Subjective: CC (chief complaint): HPI:  My fiancé was worried about how I was acting. At county

     Subjective: CC (chief complaint): HPI:  My fiancé was worried about how I was acting. At county fairs, fireworks are set off. I took off running and sought to find cover during the fireworks.P.F., a 27-year-old white male, came in for psychiatric evaluation for anxiety disorders, which include excessive fear and anxiety, as well as related behavioral problems. PTSD, agoraphobia, particular phobia, social anxiety disorder, social phobia, and panic disorder are examples of anxiety disorders. This is the patient’s first mental evaluation, according to him. He enlisted in the military after high school and served three long tours in war zones. He was discharged from the Marine Corps after eight years of service (MOS Field artillery). He is already engaged to be married and works as a salesperson in a furniture store. He stated that he grew up poor and would not be able to do much else if he did not join the military. Because his father was an alcoholic, the patient denied using drugs and tried not to drink alcohol. His father is still alive and ill; despite having diabetes, liver disease, and high blood pressure, he continues to drink. The patient’s paternal grandfather was also a veteran who suffered from depression, and he never mentioned anyone except the patient; they both served in the military. Mother is still alive and well, looking after her husband. He has a younger and an older sister. Due to an event at the fairground fireworks, his fiancée demanded that he go to a psychiatric evaluation. He reports that it terrified him. While he was running, two police officers pursued him, dragging him to the ground and handcuffing him. He stated that he informed the police officers that he was a combat veteran, and that they backed down because they, too, are veterans who understood his behavior. They assisted him in getting up and gave him some water. The patient stated that he was severely shaken because of the incident. He described the explosion as combat fire in the flashback event, and it transported him back in time to the battlefield. His initiations are loud noises, such as a car backfiring or a circular saw. Diesel fuel smells like “chopper smells” to him. His friend burned some of his hair on his arm at a cookout last week, and the smell reminded him, so he quickly left the cookout. Two of his friends were burned when their Humvee was blown up, he says. He paused speaking, and then decided that his experience was too intense to discuss. He imagines people staring at him while they are stopped or stuck in traffic. “I knew we were going down,” he says. He claims that anyone involved with children could be the cause of an IED being rolled under the car. At that point, the patient appears to be breathing heavily and becoming anxious while discussing the event. Another example is when his fiancée disagrees with her mother, and he is unable to manage the situation. Any negative case makes him want to “crawl into the hole and hide there,” he believes. He also mentioned the difficulty of going to places with large crowds, such as baseball parks, restaurants, or shopping. He usually stays in his room because he is afraid to sleep. He mentioned that this is the first time he has shared his experiences and symptoms with anyone. His bodily symptoms were stomach constriction and nausea, according to him. At the end of the interview, the patient states that he felt he was going insane and that it was never ending. My mind sometimes sinks back into itself, as if I cannot see, hear, or move; it is like a numb sensation all over, and I lose track of time. The interviewer suggested going to see an individual therapist to help the brain heal. Talking takes it out of the feeling mode and into the thing mode. As a result, you do not hear the same stories over and over. So, in some ways, you feel in command. According to the American Psychiatric Association (APA), the initial psychiatric evaluation should appropriately review the patient’s mood anxiety and thought content process, perception, and cognition. The provider should go over the patient’s trauma and psychiatric histories, as well as any psychiatric diagnoses and treatments. The guideline focuses on enhancing the clinician-patient relationship, the accuracy of psychiatric diagnoses, and the appropriateness of treatment selection (APA Updates Guidelines on Psychiatric Evaluation in Adults, 2016). Previous Psychiatric History: General Statement: The patient has never seen a psychiatric provider. Caregivers (if any): His fiancée Hospitalizations: negative  Medication trials: negative Psychotherapy or Previous Psychiatric Diagnosis: negative Current and Past Substance Use: The patient denies ever using drugs and avoids alcohol. Family Psychiatric/Substance Use History: His father is a recovering alcoholic. Paternal grandfather was a combat veteran who suffered