Comprehensive Psychiatric Evaluation Example – NRNP PRAC 6635 Week 7 Assignment

Comprehensive Psychiatric Evaluation Example – Assessing and Diagnosing Patients with Anxiety Disorders, PTSD, and OCD Example Solution for NRNP PRAC 6635 Week 7 Assignment . I have attached the information for the assignment, I have also included some examples I found of previous submissions. Please pay careful attention to the rubric because the instructor deducts points very easily. The video transcript, template, and template exemplar is also attached.(Comprehensive Psychiatric Evaluation Example)

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?(Comprehensive Psychiatric Evaluation Example)

·         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.).

Training Title 24 Name: Ms. Jess Davies Gender: female Age: 30 years old T- 98.6 P- 86 R 20 120/70 Ht 5’2 Wt 126lbs Background: Jess is brought for evaluation by her 2 roommates who are concerned with behaviors. She had some issues with depression after aunt died but worsened in the 12 days after she witnessed her brother killed via GSW in a gas station burglary. She is estranged from her parents and her brother was her only sibling. She is only sleeping 2 hours/24hrs; she will only eat canned foods. She smokes cannabis daily since she was 17 and goes out on weekdays couple. Comprehensive Psychiatric Evaluation Example – Assessing and Diagnosing Patients with Anxiety Disorders, PTSD, and OCD Example Solution

times with her roommates and has couple drinks of beer. She was prescribed alprazolam 1mg twice daily as needed by her PCP for 15 days. She works in a bakery. Allergies: medical tape Symptom Media. (Producer). (2016). Training title 24 [Video]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/wa tch/training-title-24

Comprehensive Psychiatric Evaluation Example – Assessing and Diagnosing Patients with Anxiety Disorders, PTSD, and OCD Example Solution

CC (chief complaint): “My fiancé suggested, well, demanded that I make an appointment.”

HPI: Stg. P.F. is a 27-year-old American Caucasian male who checks in for psychiatric evaluation. The client’s fiancé is concerned with his recent behaviors and recommended that he makes an appointment with a mental health practitioner. Three nights ago, while making merry, the client took off running, scared, and trying to find cover after fireworks went off without warning and the sky filled up with explosions. In the aftermath, the police took him down and tried to cuff him, suspecting he might have robbed someone. The client reported that the fireworks sounded like combat fire, making him shake. The explosive sound of the fireworks took the client back into the middle of the enemy fire. A week before the psychiatric exam, the client had jumped behind a magazine rack after a can backfired. The client reports that even the sound of a circular saw cutting into wood takes him back into the enemy fire.(Comprehensive Psychiatric Evaluation Example)

Moreover, the smell of diesel fuel or choppers smell sent him off to the enemy fire. He reports an incident a week before the psychiatric exam when his neighbor was grilling and scorched hair on the arm. The resultant smell was bad that he had to leave the party. The incident reminded him of how his two buddies smelled who got burned when their Humvee was blown. The client describes these memories as too strong. The client reports dreaming about these events daily, making him want to crawl into bed and close his eyes.

Stg. P.F. reports that he cannot stand heavy traffic or traffic light stop. He starts sweating, shaking, or having difficulty breathing whenever he is stuck in traffic or stops at a traffic light. He gets worried about people in front, behind, and beside him. Specifically, he fears that someone can roll an IED under the car while he is trapped inside. Such situations remind the client of an incident in which four of his buddies were blown to hell, and two other vehicles were blown up. The client perceives her fiancé’s arguments with her mother as negative and feels like crawling into and hole and hiding. He feels like a wimp and a freaking coward and does not want to go anywhere and stay in his room all day. He is afraid of sleeping and generally regards his situation as dire. Sometimes, he experiences tight stomach muscles and nausea and feels everything will never end. He sometimes feels crazy, stops thinking, becomes numb, and loses track of time. He does not want to be a whiner and would like to be in control of himself.(Comprehensive Psychiatric Evaluation Example)

Past Psychiatric History: No previous psychiatric history.

General Statement:   This is the first time the client is entering treatment.

Hospitalizations: No previous hospitalization, residential treatments, detox, self-harming behaviors, suicidal or homicidal behaviors.

Medication trials: No previous psychotropic medication.

Psychotherapy or Previous Psychiatric Diagnosis: No previous psychotherapy or psychiatric diagnosis.

Substance Use History: Denies substance use or abuse.

Family Psychiatric/Substance Use History: The father is an alcoholic. The paternal grandfather is a veteran and was diagnosed with depression.

Psychosocial History: The client was born and raised by both parents. The father is an alcoholic. The father has diabetes mellitus and hypertension. The mother is alive and well. The client has a younger sister and an older sister. The paternal grandfather is a live veteran and suffers from depression. After graduating from high school, the client joined the military and served for eight years. The client presently lives with the fiancé and works as a furniture salesman.(Comprehensive Psychiatric Evaluation Example)

Medical History: The client has seasonal allergies and service-connected asthma.

