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NRNP 6635: Psychopathology and Diagnostic Reasoning
Week 4:Assessing and Diagnosing Patients With 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.

“Fear,” according to the DSM-5-TR, “is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat” (APA, 2022). 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.
For this Assignment, you practice assessing and diagnosing patients with anxiety disorders, PTSD, and OCD. Review the DSM-5-TR criteria for the disorders within these classifications before you get started, as you will be asked to justify your differential diagnosis with DSM-5-TR 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 (CPE) 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.
By Day 1 of this week, select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. 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.
For the assignment
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-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.).
Include an introduction, purpose statement, reflection, and conclusion
Use at least 3 evidence-based resources

Learning Resources
https://video-alexanderstreet-com.eu1.proxy.openathens.net/p/pZz2E4og6
https://video.alexanderstreet.com/embed/training-title-37

Case study
use Training title # 37 video, transcript and case history report
https://video-alexanderstreet-com.eu1.proxy.openathens.net/p/pZz2E4og6
https://video.alexanderstreet.com/embed/training-title-37
00:00:00TRANSCRIPT OF VIDEO FILE:
00:00:00______________________________________________________________________________
00:00:00BEGIN TRANSCRIPT:
00:00:00[sil.]
00:00:15PATIENT I went to the emergency department last week, because I was feeling like I was dying from a heart attack, and they did one of those, what do you call it? Ah, an EKG. And it was normal. But I was sweating and I was having trouble like catching my own breath. And my heart was pounding really, really hard. And I, and I just felt like my, my heart was just going to explode out of my chest. It almost felt like, um, like when your… I don’t know, when you’re in the woods. Uh, alone and, and you… you, feel like someone is, is following or, or chasing you. Or something like that. I, I just, I just my heart felt like it was about to leap out of my chest. I… And uh… I don’t know, probably twelve, fifteen minutes went by and, and the feeling just went away. It just passed. But then… the next day, it was the very same thing and I, for no reason at all. Just all of a sudden, I was making coffee and then WAM, that, that, that tightness in my chest came back and I was sweating and my heart was pounding, same exact feeling. Twelve, fifteen minutes, and then it just went it away. It was like… almost it was almost like my mother, I remember she would get the same thing, probably three to four times a week. It’s just sheer panic for no particular reason at all.
00:02:20SymptomMedia Visual Learning for Behavioral Health www.symptommedia.com
00:02:20END TRANSCRIPT