from undiagnosed depression. Psychosocial History: The patient was brought up by his parents. He has two sisters, one younger and one older than him. He shares a home with his fiancée but has no children. He stated that they do want children and that they intend to marry within the next two years. Medical History: negative Current Medications: unidentified Allergies: seasonal allergies Reproductive Hx: unknown ROS: GENERAL: There is no information available.HEENT: There were no issues with his vision. There were no issues with either hearing or nose. SKIN: There have been no reports of a rash or itching. CARDIOVASCULAR: There have been no reports of c/o chest pain, chest pressure, or chest discomfort. There are no palpitations. RESPIRATORY: There was no evidence of shortness of breath, coughing, or sputum. GASTROINTESTINAL: There were no symptoms of nausea, vomiting, anorexia, or diarrhea. There is no soreness in the stomach. GENITOURINARY: There is no burning when urinating, no urgency, hesitancy, odor, or unusual color. NEUROLOGICAL: There is no headache, no loss of consciousness, no dizziness, no syncope, no paralysis, ataxia, numbness, or tingling in the extremities. MUSCULOSKELETAL: There is no muscle, back, joint, or stiffness, and all extremities can be moved. HEMATOLOGIC: Anemia, bleeding, or bruises are not present. LYMPHATICS: There are no swollen nodes. There has been no splenectomy in the past. ENDOCRINOLOGIC: There is no sweating, cold, or heat sensitivity. There is not any polyuria or polydipsia. Objective: Physical exam: Vital signs: T-97.4, P-84, R-18, B/P 134/88. Height 5’8″, weight 167 lbs. x4 alert and focused. The appearance is casual and weather appropriate. The mood is appropriate for the situation. Diagnostic results: Clinician-administered PTSD scale (CAPS). The CAPS includes the twenty-seven items needed to make the diagnosis, which cover all four criteria. ·The event itself· Re-experiencing of the event· Avoidance· Increased arousal. Evidence of a traumatic event, one symptom of re-experiencing, three of avoidance, and two of arousal are required for the diagnosis (typically, an item is counted if frequency and intensity scale for each item are present (Sadock, et al., 2015). Short PTSD Rating Interview (SPRINT) Data on accurately screening for post-traumatic stress disorder (PTSD) among survivors of car accidents, work-related accidents, or burns are limited. In a clinical setting, the clinician must evaluate the utility of the Short PTSD Rating Interview (SPRINT) and the PTSD Checklist – Civil Version (PCL-C) as screening tools. SPRINT is a screening method in clinical settings for patients with severe trauma that ensures effective identification and referral of positive cases for appropriate care. (Herta et al., 2013). Assessment: Mental Status Examination: PF is alert, focused, and capable of letting his needs be known. During the interview, he is both nervous and cooperative. He has dressed appropriately and appears to be well-groomed. There is no evidence of unusual behavior, and speech is clear with normal tone and volume. His thought processes are logical and goal oriented. There is no evidence of an abnormal thought process, and his memory, both short-term and long-term, is intact. He can focus, and his insight is excellent. He denies suicidal or homicidal thoughts, as well as auditory or visual hallucinations. Differential Diagnoses: PTSD (Post-traumatic stress disorder) A trauma- and stress-related disorder characterized by persistent difficulties that negatively affect an individual’s social interactions, capacity to work, or other areas of functioning because of direct or indirect exposure to actual or threatened death, severe injury, or sexual or emotional violence (Piotrowski & Range, 2020). PTSD Scale (CAPS). The CAPS consists of seventeen items required to make the diagnosis, and it must be administered by a trained clinician and takes 45 to 60 minutes to complete, with follow-up examinations that are brief and to the point. (Sadock et al., 2015). One or more of the following symptoms must be present for it to be diagnosed. Drug and alcohol misuse, suicidality, anger, and interrupted job and family relationships are all traumatic experiences connected with military service. (Annapureddy et al., 2020). Two of the patient’s friends were burned when their Humvee was blown, and he smelled them. As a result, he has nightmares and other triggers that create flashbacks or anxiety. A patient who is a solder may be subjected to repeated exposure to events. Panic Attacks: According to the Anxiety and Depression Association of America in 2014, panic attacks are the distinguishing symptoms of panic disorder, a painful psychiatric condition that affects 2.7 percent of Americans, or six million people, each year. Panic disorder is included in the category of anxiety disorders. (American Psychiatric Association, 2013). The Pain Disorder Severity Scale (PDSS) was a grading