Current Medications: No current medication.

Allergies: NKFDA

Reproductive Hx: Sexually active.

ROS:

GENERAL: The client is alert and oriented x 4, well groomed, dressed appropriately for the weather and occasion, and appears in no acute distress.

HEENT: Denies head injury. No visual or hearing loss. No nasal congestion, changes in smell, or difficulty swallowing.

SKIN: No skin discoloration. No scars, soreness, rashes, or abnormalities.

CARDIOVASCULAR: No chest pain, oedema, syncope, or palpitations.(Comprehensive Psychiatric Evaluation Example)

RESPIRATORY: Experiences difficulty breathing when exposed to traumatic triggers and flashbacks of traumatic events. Normal breath sounds or shortness of breath without triggers. No cough or wheezing.(Comprehensive Psychiatric Evaluation Example)

GASTROINTESTINAL: Reports nausea when anxious or memorizing flashbacks.

GENITOURINARY: No pain on urination. No urination inconsistency.(Comprehensive Psychiatric Evaluation Example)

NEUROLOGICAL: The client reports feeling numb when anxious or memorizing flashbacks and traumatic experiences in the military.

MUSCULOSKELETAL: No muscle or joint pain. Denies arthritis.

HEMATOLOGIC: No anemia or ease of bruising/bleeding. Denies blood-related disorders.

LYMPHATICS: No painful or swollen nodes.

ENDOCRINOLOGIC: No polydipsia or polyphagia. Denies diabetes diagnosis and heat or cold intolerance.

Objective:

Physical exam: N.A.

Vital signs: T97.4, P84, R18, B/P134/88, Ht5’8”, Wt167 lbs, BMI – 25.4 (overweight)

Diagnostic results: Administering the CAPS-5 would be appropriate for assessing the client’s PTSD symptoms. The CAPS-5 is a clinician-administered psychiatric interview based on the DSM-5 criteria for PTSD symptoms. The tool is effective for screening for PTSD and diagnosis of PTSD (Weathers et al., 2018). The PCL-5 is considered the gold standard for PTSD diagnosis(Comprehensive Psychiatric Evaluation Example)

Assessment

Mental Status Examination: The client is a 27-year-old Caucasian American male who looks his stated age. He is well-dressed for the occasion. He is calm, conversant, and cooperative. He does not make direct eye contact. His mood is sad and congruent with the constricted affect. No psychomotor abnormality was noted during the exam. The client shivered at the mention of combat fire during the exam, breathed heavily, and became tearful as he recounted traumatizing incidences that he keeps memorizing. The speech is coherent. However, form and content are goal-oriented and optimistic. Memory is intact and recent. The client is alert and oriented in all spheres. No difficulty with attention and concentration. Judgment and insight are fair. Denies suicide or homicide ideation. The client is not at risk of harm to himself or others.(Comprehensive Psychiatric Evaluation Example)

Differential Diagnoses for Comprehensive Psychiatric Evaluation Example

1. Posttraumatic Stress Disorder (PTSD), 81 (F43.10). The diagnostic criteria for PTSD in adults include exposure to threatened or actual injury, death, or sexual violence, presence of one or more intrusion symptoms, persistent stimuli avoidance, altered cognitions/mood associated with the traumatic event, and altered arousal or reactivity associated with the traumatic event (American Psychiatric Association [APA], 2019). These symptoms include intrusive distressing and recurrent dreams or memories of traumatic events, dissociative reactions or flashbacks, prolonged psychological reactions or distress cures that resemble the traumatic event, and avoidance of distressing memories or reminders that arouse recollections of traumatic events. Individuals also experience altered mood and cognition associated with traumatic events, which cause distorted cognition of the events, negative emotional state, detachment, and inability to experience positive emotions (APA, 2019). This is the primary diagnosis.(Comprehensive Psychiatric Evaluation Example)
2. Generalized anxiety disorder (GAD), 300.02 (F41.1). GAD is determined by excessive worry/anxiety, difficulty controlling worry, and presenting three or more worry/anxiety-related symptoms (APA, 2019). These symptoms include restlessness, fatigue, irritability, difficulty concentrating, sleep disturbance, and muscle tension. These symptoms cause significant clinical distress, impair essential areas of functioning, and have been present for the past six months.(Comprehensive Psychiatric Evaluation Example)
3. Acute stress disorder (ASD), 308.3 (F43.0). The diagnostic criteria for ASD include exposure to threatened or actual injury, death, or sexual abuse and experiencing symptoms for at least nine related to dissociative signs, arousal intrusion, negative mood, and avoidance symptoms between three days and one month. These symptoms include intrusive and recurrent distressing dreams, memories, and reactions of a traumatic event, lack of positive emotions, altered sense of reality and aspects of the traumatic event, hypervigilance, avoidance of the distressing memories and reminders, sleep disturbance, irritability, startle response, and altered concentration. This is a secondary diagnosis.(Comprehensive Psychiatric Evaluation Example)

