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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.
• 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
Intrusive Thoughts:
What are the specific thoughts that are intruding on your mind?
How often do you experience them?
What do you do when you have these thoughts?
Compulsions:
What are the specific rituals you engage in to manage your anxiety?
How much time do these rituals take up in your day?
Do you feel like you can control them?
Traumatic Event:
Can you tell me more about the car accident you experienced?
How did you feel immediately after the accident?
Are you currently experiencing any symptoms related to the accident?
Coping Strategies:
What coping mechanisms do you currently use to manage your anxiety?
Do these strategies help?
Are there any other strategies you would like to try?
Sleep and Appetite:
How has your sleep been lately?
Are you experiencing any changes in your appetite?
Differential Diagnoses:
Generalized Anxiety Disorder (GAD):
DSM-5-TR Criteria: Excessive worry and anxiety occurring more days than not for at least 6 months, with symptoms including restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance.
Justification: Sarah's report of persistent worry, difficulty concentrating, and fatigue, as well as her heightened anxiety levels, are consistent with GAD. However, the presence of intrusive thoughts and compulsions suggests a more complex picture.
Post-Traumatic Stress Disorder (PTSD):
DSM-5-TR Criteria: Development of characteristic symptoms following exposure to a traumatic event. Symptoms include intrusive memories, avoidance of stimuli related to the trauma, negative thoughts and feelings, and altered arousal and reactivity.
Justification: Sarah's car accident and the subsequent anxiety, her sense of responsibility, and withdrawal from social activities could be consistent with PTSD. However, the presence of contamination fears and compulsions suggests a more specific diagnosis.
Obsessive-Compulsive Disorder (OCD):
DSM-5-TR Criteria: Presence of obsessions, which are recurrent and persistent thoughts, urges, or images that are intrusive and unwanted, and compulsions, which are repetitive behaviors or mental acts performed in response to an obsession or according to rigid rules.
Justification: Sarah's contamination fears and handwashing rituals are consistent with OCD. Her history of anxiety and the recent trauma might have acted as triggers, exacerbating her OCD symptoms.
Next Steps:
A comprehensive assessment is necessary to determine the specific diagnosis and formulate an appropriate treatment plan. This may involve further interviews, psychological testing, and consultation with a psychiatrist. Treatment options might include therapy (e.g., cognitive-behavioral therapy, exposure and response prevention therapy) and medication (e.g., antidepressants, anti-anxiety medications).
Presenting Problem: Sarah, a 24-year-old female, presents to the clinic seeking help for persistent anxiety and intrusive thoughts. She reports feeling constantly on edge, having difficulty concentrating, and experiencing frequent panic attacks. She also describes a fear of contamination and engages in repetitive handwashing rituals to manage her anxiety.
History:
Personal History: Sarah reports a history of experiencing anxiety since adolescence, but it intensified after a car accident a year ago. The accident involved a serious injury to a close friend, and Sarah feels responsible for the accident despite having no control over it.
Family History: Sarah's mother has a history of depression and generalized anxiety disorder.
Social History: Sarah is a college student, but she has been struggling to keep up with her studies due to her anxiety. She has withdrawn from social activities and feels increasingly isolated.
Medical History: Sarah has no significant medical history.
Medication History: Sarah is currently not taking any medications.
Interview Questions:
Anxiety Symptoms:
Can you describe the feelings you experience when you are anxious?
How often do you experience these feelings?
How intense are they?
What thoughts and physical sensations accompany your anxiety?
Panic Attacks:
Can you describe the panic attacks you experience?
When do they typically occur?
What do you do to manage them?