A female patient presents to your office with a chief complaint of intense anxiety and fear of driving a car
A female patient presents to your office with a chief complaint of intense anxiety and fear of driving a car
((A female patient presents to your office with a chief complaint of intense anxiety and fear of driving a car after a history of a serious car accident. Her anxiety is becoming more disruptive and is now affecting all elements of her life. She won’t go to the store unless someone else drives her, she quit her job, and she stopped seeing friends. ))
Respond to your peers with the following:
What are 3 questions you would ask to help determine if the patient meets criteria for one of the differentials?
Post 1-
With the patient’s history of the direct involvement in a serious car accident, along with the subsequent anxiety and fear that she has been having revolving around driving, an appropriate diagnosis for the patient could be Post-Traumatic Stress Disorder (PTSD). Post-Traumatic Stress Disorder occurs following one or more traumatic events. The typical characteristic symptoms are shown following exposure to these traumatic events. The time between the trauma and symptom presentation can vary from 3 months to a year after event (NIMH, 2022). The patient exhibits symptoms that correlate with DSM-V criteria for Post-Traumatic Stress Disorder. These symptoms include being exposed directly to the traumatic event and the resulting multiple disturbances and changes in her life, as expressed by the patient. Specifically, this involves the consistent avoidance of factors related to the motor vehicle accident as well as the social, occupational, and overall deterioration in personal functioning (APA, 2022).
Acute stress disorder can be ruled out as a differential diagnosis depending on the amount of time following the traumatic event exposure. According to the American Psychiatric Association (2022), acute stress disorder is limited to 3 days to 1 month following the trauma, which would differentiate it from PTSD. The patient would need to indicate when her symptoms started as well as how long she has been feeling exhibiting symptoms. Another differential diagnosis could be specific phobia. Because the patient began experiencing her fear and anxiety following and as a result of the car accident, the diagnosis of specific phobia would not be sufficient for the patient. Additionally, with the specific phobia diagnosis, the fear, anxiety, and avoidance usually last for 6 months or more (APA, 2022).
References
American Psychiatric Association. (2022). Neurodevelopmental disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
National Institute of Mental Health. (2022). Post-Traumatic Stress Disorder. https://www.nimh.nih.gov/health/topics/post-trauma…
Post 2-
A patient presents with complaints of intense anxiety and fear of driving following a serious car accident. Her anxiety begins to affect all elements of her life. She is unable to drive, quitting her job, and isolating herself from her friends. After reviewing her complaints and her history, the patient could be experiencing post-traumatic stress disorder (PTSD).
Post-traumatic stress disorder is when a patient experiences either personally or witnessing a traumatic event that causes the patient to avoid reminders of the traumatic event, inability to focus, self-isolation, and repeated memories of the event (Coleman, 2022). The traumatic stressor creates alterations in the function of the hippocampus and amygdala due to the release of high levels of glucocorticoids in the amygdala and hippocampus (2022).
In order for the patient to be diagnosed with PTSD, certain criteria must be met from different categories. First, the patient must have either directly experienced or witnessed the traumatic stressor, learned of a traumatic event occurring to a close family member or friend, or experienced repeated or have experienced extreme exposure to traumatic stressors. Secondly, the patient must have at least one intrusive symptom related to the traumatic stressor, such as recurrent distressing memories or dreams of the event, and intense psychological distress related to the stressor (American Psychiatric Association, 2022). Third, the patient must have persistent avoidance of the stimuli that caused the traumatic event (2022). Finally, the patient must have two or more negative alterations in thoughts and mood and marked alterations in arousal and activity related to the trauma that began or became worse after the event occurred (2022). The patient must be experiencing these symptoms from each category for more than a month and it must be leading to significant distress, social and occupational impairment, and impairment in functioning that is not caused by substances or medical conditions.
As stated above, the patient presents with a chief complaint of intense anxiety and fear of driving after a history of a serious car accident that has led to the patient being unable to drive, quitting her job, and isolating herself from friends. The patient experienced a traumatic event (the car accident) that has caused intense psychological distress which is evidenced by her avoiding driving (persistent avoidance) that has led her to quit her job and isolate herself from her friends (negative and marked alterations).
If the patient does not meet the full criteria of post-traumatic stress disorder, the patient could be experiencing acute stress disorder. Acute stress disorder has a shorter duration, usually occurring three days after the event but not lasting for more than a month, and the patient must have a minimum of nine symptoms of PTSD but the criteria to be diagnosed does not have to include all categories (Boland et al, 2021). The patient could also be diagnosed with adjustment disorder if the patient has been experiencing reactions to the stressor beginning more than 3 months after the stressor but resolving within 6 months of the traumatic event. The patient must be experiencing emotional changes and marked distress. It is important to ask when the event occurred and how long has the patient been experiencing the symptoms. In addition, the therapist must determine if other mood disorders are present, such as depression if the patient has had a low mood or feelings of hopelessness.
References:
Association, A. P. (2022). Diagnostic and Statistical Manual of Mental Disorders, Text Revision (DSM-5-TR) (5th ed.). American Psychiatric Publishing, Inc.. https://online.vitalsource.com/books/9780890425770
Boland, R., Verdiun, M., & Ruiz, P. (2021). Kaplan & Sadock’s Synopsis of Psychiatry (12th ed.). Wolters Kluwer Health. https://online.vitalsource.com/books/9781975145583
Coleman, K. L. (2022). Post-traumatic Stress Disorder and Its Effects on the Brain. Radiologic Technology, 93(6), 556–559.x`
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Subject: Nursing
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