What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis?
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.
- View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.
- Consider what history would be necessary to collect from this patient.
- Consider what interview questions you would need to ask this patient.
- Identify at least three possible differential diagnoses for the patient.
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?
- 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 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.
- 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 40
Name: Ms. Barbara Weider Gender: female Age: 56 years old
T-99.0 P-99 R 24 BP 132/89 Ht 5’4 Wt 168lbs
Background: Lives with her husband in Knoxville, TN, has one daughter age 23. She has never worked. Raised by mother, she never knew her father. Mother with hx of anxiety; no substance hx for patient or family. No previous psychiatric treatment. Has one glass red wine with dinner. Sleeps10-12hrs; appetite decreased. Has overactive bladder, untreated. Allergic to Phenergan; complains of headaches, takes prn ibuprofen, has diarrhea once weekly, takes OTC Imodium.
Weider -She nervously plays with her scarf as she breathes anxiously]
Physician- Hello Mrs. Weider. Are you ok? Do you want some water or something?
WEIDRE I’m ok. I’m fine.
Physician- I understand you wanted to see me today.
Patient- She breathes anxiously]
Patient- I just really needed to sit and talk.
Physician- Well, tell me what’s wrong, what are you feeling?
Patient- I’m just so… so unsure. I’m tired of being stuck in my house. I don’t like it.
Physician- Stuck in your house? Do you have difficultly leaving your house?
Patient- Yes. All the time.
Physician- When do you go out?
Patient…maybe, once or twice.
Physician- A day?
Patient- [She clutches her hands to her chest]
Patient- A week. Tuesdays and Saturdays.
Physician- Why Tuesday and Saturday?
Patient- Because when my husband gets home, he can go with me.
Physician- What do you do when you go out?
Patient- I take walks.
Physician- Where do you walk?
Patient- I only go to the end of the block, and then I cross the street, and turn around, and I go back around the cul-de-sac. I’ll do that three times. [Losing breathe] No more, then I have to go back inside… I also go in my backyard. That’s usually okay.
Physician- On the walks, why do you have to go back after three times? What happens?
Patient- [She nervously looks around] I just can’t go any further.
Physician- Is this a physical problem, knees or something?
Patient- [She plays with her scarf]
Patient- No. No. Well… maybe. I just can’t breathe if I’m out any longer.
Physician- Oh, breathing?
Physician- What do you feel?
Patient- [Her voice quivering] I’m just so frightened. Really, really scared. You don’t realize what it took for me to get here today. I really had to. I willed it. I closed my eyes and my husband turned the radio up all the way as he drove. And then he lead me into the building.
Physician- Is there something that triggers this, anything in particular?
Patient- I don’t like people. Maybe that’s it. I mean I can tolerate them. Ethan, the little boy next door, I’ll bake things for him and say hello. Sometimes, sometimes I watch him when his parents are gone. I mean I can be around people. Maybe that’s not that’s not what I meant.
Physician- Ok, can you walk me through what happens when you do leave the house?
Patient- I get shortness of breath, everything, the world just seems to close in on me, and everything gets feels really tight, the air in my body, my chest. I get dizzy. I don’t know what’s wrong… I could be sick. What is this?
Physician- There can be many different causes for this. What is it that frightens you?
Patient- [She’s short of breathe] Death. I’m afraid to die.
Physician- You’re afraid you might die?
Patient- Yes. Among other things but that’s what pops into my head.
Physician- Is there other stuff?
Patient- Cars go to fast. And there’s murders and rapes that I see on the news. And flashfloods. I just think its close, its safer to stay close to home.
Physician- How long have you had this fear?
Patient- I don’t really know.
Physician- Do you know when it all started?
Patient- I’m not sure.
Physician- Do you know what started it?
Physician- When was the last time you really ventured out for any length of time?
Patient- Fifteen years.
Patient- [She nervously shifts in her chair]
Physician- That long. Is this the farthest you’ve been in fifteen years? What happened fifteen years ago?
Patient- I don’t really know.
Physician- There is nothing that happened to you personally that could have made you afraid of dying?
Patient- I always was. My mother died the year before that. But it happened little by little. First it was planes. And then I couldn’t drive on the freeway, then I couldn’t drive at all, then errands, then it was going out… and soon… here I am.
Physician- It must have taken you extraordinary courage to come here today. What finally brought you to see me?
Patient- My grandson was born. But I couldn’t go and see him. I still haven’t seen him. My daughter gave birth last week and she’s not going to bring him to see me for several months and I don’t want to wait that long.
Physician- You miss out.
Patient- Yes! Of course, I do! My grandson is a thousand miles away and I can’t leave the God damned house.
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