Case Formulation and Treatment Plan f0r (Comprehensive Psychiatric Evaluation Example – Assessing and Diagnosing Patients with Anxiety Disorders, PTSD, and OCD Example Solution)

Psychotherapy: Start the client on prolonged exposure therapy (P.E.). P.E. is effective in managing PTSD symptoms. Clients are taught how to progressively approach traumatic situations, feelings, and memories (Watkins et al., 2018). This would allow the client to go through the painful memories and gradually begin participating in activities previously avoided.(Comprehensive Psychiatric Evaluation Example)

Pharmacotherapy: Two selective serotonin reuptake inhibitors, i.e., Zoloft and Paxil, are primarily recommended by the FDA. For this client, Zoloft 50mg P.O. Q.D. Zoloft effectively reduces PTSD symptoms (Kaysen et al., 2019).(Comprehensive Psychiatric Evaluation Example)

Education: The client should be given the Veterans Crisis Line: 1-800-273-8255, press 1, and a guide to coping with combat stress. Inform the client of the importance of pharmacological and psychological therapies.(Comprehensive Psychiatric Evaluation Example)

Reflections

PTSD is the primary diagnosis. The client’s symptoms meet the full diagnostic criteria for PTSD diagnosis. The client experienced traumatic events while serving in the army and associates his present encounters with these events through dressing memories and flashbacks. For instance, the client associated loud noises and firework explosions to enemy fire and downtown traffic to IED experiences during the war. Moreover, the client practices avoidance of these reminded as shown by running away from notice or disagreements. These are flashbacks of enemy fire, and running to find the cover is an attempt to avoid the stimuli. Thu, the client shows altered cognition and mood towards loud noises.(Comprehensive Psychiatric Evaluation Example)

Studies have shown that PTSD is common among service members. The condition is associated with direct involvement in combat and exposure to horrible and life-threatening experiences. Armenta et al. (2018) established that combat experiences and intensity, sexual assault, illness/injury, and death predispose individuals to develop PTSD. When dealing with military-related PTSD, the mental health practitioner must uphold the ethical and legal tenets of beneficence and nonmaleficence (Yang et al., 2017). In this case, maintaining nonmaleficence and beneficence would allow a mental health practitioner to establish therapeutic alliances with the client, adopt a client-centered approach, and engage the client, incorporating the client’s interest. In this case, the practitioner should encourage the client and advise him of the importance of medication.(Comprehensive Psychiatric Evaluation Example)

Comprehensive Psychiatric Evaluation Example – Assessing and Diagnosing Patients with Anxiety Disorders, PTSD, and OCD Example Solution

References

American Psychiatric Association. (2019). Diagnostic and statistical manual of mental disorders  (7^th ed.). American Psychiatric Publishing, Inc.

Armenta, R. F., Rush, T., LeardMann, C. A., Millegan, J., Cooper, A., & Hoge, C. W. (2018). Factors associated with persistent posttraumatic stress disorder among U.S. military service members and veterans. BMC Psychiatry, 18(1), 1-11. https://doi.org/10.1186/s12888-018-1590-5

Bipeta, R. (2019). Legal and ethical aspects of mental health care. Indian Journal of Psychological Medicine, 41(2), 108-112. https://doi.org/10.4103%2FIJPSYM.IJPSYM_59_19

Kaysen, D. L., Bedard-Gilligan, M. A., & Saxon, A. J. (2019). Use of prolonged exposure and sertraline in the treatment of posttraumatic stress disorder for veterans. JAMA Psychiatry, 76(2), 109-110. https://doi.org/10.1001/jamapsychiatry.2018.3410

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A review of evidence-based psychotherapy interventions. Frontiers in Behavioral Neuroscience, 12, 258. https://doi.org/10.3389%2Ffnbeh.2018.00258

Weathers, F. W., Bovin, M. J., Lee, D. J., Sloan, D. M., Schnurr, P. P., Kaloupek, D. G., … & Marx, B. P. (2018). The Clinician-Administered PTSD Scale for DSM–5 (CAPS-5): Development and initial psychometric evaluation in military veterans. Psychological Assessment, 30(3), 383. https://doi.org/10.1037%2Fpas0000486

Yang, S., Schneider, B., Wynn, G. H., & Howe III, E. (2017). Ethical considerations in the treatment of PTSD in military populations. Focus, 15(4), 435-440. https://doi.org/10.1176%2Fappi.focus.20170035