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Anxiety Disorders, PTSD, and OCD

· Apply concepts, theories, and principles related to patient interviewing, diagnostic reasoning, and recording patient information

· Formulate differential diagnoses using DSM-5 criteria for patients with anxiety disorders, PTSD, and OCD across the lifespan

Resources

American Psychiatric Association. (2013). Anxiety disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm05

American Psychiatric Association. (2013). Obsessive compulsive and related disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm06

American Psychiatric Association. (2013). Trauma- and stressor-related disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm07

Sadock, B. J., Sadock, V. A., and Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

· Chapter 9, Anxiety Disorders

· Chapter 10, Obsessive-Compulsive and Related Disorders

· Chapter 11, Trauma- and Stressor-Related Disorders

· Chapter 31.11 Trauma-Stressor Related Disorders in Children

· Chapter 31.13 Anxiety Disorders in Infancy, Childhood, and Adolescence

· Chapter 31.14 Obsessive-Compulsive Disorder in Childhood and Adolescence

Agoraphobia

Individuals with agoraphobia are fearful and anxious about two or more of the following situations: using public transportation; being in open spaces; being in enclosed places; standing in line or being in a crowd; or being outside of the home alone in other situations. The individual fears these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms. These situations almost always induce fear or anxiety and are often avoided or require the presence of a companion.

Name: Ms. Barbara Weidre Gender: female Age: 56 years old T- 99.0 P- 99 R 24 132/89 Ht 5’4 Wt 168lbs Background: Lives with her husband in Knoxville, TN, has one daughter age 23. She has never worked. Raised by mother, she never knew her father. Mother with hx of anxiety; no substance hx for patient or family. No previous psychiatric treatment. Has one glass red wine with dinner. Sleeps 10-12 hrs; appetite decreased. Has overactive bladder, untreated. Allergic to Phenergan; complains of headaches, takes prn ibuprofen, has diarrhea once weekly, takes OTC Imodium.

TRANSCRIPT OF VIDEO FILE: 

00:00:00______________________________________________________________________________ 

00:00:00BEGIN TRANSCRIPT: 

00:00:00[sil.] 

00:00:15[She nervously plays with her scarf as she breathes anxiously] 

00:00:25OFF CAMERA Hello Mrs. Weidre. Are you ok? Do you want some water or something? 

00:00:30MRS. WEIDRE I'm ok. I'm fine. 

00:00:35OFF CAMERA I understand you wanted to see me today. 

00:00:40[She breathes anxiously] 

00:00:40MRS. WEIDRE I just really needed to sit and talk. 

00:00:40OFF CAMERA Well, tell me what's wrong, what are you feeling? 

00:00:50MRS. WEIDRE I'm just so… so unsure. I'm tired of being stuck in my house. I don't like it. 

00:01:00OFF CAMERA Stuck in your house? Do you have difficultly leaving your house? 

00:01:05MRS. WEIDRE Yes. All the time. 

00:01:05OFF CAMERA When do you go out? 

00:01:10MRS. WEIDRE …maybe, once or twice. 

00:01:15OFF CAMERA A day? 

00:01:15[She clutches her hands to her chest] 

00:01:15MRS. WEIDRE A week. Tuesdays and Saturdays. 

00:01:20OFF CAMERA Why Tuesday and Saturday? 

00:01:30MRS. WEIDRE Because when my husband gets home, he can go with me. 

00:01:35OFF CAMERA What do you do when you go out? 

00:01:40MRS. WEIDRE I take walks. 

00:01:40OFF CAMERA Where do you walk? 

00:01:40MRS. WEIDRE I only go to the end of the block, and then I cross the street, and turn around, and I go back around the cul-de-sac. I'll do that three times. [Losing breathe] No more, then I have to go back inside… I also go in my backyard. That's usually okay. 

00:02:15OFF CAMERA On the walks, why do you have to go back after three times? What happens? 

00:02:20MRS. WEIDRE [She nervously looks around] I just can't go any further. 

00:02:25OFF CAMERA Is this a physical problem, knees or something? 

00:02:30[She plays with her scarf] 

00:02:30MRS. WEIDRE No. No. Well… maybe. I just can't breathe if I'm out any longer. 

00:02:40OFF CAMERA Oh, breathing? 

00:02:40MRS. WEIDRE Yeah. 

00:02:40OFF CAMERA What do you feel? 

00:02:45MRS. WEIDRE [Her voice quivering] I'm just so frightened. Really, really scared. You don't realize what it took for me to get here today. I really had to. I willed it. I closed my eyes and my husband turned the radio up all the way as he drove. And then he lead me into the building. 

00:03:20OFF CAMERA Is there something that triggers this, anything in particular? 

00:03:30MRS. WEIDRE I don't like people. Maybe that's it. I mean I can tolerate them. Ethan, the little boy next door, I'll bake things for him and say hello. Sometimes, sometimes I watch him when his parents are gone. I mean I can be around people. Maybe that's not that's not what I meant. 

00:04:00OFF CAMERA Ok, can you walk me through what happens when you do leave the house? 

00:04:05MRS. WEIDRE I get shortness of breathe, everything, the world just seems to close in on me, and everything gets feels really tight, the air in my body, my chest. I get dizzy. I don't know what's wrong… I could be sick. What is this? 

00:04:30OFF CAMERA There can be many different causes for this. What is it that frightens you? 

00:04:40MRS. WEIDRE [She's short of breathe] Death. I'm afraid to die. 

00:04:45OFF CAMERA You're afraid you might die? 

00:04:50MRS. WEIDRE Yes. Among other things but that's what pops into my head. 

00:04:55OFF CAMERA Is there other stuff? 

00:05:00[sil.] 

00:05:05MRS. WEIDRE Cars go to fast. And there's murders and rapes that I see on the news. And flashfloods. I just think its close, its safer to stay close to home. 

00:05:15OFF CAMERA How long have you had this fear? 

00:05:20MRS. WEIDRE I don't really know. 

00:05:20OFF CAMERA Do you know when it all started? 

00:05:25MRS. WEIDRE I'm not sure. 

00:05:30OFF CAMERA Do you know what started it? 

00:05:30MRS. WEIDRE No. 

00:05:35OFF CAMERA When was the last time you really ventured out for any length of time? 

00:05:40MRS. WEIDRE Fifteen years. 

00:05:45[She nervously shifts in her chair] 

00:05:45OFF CAMERA That long. Is this the farthest you've been in fifteen years? What happened fifteen years ago? 

00:06:00MRS. WEIDRE I don't really know. 

00:06:05OFF CAMERA There is nothing that happened to you personally that could have made you afraid of dying? 

00:06:10MRS. WEIDRE I always was. My mother died the year before that. But it happened little by little. First it was planes. And then I couldn't drive on the freeway, then I couldn't drive at all, then errands, then it was going out… and soon… here I am. 

00:06:40OFF CAMERA It must have taken you extraordinary courage to come here today. What finally brought you to see me? 

00:06:50MRS. WEIDRE My grandson was born. But I couldn't go and see him. I still haven't seen him. My daughter gave birth last week and she's not going to bring him to see me for several months and I don't want to wait that long. 

00:07:10OFF CAMERA You miss out. 

00:07:15MRS. WEIDRE Yes! Of course I do! My grandson is a thousand miles away and I can't leave the God damned house. 

00:07:25[sil.] 

00:07:25END TRANSCRIPT