th edition
Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

A minimum of 6 responses per week, on at least 3 days of the week.
Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
Each response needs to be at least 75 words in length (does not include your list of references)
Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
Follow APA 7th edition
Points will be deducted if the above is not followed
Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
Here are some helpful links
Student paper example
Citing Sources
The Writing Center is a great resource