ASSESSING AND DIAGNOSING PATIENTS WITH ANXIETY DISORDERS, PTSD, AND OCD “Fear,” according to the DSM-5-TR, “is the emotional response to real or perceived imminent threat, whereas anxiety is anticipat ASSESSING AND DIAGNOSING PATIENTS WITH ANXIETY DISORDERS, PTSD, AND OCD “Fear,” according to the DSM-5-TR, “is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of
Comprehensive Psychiatric Evaluation
Subjective: The patient, a 27-year-old female, reported feeling very anxious and fearful. She is unable to sleep or concentrate on work. She feels that something terrible will happen to her, and she worries excessively about various things. The patient has been experiencing these symptoms for the past six months, and they have been impacting her functioning in life. She reported feeling irritable, restless, and easily fatigued. She has also been avoiding social situations and has lost interest in activities that she used to enjoy. The patient reports no history of substance abuse or addiction.
Objective: The patient appeared anxious and restless during the psychiatric assessment. She had a flat affect and poor eye contact. She was cooperative with the assessment, but she appeared guarded.
Assessment: The patient’s mental status examination results revealed poor attention, memory, and concentration. Based on the patient’s chief complaint and symptomology, the following differential diagnoses were considered:
- Generalized anxiety disorder (GAD)
- Panic disorder
- Obsessive-compulsive disorder (OCD)
The DSM-5-TR diagnostic criteria for GAD include excessive anxiety and worry about various things for at least six months, difficulty controlling worry, restlessness, fatigue, irritability, muscle tension, and sleep disturbances. The patient meets the criteria for GAD as she reported excessive anxiety and worry about various things for the past six months, difficulty controlling her worry, restlessness, irritability, and sleep disturbances.
The DSM-5-TR diagnostic criteria for panic disorder include recurrent and unexpected panic attacks, persistent concern or worry about additional panic attacks, and significant maladaptive behavior related to panic attacks. The patient did not report any panic attacks, ruling out the diagnosis of panic disorder.
The DSM-5-TR diagnostic criteria for OCD include the presence of obsessions, compulsions, or both. Obsessions are defined as recurrent and persistent thoughts, urges, or images that are intrusive and unwanted. Compulsions are defined as repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession. The patient did not report any obsessions or compulsions, ruling out the diagnosis of OCD.
Based on the above assessment, the primary diagnosis is GAD. The critical-thinking process that led to this diagnosis was based on the patient’s symptomology and the DSM-5-TR diagnostic criteria for GAD.
Reflection notes: If I could conduct the session over, I would ask more questions about the patient’s family history of anxiety disorders and stressors in her life. In terms of legal/ethical considerations, I would ensure that the patient understands the risks and benefits of treatment options, such as medication and therapy, and provide informed consent. I would also consider cultural factors and ensure that the patient’s values and beliefs are taken into account when developing a treatment plan. Health promotion and disease prevention strategies, such as stress reduction techniques and exercise, could also be incorporated into the treatment plan.