assessing and diagnosing patients with anxiety disorders, PTSD, and OCD. Review the DSM-5

Answer

Week (enter week 4 ): (Enter assignment title)

Subjective:

CC (chief complaint):

Sergeant Patrick Flanrey books an appointment with Dr. Schwartz for psychiatric assessment and evaluation of anxiety disorder, PTSD, and OCD. According to Patrick, his fiancé suggested that he makes the appointment with the doctor following his mental breakdown during a county fair.

HPI:

Sergeant Patrick is a 27-year-old male, present for psychiatric evaluation for anxiety disorder, PTSD, and OCD. He is not prescribed to psychotropic medication at the moment. He is referred by his psychiatrist Dr. Schwartz for assessment and diagnosis of anxiety disorder, PTSD, and OCD.

Past Psychiatric History:

• General Statement:

Sergeant Patrick entered psychiatric evaluation for treatment of anxiety disorder, PTSD and OCD after showing signs of the disorder during a county fair.

• Caregivers (if applicable):

Dr. Schwartz

• Hospitalizations:

Sergeant Patrick has no record of psychiatric or substance use treatment.

• Medication trials:

The patient has no record of psychotropic medication.

• Psychotherapy or Previous Psychiatric Diagnosis:

The patient has not had any previous psychotherapy sessions. Patrick finds psychotherapy useful since he can share what he experienced during his time at the army. The patient reveals that he has not been able to talk to anybody about his experience. Patrick finds his session with Dr. Schwartz helpful since he has the opportunity to talk about his current situation. The patient is cooperative and would like to continue with his behavioral examination. There is no record of previous diagnosis and treatment of Patrick's illness.

Substance Current Use and History:

Sergeant Patrick admits that he does not use any type of drugs and alcohol.

Family Psychiatric/Substance Use History:

Psychosocial History:

Social history: Sergeant Patrick was raised by his paternal parents. He currently has two siblings, one younger brother and an older sister. Patrick is the second born child out of three siblings. Sergeant Patrick lives with his fiancé and they are engaged. Patrick and his fiancé have no children of their own at the moment but they are enthusiastic of having them someday.

Educational background: Sergeant Patrick attained high school education before entering the military.

Current occupation: Sergeant Patrick is working as a furniture salesman after retiring from the army.

Legal history: Patrick has no criminal record or legal lawsuit.

Trauma history: Sergeant Patrick suffers from trauma in his adulthood stage. There is no evidence to prove the patient experienced trauma during his childhood. According to Patrick, sometime, he experiences trauma when something triggers his memory to the events during his combat in the army.

Violence history: Sergeant Patrick has experienced violence during service in the military. According to his own revelation, he sometime finds himself in combat episodes when something triggers his cognition or emotions. For instance, Patrick records that he gets frightened by fireworks since they sound like combat fire. He is also disturbed when there is a smell of roasted meat or when he is stuck in heavy traffic.

Medical History:

• Current Medications: Sergeant Patrick is currently suffering from service-connected asthma. There is no record of medication for his illness.
• Allergies: The patient experiences seasonal allergies. There is no evidence of medication for his allergies.

ROS:

• GENERAL: no weight loss, fever, chills, weakness, or fatigue.
• HEENT:

Eyes: Sergeant Patrick is not suffering from impaired vision.

Ears, Nose, Throat: there is no sign of impaired hearing, sneezing, or sore throat.

• SKIN: the patient does not have a skin disease, no rush or itching.
• CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort.
• RESPIRATORY: no shortness of breath, cough, or sputum.
• GASTROINTESTINAL: no anorexia, nausea, vomiting, or diarrhea. There is no evidence of abdominal pain or blood.
• GENITOURINARY: there is no record of burning when urination, urgency, hesitancy, or odor.
• NEUROLOGICAL: there is no record of dizziness, headache syncope, paralysis, numbness, or change in bowel and bladder control.
• MUSCULOSKELETAL:  no muscle, back pain, joint pain, or stiffness
• HEMATOLOGIC: no anemia, bleeding, or bruising
• LYMPHATICS: no enlarged nodes, no history of splenectomy
• ENDOCRINOLOGIC: no report of sweating, cold, or heat intolerance, no polyuria or polydipsia

Objective:

Physical exam:

Exposure: The patient is directly exposed and an eyewitness to trauma.

Intrusive:

• The patient has experienced distressing trauma memories.
• The patient has a recurrent distressing trauma-related hallucination
• The patient avoids distressing trauma-related reminder
• The experience flashbacks related to trauma

Negative cognition: the patient experience persistent distorted trauma-related cognition.

Diagnostic results:

According to the patients experience, it can be singled out that the patient has experienced trauma. This is evidence that the patient has PTSD disorder.

