WEEK 4 patients with anxiety disorders, PTSD, and OCD. Review the DSM-5 criteria

Answer

1.  (WEEK 4): (Patients with Anxiety Disorders, PTSD, and OCD)

    

   Patients with Anxiety Disorders, PTSD, and OCD

   1. Subjective

   CC (Chief Complaint):

   The interviewer attempted to know the reason why Mrs. Weidre wanted to seek treatment; hence, she responded by saying, "I'm just so…so unsure. I'm tired of being stuck in my house. I don't like it."

   HPI:

   B.W is a 56-year-old female presenting for psychiatric evaluation for anxiety disorder. She is currently prescribed Phenergan, prn Ibuprofen, and OTC Imodium. However, she has had no previous psychiatric treatment, therefore, no referrals whatsoever.

   B.W. is seeking medical evaluation due to being stuck in the house; thus, she finds it difficult going out. The psychiatric review of B.W involved studying the onset, duration, frequency, severity, and impact of his symptoms. Based on the general questions asked, the onset of his symptoms is unknown. The duration is also unknown. The frequency of their occurrence was slowly or little by little; their severity is 15 years; and, their impacts include difficulties in driving, running errands, and going out.

   Past Psychiatric History:

   General Statement: The patient records no history of any previous psychiatric treatment.

   Caregivers: Mrs. Weidre’s husband.

   Hospitalizations: Mrs. Weidre’s history does not indicate any instances of hospitalizations, detoxifications, residential treatments, suicidal, homicidal, or self-harm behaviors.

   Medication Trials: Phenergan (Decreased appetite, Overactive bladder).

   Psychotherapy or Previous Psychiatric Diagnosis: Instances of psychotherapy or a diagnosis from a previous psychiatric disorder are not indicated in Mrs. Weidre’s past medical history.

   Substance Current Use and History:

   There is no patient's history regarding the use of caffeine, nicotine, or illicit substances.

   Family Psychiatric/Substance Use History:

   The patient’s family history indicates her mother to have had a history of anxiety; however, there is no indication of any substance use illnesses or suicides among her family.

   Psychosocial History:

   Details regarding Mrs. Weidre’s birth location are not indicated; however, she never got the chance to know her father, thereby getting to be raised only by his mother.

   Information describing the patient's siblings is missing; thereby, details regarding his brothers or sisters are not known.

   The patient is married and currently lives with her husband in Knoxville, TN. She has one daughter, who is 23 years of age.

   The education history of Mrs. Weidre is not indicated; thus, his specific level of education is not known.

   Mrs. Weidre’s report does not indicate any hobbies that she engages in. The patient's work history indicates that she has never been engaged in any work whatsoever; thus, his profession is unknown.

   Mrs. Weidre’s legal history does not indicate any past or current issues with the law.

   The patient’s trauma history notes that she is afraid of dying; hence, this might have been triggered by the death of his mother.

   The patient has a violence history, which is denoted by his concerns regarding safety around the community. Some of his concerns entail speeding vehicles, issues of rape, and the occurrence of floods.

   Medical History:

   Current Medications: The patient uses Phenergan, homeopathic products such as red wine, and over-the-counter drugs- ibuprofen and Imodium. Dosages for Phenergan, ibuprofen, and Imodium have not been illustrated. As for the red wine, Mrs. Weidre consumes only a single glass.

   The frequency intake of Phenergan and ibuprofen have not been indicated; however, she might be taking red wine daily and Imodium once a week. Mrs. Weidre might be consuming red wine daily since she indicates that she takes it with dinner, hence his longer sleeping hours (10-12 hours). Additionally, Imodium might only be consumed weekly since the patient indicates that she only experiences diarrhea once a week.

   The length of time that Mrs. Weidre has been using both the homeopathic products, Phenergan, and over-the-counter drugs is unknown.

   The patient indicates valid reasons for consuming red wine, ibuprofen, and Imodium. The consumption of red wine aids the patient to have longer sleeping hours of around 10-12 hours, intake of ibuprofen lessens the patient's headaches, and utilization of Imodium helps the patient curb diarrhea. The patient has not indicated reasons for using Phenergan.

   Allergies: The allergies reported by the patient include loss of appetite and an overactive bladder. The allergies were indicated to occur due to the Phenergan medication; therefore, any instances of food and environmental allergies were not mentioned. Appetite loss entails an individual's disregard towards food, resulting in weight loss (Blake, 2019). Overactive bladder is a condition in which the bladder malfunctions, causing urine leakages or increased urgency to urinate (Cleveland Clinic, 2019).

    

    

   Reproductive History: Mrs. Weidre's reproductive history has not been highlighted. Therefore, there is no record of his menstrual history, pregnancy, contraceptive use, type of intercourse, and information on whether she is lactating.

   ROS:

   GENERAL:  Weight gain, currently taking Phenergan, ibuprofen, and Imodium. No fatigue, fever, chills, or difficulties in sleeping.

   HEENT: Head; no previous head disorders. Eyes; no past vision disorders, double vision, or eye discharge. Ears; no loss of hearing. Nose; no nasal discharge; Throat; no sore throats.

   SKIN: No sores, rashes, or itching

   CARDIOVASCULAR: Chest pains, chest pressure, palpitations.

