Discussion for Quanisha

Hello, Everyone!

In the case I was given I had to talk about a 27 year old male student who was referred for psychiatric help for gastrointestinal distress. The reason he needed that appointment is because he is feeling bloated and nauseated in anticipation of certain distressing events (APA,2013). Briceson has described to us that he has had 3 years of anxiety attacks that makes him have shortness of breath, hot flashes, sweating, and parathesias, on top of abdominal discomfort. After analyzing the known information about this case I feel like he could have claustrophobia, because he always feels like he has no way out and that he is trapped. Which means he is demonstrating F40.240, which is the sign of claustrophobia (APA,2013).

Claustrophobia is a feeling of discomfort or discontent caused by being in a limiting or restrictive situation or environment. It is also the fear of being in (and not being able to get out of) small or confined spaces, such as tunnels, elevators, and crowded rooms (APA,2013). That is why after reading Briceson’s case I feel that he has a bad case of claustrophobia. I had considered just bad anxiety, but he would of had a lot more anxiety attacks if anxiety was the only problem. Therefore, when dealing with claustrophobia the best evidence-based assessment scale to use is a psychometric evaluation (APA,2013). A psychometric test is any activity or assessment that is conducted in order to evaluate a candidate performance and includes, but is not limited to, skills, knowledge, abilities, personality traits, attitudes and job/academic potential. There are many psychometric test styles and formats with 3 main areas we will elaborate on (APA,2013).

Overall, when dealing with claustrophobia it is very difficult, because you always tend to have anxiety for many different reasons. That is why when you are dealing with claustrophobia the best intervention to use is cognitive behavioral therapy (APA,2013). The reason I state that is because it will help the client learn how to cope with their anxiety a lot more. Not only will it allow them to cope a lot better, but it will also allow them the opportunity to share their experience with someone so they can learn how to be transparent with their feelings and emotions to better help themselves (APA,2013). With the above help of therapy Briceson should be able to learn how to cope with his claustrophobia in a sense that it does not bring him that much anxiety anymore. 

References:

American Psychiatric Association. (2013). Anxiety Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.) Arlington, VA: Author 

Discussion Keyara Holmes 

• Provide the full DSM-5 diagnosis for the client. Remember, a full diagnosis should include the name of the disorder, ICD-10-CM code, specifiers, severity, and the Z codes (other conditions that may be a focus of clinical attention).  Keep in mind a diagnosis covers the most recent 12 months:

F41.1    Generalized Anxiety Disorder with Panic Attack Specifier

Z56.9 Other Problem related to employment

• Explain the diagnosis by matching the symptoms identified in the case to the specific criteria for the diagnosis:

Briceson meets criteria’s

 A. because he describes himself having anticipatory anxiety.

 B. because he has described himself having anxiety for three years, he even panics at the thought of going on a date.

 C1 he feel’s anxious when going out.

C2, described as having abdominal discomfort, sweating, shortness of breath hot flashes.

C3, Briceson is forgetting things at work and has trouble focusing. He also fits C6, because he has trouble staying asleep.

D. Briceson has found himself staying home more, he has also developed a fear of talking over the phone

E. There is no history of drug use

F. There are no other mental disorders that attributes to his diagnosis

Briceson also fits Panic Attack Specifier because he exhibits 4 or more of the required symptoms for the diagnostic criteria:

1. He experiences palpitations
2. Sweating
3. No evidence
4. Shortness of breath
5. No evidence
6. No evidence
7. Abdominal discomfort
8. No evidence
9. Hot flashes
10. Paresthesias
11. No evidence
12. No evidence
13. No evidence  

• Discuss other disorders you considered for this diagnosis and eliminated (the differential diagnoses):

The two other disorders that I believe Briceson may have fit but he did not meet the full criteria:

             F40.10 Social Anxiety Disorder

             F42.2 Obsessive-Compulsive Disorder

At first, I believed that Briceson fit the criteria for social anxiety because he seemed anxious when going to different events such as basketball games, concerts, and bars. Briceson does not exhibit any symptoms of fear when speaking to people in public so that ultimately ruled out this diagnosis. I also thought he fit Obsessive-Compulsive Disorder because he continued to think about what happened when he previously went on a date.

• Describe an evidence-based assessment scale that would assist in ongoing validation of your diagnosis:

An evidence-based assessment scale that could be used to support my diagnosis is the Generalized Anxiety Disorder-7 scale (GAD-7 scale). This scale consists of seven questions that patients can directly answer to share how they are feeling. It will also show if the patient does indeed suffer from having anxiety. The study can also be used to rate the level of severity for those who suffer from anxiety. The study that I found used this GAD-7 scale to measure anxiety with health-care workers (Alharthy et al., 2017).

• Recommend a specific intervention and explain why this intervention may be effective in treating the client:

A specific intervention that can be used to treat Briceson is some form of psychotherapy such Cognitive behavioral therapy (CBT) and pharmacotherapy. This can be done on an outpatient basis. CBT can teach Briceson about the physiology of his body and why he is experiencing anxiety, he will also learn about his thoughts and feelings.  Also, “when using psychotropic drugs, it is essential to warn the patient about the possible adverse effects” (Bandelow et al., 2017). The researchers found that their study showed individuals who combined Psychotherapy and pharmacotherapy were found to be less and ill an experience fewer symptom. Some of the medications include antidepressants, Buspirone and Benzodiazepines (Bandelow et al., 2017). This information would be important in Briceson’s case because it will help him get over his fear of going out around females, calming his symptoms and being able to focus better at work. Overall, this will help to build towards his success.

References

Alharthy, N., Alrajeh, O. A., Almutairi, M., & Alhajri, A. (2017). Assessment of Anxiety Level of  Emergency Health-care Workers by Generalized Anxiety Disorder-7 Tool. International Journal of Applied & Basic Medical Research, 7(3), 150–154. https://doi-org.ezp.waldenulibrary.org/10.4103/2229-516X.212963

American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental health disorders (5th ed). Arlington, VA: Author.

Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in clinical neuroscience, 19(2), 93–107.