Discussion 1 Everton
Generate a primary and differential diagnosis using the DSM-5 criteria.
Based on the fact that J.T has verbally stated he feels depressed with many negative thoughts, has been very stressed out with school, he does not spend time with others but rather alone, has been skipping classes, declining invites for activities and isolating himself more would align more with his primary diagnosis being major depressive disorder. J.T. is also avoiding reality and seems to no longer be concentrated on the important things in his life. For J.T., the differential diagnosis would be anxiety vs obsessive compulsive disorder. He is very doubtful and does not seem to feel like he is complete or even capable of being around new people without thinking that they think he is less of a person. His own thoughts cause him to almost panic and not think clearly to the point he starts to stutter. When moments like that happens, he replays those moments over and over again causing him to be even more afraid.
Develop a biopsychosocial plan of care for this client.
The biopsychosocial plan of care for J.T. would be to see what medications could be prescribed to him to see they could uplift his mood. Hopefully that will help him avoid isolating himself and seek out to teachers and attend class and to also accept invitations from friends. In addition, seeing what therapy sessions could help, teaching him some distraction methods such as meditating to see if that would help to relieve his stress and allow him to focus more on thinking positive towards things including school. Suggesting or referring him to group therapies with others that are in college possibly experiencing the same stress, anxiety and depression to see if that would also help him relax.
Compare and contrast fear, worry, anxiety, and panic.
Fear is an immediate response to something that one may feel threatened by. Fear is a learned response that triggers the amygdala in the brain to work. When a person becomes fearful of something or someone it triggers the nervous system where cortisol and adrenaline are released causing an increase in the person’s heart rate and blood pressure (Northwestern Medicine, 2020). This is called the fight or flight response which can either cause someone to not be able to make clear decisions or think clearly. The fight or flight response can also cause the person to gain pleasure out of this fear as well (Northwestern Medicine, 2020). Anxiety is also a fight or flight response to something or someone that causes fear or worry. Anxiety can lead to a panic depending on the severity of the anxiety or feelings or fear and worry. Anxiety can be caused by personal life experiences or medical conditions (Mayo Clinic, 2018). According to Mayo Clinic (2018), no matter what type of anxiety or what causes the patient to become anxious, anxiety always has a treatment. Worry is a form of thinking that can lead to fear, anxiety, and panic. Panic is considered to be a sudden feeling of fear which typically is the last resort and worst case scenario when relating it to fear, worry and anxiety. All four work hand in hand and can lead to chronic mental disorders that need proper treatment in order to allow the patient to live a normal day to day life.
Mayo Foundation for Medical Education and Research. (2018, May 4). Anxiety disorders. Mayo Clinic. Retrieved September 7, 2022, from https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961
Northwestern Medicine. (2020, October). 5 things you never knew about fear. Northwestern Medicine. Retrieved September 7, 2022, from https://www.nm.org/healthbeat/healthy-tips/emotional-health/5-things-you-never-knew-about-fear
Generate a primary and differential diagnosis using the DSM-5 criteria
J.T. is a patient seeking care following feelings of depression and a significant amount of stress about school. Based on the patient’s explanation, he feels depressed, and stressed, has difficulties identifying what is enjoyable on a typical day, and fears negative evaluation. J.T has hard time interacting with peers, interacting with teachers, turns down invitations, and is uncomfortable with authority figures.
The primary diagnosis for J.T is social anxiety disorder. A person with this condition feels symptoms of fear in situations where they may be judged or scrutinized by others (Hyett & McEvoy, 2018). Students may have challenges answering questions in class, doing daily tasks in front of others, and interacting with friends. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the criteria for diagnosis of social anxiety disorder involves persistent, intense fear of specific social situations (American Psychiatric Association, 2013). The individual develops fear because they believe they may be judged negatively, embarrassed, or humiliated. Secondly, the individual avoids anxiety-producing social situations, and if present, they endure them with intense fear. Additionally, these individuals have excessive fear that is out of proportion and their anxiety interferes with daily living (Hyett & McEvoy, 2018). J.T presents with anxiety, depression, ruminations, and social anxiety symptoms that indicate he has a social anxiety disorder.
The differential diagnoses for J.T include depression, generalized anxiety disorder, and avoidant personality disorder. Depression is a mood disorder characterized by persistent feelings of sadness and hopelessness. Affected individuals lose interest in pleasurable activities, feel unworthy, and have diminished ability to think (American Psychiatric Association, 2013). J.T has problems with concentration, stays alone in his room, and skips classes indicating a possibility of depression. Generalized anxiety disorder is a condition observed to produce fear, worry, and a constant feeling of being overwhelmed. Affected individuals persistently and excessively worry about everyday things, have difficulty controlling the worry, have difficulty concentrating and their mind goes blank sometimes. Regarding avoidant personality disorder, the affected individuals avoid any work that requires social contact because of fear that they will be criticized 9American Psychiatric Association, 2013). They may have restrained close relationships, low self-esteem, and withdrawal behavior. J.T’s symptoms of turning down invitations, ignoring phone calls, skipping classes, and isolation is an indication of avoidant personality disorder.
Develop a biopsychosocial plan of care for this client.
The initial plan of care for the patient will involve establishing the correct diagnosis using social anxiety screening tools like the Social Phobia Inventory (SPIN). SPIN is a 17-item questionnaire that is proven effective for measuring the severity of social anxiety disorder (Hyett & McEvoy, 2018). A score of 21-30 will indicate mild social phobia, 31-40 moderate 41-50 severe, and above 50 very severe social phobia.
Upon establishing the diagnosis, the second approach will involve treatment with medication and psychotherapy. The first choice of medication for social anxiety is selective serotonin reuptake inhibitors (SSRIs). For example, Zoloft (Sertraline) is FDA approved for the treatment of social anxiety disorder (Bernik et al., 2018). The drug has a high success rate with a dosage of 50 mg orally daily observed to produce tremendous results. The patient should be reviewed for improvement of symptoms after four weeks and the dosage may be increased by 25 mg weekly to a maximum of 200 mg/day (Bernik et al., 2018). The second approach will involve the use of cognitive behavioral therapy (CBT) to ensure the patient works to face the fears gradually through exposure therapy. The patient may benefit from CBT and improve confidence to deal with anxiety-inducing situations.
American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders. American psychiatric Association Press, Washington, DC.
Bernik, M., Corregiari, F., Savoia, M. G., Barros Neto, T. P., Pinheiro, C., & Neto, F. L. (2018). Concomitant treatment with sertraline and social skills training improves social skills acquisition in social anxiety disorder: A double-blind, randomized controlled trial. PloS One, 13(10), e0205809. https://doi.org/10.1371/journal.pone.0205809