system for panic disorder severity. It contained seven items, each assessed on a 5-point Likert scale, and was based on the Yale-Brown Obsessive-Compulsive Scale. The seven questions are about attack frequency, attack distress, anticipatory anxiety, phobic avoidance, and disability. Growing experience with the PDSS implies that panic disorder should be monitored in clinical practice. (Sadock et al., 2015).Panic attacks are extremely acute episodes of great dread that occur repeatedly, without warning, and in innocuous situations. The episodes typically last 15 to 20 minutes and are characterized by waves of symptoms that include a wide range of bodily manifestations. (Lurigio, 2021). “I despise really congested downtown traffic,” the patient said. People in front of and behind you in a car stopped at a traffic light. That is something I cannot stand. I begin to break out in a cold sweat. I am trembling and cannot seem to catch my breath. Agoraphobia: is the fear or anxiety of being trapped in a situation from which escape is difficult. It is one of the most distressing phobias; it can make it difficult to operate at work and in social circumstances. Most panic disorder researchers in the United States feel that agoraphobia invariably occurs as a complication in panic disorder patients. Agoraphobia is supposed to be caused by the dread of having a panic attack in a public location where escape would be difficult. Although agoraphobia and panic disorder frequently coexist. Agoraphobia is classified as a separate illness in the DSM-5, and it may or may not be associated with panic disorder. The DSM-5 diagnostic criteria for agoraphobia include a strong fear or apprehension in at least two of five situations: using public transportation, such as the bus, train, car, or airline, being in an open space, shopping center, or parking lot. In a confined space, there are stores, elevators, and theaters. Outside of the house, the crowd, standing in line, or being alone. Consistent anxiety or terror for at least six months is required. Patients with agoraphobia quickly avoid situations where getting aid would be difficult (Sadock et al., 2015). It is any unfavorable event, such as when my fiancé and her mother get into a fight. “I want to crawl into a hole and hide,” the patient said. “I don’t want to go somewhere, so I stay in my room all day,” he explained. I’m terrified of falling asleep.”aReflections: Learning about various anxiety disorders and diagnostic scales is beneficial. I surely gain a better understanding of PTSD, panic attacks, and agoraphobia. I am hoping for more specific information regarding the patient. It is difficult to remember all the details and explain why some details are not addressed. I believe that the focus should be on neuropsychological exams as well as emotional illnesses like sadness and anxiety. Detailed evaluations are required for presentations with a higher index of suspicion for other medical causes of anxiety, such as EEG, lumbar puncture, and head or brain imaging, electrocardiography, infection tests, arterial blood gas analysis, chest radiography, and thyroid function, to identify or rule out underlying medical disorders. Selective serotonin reuptake inhibitors (SSRIs) are first-line medications for long-term anxiety disorder therapy, with control gradually acquired during a 2- to 4-week course, depending on required dosage increases. Another suggestion is that the patient get individual psychotherapy to help him recover from his trauma.  ReferencesAmerican Psychiatric Association, (2013). Anxiety disorder in Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA Author. Doi: 10.1176/appi.books 9780890425596.dsm05APA Updates Guidelines on Psychiatric Evaluation in Adults, (2016). American Family Physician, 94(1), 62-64.Annapureddy, P., Hossain, M. F., Kissane, T., Frydrychowicz, W., Nitu, P., Coelho, J., Johnson, N., Madiraju, P., Franco, Z., Hooyer, K., Jain, N., Flower, M., & Ahamed, S. (2020). Predicting PTSD Severity in Veterans from Self-reports for Early Intervention: A Machine Learning Approach. 2020 IEEE 21st International Conference on Information Reuse and Integration for Data Science (IRI), Information Reuse and Integration for Data Science (IRI), 2020 IEEE 21st International Conference On, 201-208. https://doi-org.ezp.waldenulibrary.org/10.1109/IRI49571.2020.00036HER?A, D.-C., NEMES, B., & COZMAN, D. (2013). Screening Methodology for Posttraumatic Stress Disorder through Self-Assessment Scales. Journal of Cognitive & Behavioral Psychotherapies, 13(1), 89-100.Lurigio, A. J. (2021). Panic attacks. Salem Press Encyclopedia of Health.Piotrowski, N. A., PhD, & Range, L. M., PhD. (2020). Post-traumatic stress disorder. Magill’s Medical Guide (Online Edition).Sadock, B. J., Sadock, V. A., and Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.Please revise underline parts. Thank you.   Health Science Science Nursing NRNP 6635 Share QuestionEmailCopy link Comments (0)