Training Title 21 Video content/Information to use alongside with Patient’s info
Patient tends to shift a lot in his chair and seems startled/nervous, very hypervigilant and was reluctant to speak at the beginning of the interview. His fiancé demand him to meet up with the psychiatrist
His fiancé demanded that he see a psychiatrist because of him being triggered by fireworks and him having flashbacks of the past event that happened during service as a solider.
The event that lead to him to see a psychiatrist happened 3 nights ago during a county fair he attended with his fiancé- while they are having fun the sudden outburst of firework “sky full of explosion” which frightened the patient and triggered past event of war in the Patient’s memory. This suddenly firework outburst lead to the patient running and was grabbed and pinned down by officers but the patient immediately yelled out that he was a veteran they knew their place and backed off because they were also veterans and the officers helped calm him down.
He gets the same feelings around negative situations and loud noises (car backfire, cutting of circular saw) like how he felt about the fireworks, he also mentions how he gets triggered from some smells such as diesel fuel, chopper smells, smell of burning flesh
Patient was breathing heavily when mentioned the smell of burning flesh and remembered two of his friends that got burned when their area was blown up in the army
He doesn’t feel comfortable talking about the smell of how his friends got burned and he suddenly became scary and tearful.
He mentioned that every night he dreams about the past events that triggered him and makes him feel as if he shouldn’t sleep at all.
He also mentioned that he gets nervous during traffic; he can’t stand traffic because it feels as if he’s stuck and feels like enemies are everywhere and on lookout for them.
When he was over traffic 4 of his other friends got killed by other people on the road and he saw it happened, he could see people staring at him per patient.
He can’t stand when his fiancé and her mother are fighting that triggers him as well
He doesn’t want to go anywhere because of how easily he gets scared and triggered by people’s actions, he just wants to stay in his room all day and he doesn’t want to sleep because of the nightmares feel he should run to a hole.
Patient hasn’t seen or related his current situation to anyone except the interviewer from this video
Sometimes the patient feel nauseated with tight abdominal muscle
The patient felt relaxed and happier when the interviewer told him that it is good that the patient talk about the past event/situation and that the patient will be scheduled for another section so they can work together and feel better
Anxiety Disorders, PTSD, and OCD
Your own experiences might tell you that expectations from family, friends, and work—as well as your own expectations regarding achievement, success, and happiness—can create stress. Stressors are a normal part of life, and stress traditionally has been viewed as an adaptive function with a set of physiological responses to a stressor. In a situation where stress is perceived, the organism is physiologically prepared to attack or flee from the threat. Those with effective fight or flight responses tended to survive long enough to reproduce, so we are descended from those who are genetically hardwired for self-protection. When you experience stress, your biology, emotions, social support, motivation, environment, attitude, immune function, and wellness all feel the ripple effect.
This stress response is an adaptive response the human body has to threats; however, stress can also be difficult to handle and—depending upon the nature and intensity of the stress—can result in anxiety disorders, obsessive-compulsive disorders, or trauma- and stressor-related disorders. This week, you will focus on these disorders and explore strategies to accurately assess and diagnose them.
Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD
“Fear,” according to the DSM-5, “is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat” (APA, 2013). 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.
Photo Credit: Hill Street Studios / Blend Images / Getty Images
For this Assignment, you practice assessing and diagnosing patients with anxiety disorders, PTSD, and OCD. Review the DSM-5 criteria for the disorders within these classifications before you get started, as you will be asked to justify your differential diagnosis with DSM-5 criteria.
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.
·
NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar
INSTRUCTIONS ON HOW TO USE EXEMPLAR AND TEMPLATE—READ CAREFULLY
If you are struggling with the format or remembering what to include, follow the Comprehensive Psychiatric Evaluation Template
AND
the Rubric as your guide. It is also helpful to review the rubric in detail in order not to lose points unnecessarily because you missed something required. Below highlights by category are taken directly from the grading rubric for the assignment in Weeks 4–10. After reviewing the full details of the rubric, you can use it as a guide.
In the Subjective section, provide:
· Chief complaint
· History of present illness (HPI)
· Past psychiatric history
· Medication trials and current medications
· Psychotherapy or previous psychiatric diagnosis
· Pertinent substance use, family psychiatric/substance use, social, and medical history
· Allergies
· ROS
· Read rating descriptions to see the grading standards!
In the Objective section, provide:
· Physical exam documentation of systems pertinent to the chief complaint, HPI, and history
· Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.
· Read rating descriptions to see the grading standards!
In the Assessment section, provide:
· Results of the mental status examination,
presented in paragraph form.
· At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 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
.
· Read rating descriptions to see the grading standards!
Reflect on this case. Include: Discuss what you learned and what you might do differently. 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.).
(The comprehensive evaluation is typically the initial new patient evaluation. You will practice writing this type of note in this course. You will be ruling out other mental illnesses so often you will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for all illnesses which could be impacting your patient. For example, anxiety symptoms, depressive symptoms, bipolar symptoms, psychosis symptoms, substance use, etc.)
EXEMPLAR BEGINS HERE
CC (chief complaint): A brief statement identifying why the patient is here. This statement is verbatim of the patie
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