NRNP 6635 Week 4: Anxiety Disorders, PTSD, and OCD

NRNP 6635 Week 4: Anxiety Disorders, PTSD, and OCD

NRNP 6635 Week 4: 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.

Learning Objectives

Students will:

• Apply concepts, theories, and principles related to patient interviewing, diagnostic reasoning, and recording patient information
• Formulate differential diagnoses using DSM-5 criteria for patients with anxiety disorders, PTSD, and OCD across the lifespan

Learning Resources

American Psychiatric Association. (2013). Anxiety disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm05

American Psychiatric Association. (2013). Obsessive compulsive and related disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm06

American Psychiatric Association. (2013). Trauma- and stressor-related disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm07

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

• Chapter 9, Anxiety Disorders
• Chapter 10, Obsessive-Compulsive and Related Disorders
• Chapter 11, Trauma- and Stressor-Related Disorders
• Chapter 31.11 Trauma-Stressor Related Disorders in Children
• Chapter 31.13 Anxiety Disorders in Infancy, Childhood, and Adolescence
• Chapter 31.14 Obsessive-Compulsive Disorder in Childhood and Adolescence

Document: Comprehensive Psychiatric Evaluation Template

Document: Comprehensive Psychiatric Evaluation Exemplar

Required Media (click to expand/reduce)

Classroom Productions. (Producer). (2015). Anxiety disorders [Video]. Walden University.

Classroom Productions. (Producer). (2012). The neurobiology of anxiety [Video]. Walden University.

Classroom Productions. (Producer). (2015). Obsessive-compulsive disorders [Video]. Walden University.

Classroom Productions. (Producer). (2015). Trauma, PTSD, and Trauma-Informed Care [Video]. Walden University.

MedEasy. (2017). Anxiety, OCD, PTSD and related psychiatric disorders | USMLE & COMLEX [Video]. YouTube. https://www.youtube.com/watch?v=-BwzQF9DTlY

Video Case Selections for Assignment (click to expand/reduce)

Select one of the following videos to use for your Assignment this week. Then, access the document “Case History Reports” and review the additional data about the patient in the specific video number you selected.

Symptom Media. (Producer). (2017). Training title 15 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-15

Symptom Media. (Producer). (2016). Training title 21 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-21

Symptom Media. (Producer). (2016). Training title 37 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-37

Symptom Media. (Producer). (2016). Training title 40 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-40

Symptom Media. (Producer). (2017). Training title 55 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-55

Symptom Media. (Producer). (2017). Training title 85 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-85

Symptom Media. (Producer). (2018). Training title 95 [Video]. https://video-alexanderstreet-com.ezp.waldenulibrary.org/watch/training-title-95

Document: Case History Reports

Assignment: 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.

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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.
• 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.

By Day 7 of Week 4

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.).

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

• Please save your Assignment using the naming convention “WK4Assgn+last name+first initial.(extension)” as the name.
• Click the Week 4 Assignment Rubric to review the Grading Criteria for the Assignment.
• Click the Week 4 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK4Assgn+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission.

Grading Criteria

To access your rubric:

Week 4 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 4 Assignment draft and review the originality report.

Submit Your Assignment by Day 7 of Week 4

To participate in this Assignment:

Week 4 Assignment

What’s Coming Up in Week 5?

Next week, you will continue to practice your assessment and diagnosis skills, focusing on disruptive, impulse-control, conduct, dissociative, and somatic symptom-related disorders.

Midterm Exam

You should also begin studying for your midterm exam, which is completed in Week 6. This will be a 100-question, multiple-choice exam covering all topics in Week 1–Week 6 of the course. The exams in your MSN program are designed to test your knowledge in preparation for your certification exam and to simulate the certification exam environment. Accordingly, no outside resources, including books, notes, websites, or any other type of resource, may be used to help you complete the exams in your courses.

Photo Credit: [Vergeles_Andrey]/[iStock / Getty Images Plus]/Getty Images

Next Week

To go to the next week: Week 5 NURS 6670 Week 5 Discussion: Treatment of Anxiety Disorders