Assessment:

Mental Status Examination:

The patient is a 27 years old male, retired from the army. He looks his age, smiles often; he has an appealing face and appears well articulated, aside from looking absolutely healthy. In regard to Snyderman et al. (2009), explanation of motor activity, he seems harmless, as he normally crosses over his hands while conversing– hence showing a sign of restraint and inferiority. Despite his lack of confidence shown in his body posture, he speaks eloquently and appears to master outstanding dialogue, as he expresses himself adequately, without leaving out any useful information. He has a cheerful mood when not under stress; this is perceived when first contact is made with the doctor. As evidenced by his mood, one would agree that he is emotionally stable and open to conversation. While speaking, he sometimes holds back with a revelation and appears to be in deep thought, mixed with felt feelings. However, his answers are not distorted. Importantly, he does not possess any thought of suicide or resentment. He has a conscious mind and a careful controlled cognition since he knows of every occurrence or situation taking place and does not experience sudden lapses. In light of this mental examination, further referral is demanded, to ascertain his thoughts and if he does or does not hold back any meaningful information.

Differential Diagnoses:

Considering the patient’s symptoms, it would be futile to concentrate on one disorder as the symptoms are similar to one another. Therefore, three possible disorders are evaluated in his case, these are; generalized anxiety disorder, panic disorder and specific phobias.

Generalized Anxiety Disorder

As directed by the diagnostic and statistical manual of mental disorders, 5^th edition, patients with this condition experience irritability, edginess, restlessness and difficulties in sleeping. Above all, they worry too much and tend to hide away (Gillespie, 2021). While the patient does not show symptoms of muscle tension, he says his stomach tightens and fears falling asleep as he experiences nightmares during the night. He is highly irritable; he explains his dislike of fireworks as they make him agitated. These symptoms are articulated to anxiety disorder

Panic Disorder

Bennett (2017) describes panic disorder as unprecedented and recurring, uncomfortable; startling events that lead to uneasiness, rapid blood pressure and uncontrolled heart beats. They may cause strokes when in extreme. The patient confesses his sudden drawbacks, where he is taken to the field of battle and explosions trigger his flight response in order to take cover. While this is not real, as he is in a fair where fireworks are being shot, when this traverses, his heart beats faster and he trembles in shock and fear. His panic attacks are not triggered by any tangible substance or drugs, but by psychological effects.

Specific Phobia

The patient explains that he tends to avoid grilling meat or any other sort of something burning. It makes him uneasy, nauseated and breaths heavily. This is attributed to specific phobia category as described by Fleming (2021). He further explains the cause of this phobia, at one time during his tours, his mates got burned to death and this traumatizing event left him with the smell of his colleagues’ bodies being consumed by fire. He tends to avoid grilling anything or places where there is grilling.

After a concise and distinct evaluation, one would agree that the main recurring disorder is generalized anxiety. This is because most, if not all, symptoms relate to his inability to perceive what is real and what is not, as he claims to feel everything single thing during these events of tension. They are not just mere hallucinations. He has generalized anxiety disorder as he experiences difficulty in concentrating; he is highly irritable and fearful of any new or pre-lived vigorous scenarios. He has trouble sleeping and avoids almost all public places or unfamiliar faces.

Reflections:

Reflecting on the patient’s case and the predominant results of the diagnoses, it is highly substantiated that intense activities or experiences such as military warfare, rape, kidnapping, sexual abuse, serious accidents and certain fatal diseases cause a myriad of challenges, not only physically, but most importantly, mentally. Mental illnesses are severe and may lead to extreme conditions and even death.

Focusing on the patient, his tours seem to be the major cause of his condition and the resultant features. However, facing his fears and conditions, obviously supported by his fiancé, shows how ready he is to receive treatment and live a normal life again

In this case, one would agree that, speaking out traumatizing events is helpful, as it relieves a patient of recurrent emotions and thoughts. Holding them back is harmful to one’s mental and physical health as the trauma affects the body and mind. One feels every pain as he/she relieves the past events. However, speaking them out disconnects the effect on the body and they become just bad memories. This helps a patient take control, therefore relinquishing fear and welcoming confidence, apt cognitive behavior and emotional stability.

I agree with my receptors assessment and diagnostic impression of the patient. According to the patient's psychiatric evaluation there is strong evidence to link the patient symptoms with PTSD. In this case I learned that psychiatric evaluation of combat veteran is necessary. Clinical interview is critical when evaluating the patient so the patient's symptoms can be classify patients mental state and ensure appropriate medication.

Psychiatrists ethical responsibility and legal obligation are directly connect. Patients with mental illness should be classified according to their socio-demographic variables. Socio-demographic factor to consider includes patients gender, age and educational background. The socio-demographic considerations are factored into ethical decision making process to ensure an appropriate diagnosis is established. It’s is therefore vital to ensure that the patient’s socio-demographic factor are considered since they influence patients willingness to disclose personal concerns and experience.