   RESPIRATORY: Shortness of breath, chest pains. No cough or wheezing.

   GASTROINTESTINAL: Diarrhea. No nausea or vomiting.

   GENITOURINARY: Frequent urination, urgency, and incontinence. No burning during urination.

   NEUROLOGICAL: Headaches and dizziness. No seizures.

   MUSCULOSKELETAL: No muscle ache or back pain.

   HEMATOLOGIC: No fevers, bleeding, or anemia.

   LYMPHATICS: No lymph nodes.

   ENDOCRINOLOGIC: Presence of polyuria. No polydipsia or polyphasia.

    

    

    

   1. Objective

   Physical Exam:

   A physical exam is not applicable since the ROS has already been utilized in identifying the patient’s given symptoms. Consequently, the information gathered from the ROS is adequate in formulating a differential diagnosis and identifying the patient’s underlying condition.

   Diagnostic Results:

   Developing a differential diagnosis will involve the incorporation of various diagnostics. Therefore, some of the diagnostics that will be used to distinguish various conditions causing Mrs. Weidre's symptoms entail; the zung self-rating anxiety scale, brain scans, the CAPS-5 test, and the Yale-Brown Obsessive Compulsive Scales (Y-BOSCS). The zung self-rating anxiety scale is a questionnaire used to rate the severity of the patient’s symptoms by assessing nervousness, heart rates, urinations, and anxiety (Healthline Editorial Team, 2017). Brain scans are used to determine a patient’s mental health by their ability to detect lesions, which are damaged tissues in the brain that can cause mental conditions such as anxiety and depression (StoneRidge, n. d). Additionally, the CAPS-5 test is a questionnaire that aids physicians in evaluating the onset and duration of a patient’s symptoms (Polizzi, 2021). Finally, the Y-BOCS scale can be utilized in assessing a patient’s obsessions and compulsions (NOCD, 2021).

   • Assessment

   Mental Status Examination:

   B.W. is a 56-year-old female who is a bit short in stature. She is nervous and unsettled. His behavior is, however, accommodative. His mood is melancholic, and her affect demonstrates frustration. His speech is fluent and insistent on details. She has a vague thought process and difficulties giving accurate data. The thought content is meaningful and comprehensible. She displays perceptions of thanatophobia and the possibility of an arising danger. His ability to think, formulate and enact decisions is superb. She has deep insight and understands the risk factors associated with his condition. There are instances of his insensible judgments. She does not illustrate any instances of suicidal or homicidal ideations.

   Differential Diagnosis:

   Some of the conditions associated with Mrs. Weidre’s symptoms entail anxiety disorders, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). By utilizing the DSM-5 criteria, a differential diagnosis was conducted on the given conditions; thus, leading to the diagnosis of anxiety disorders as the primary condition affecting the patient. Reasons for settling on anxiety disorder is because the DSM-5 criteria evaluated it to be relevant with the majority of the symptoms and medical history of Mrs. Weidre.

   The DSM 5 describes PTSD as a condition that arises after exposure to a particularly traumatic event; hence, the patient has to experience direct exposure to the situation that may result in unwanted memories, flashbacks, or even nightmares (U.S. Department of Veterans Affairs, 2019). However, based on the patient’s case history, Mrs. Weidre does not indicate any instances of being directly exposed to a traumatic event nor having any unwanted memories or flashbacks.

   The DSM-5 describes the obsessive-compulsive disorder as a condition in which a person engages in repetitive activities (Leon, n. d). Acts of repetition can be viewed from Mrs. Weidre's behavior of going round the block strictly three times before returning home. However, people suffering from this condition usually have difficulties getting rid of possessions, which has not been indicated in the case of Mrs. Weidre, therefore, ruling it out.

   Finally, anxiety disorders are described as excessive feelings of anxiety, worry, and fear which may negatively affect a person’s daily activities (Glasofer, 2021). Feelings of anxiety can be noted from Mrs. Weidre’s behavior while being attended to. Some of the symptoms observed include shortness of breath and signs of increased palpitations demonstrated by the clutching of his hand on his chest. Furthermore, according to Glasofer (2021), the DSM-5 outlines various symptoms that physicians can use to diagnose an anxiety disorder, including headaches, diarrhea, and difficulties in sleeping. Consequently, the patient indicated instances of headaches and diarrhea, thus the reason for her taking ibuprofen and Imodium. Additionally, insomnia can also be associated with the patient's consistent uptake of red wine with dinner. Feelings of worry and fear can also be linked to Mrs. Weidre’s constant feeling of insecurities and disasters such as murders, rapes, and floods.

   Reflections:

   I agree with the preceptor's assessment and diagnostic impression because it covers most of the patient's background and personal information, which makes it easier to determine the onset and progression of the condition. From this case, I learned that most patients with mental health issues find it difficult to access healthcare facilities. Difficulties in accessing health services might range from various factors such as advanced age, lack of medical cover, or cultural backgrounds. Therefore, to address the given issues, I will conduct online seminars to reach the aged who cannot physically attend sessions. I will engage in volunteer programs geared towards promoting health in marginalized societies with no conflict of interest whatsoever, and I will tailor patient-centered services to ensure there is equal distribution of resources to all people of different ethnicities.