Diagnostic Workup: Panic Disorder, Essay Example

Other Conditions That May Be a Focus of Clinical Attention: For this patient, it is possible that her difficulties in breathing, trembling periods, dizziness, and disorientation may be cause for a clinical workup, given that she has been suffering from multiple episodes over the past few weeks which have caused her much grief and concern.

Rationale

For this patient, her primary symptoms must be examined more closely in the context of her current life experiences, as well as what she has experienced over the past few years. Her divorce of three years ago, coupled with her focus on being a single mother has likely been a very stressful part of her life. In addition, her episodes where she feels as if she is losing control of her physical needs but also her emotions are of primary concern. Symptoms such as dizziness, shortness of breath, disorientation, spasms in her extremities, heart pounding, and trembling are likely to be related, based on her experiences and life circumstances. Under these conditions, it is evident that the patient is experiencing her own form of Panic Disorder, whereby she is facing a number of physical symptoms that appear to be a direct result of stress throughout her life. It appears as if she is trying to take on too much and has become increasingly frustrated with herself in this regard. Perhaps she believes that she is failure due to her divorce, and perhaps her job is also difficult at this time. Based upon her symptoms, other possibilities include Generalized Anxiety Disorder (300.02) and Other Anxiety States (300.09). However, the most likely scenario in this case is Panic Disorder because of her physical symptoms and states of panic that she experiences on a regular basis and that occur on a spontaneous basis without any specific warning factors.

Diagnostic Workup

Other Conditions That May Be a Focus of Clinical Attention: This patient’s condition is characterized by an extreme response to any type of reptile to the point that she is almost incapacitated for periods of time. Her physical symptoms include rapid heart rate, sweating, trembling, and loss of bladder control. These symptoms should be considered in a clinical capacity in order to rule out any other type of explanation that could result in a different diagnosis for this patient.

Rationale

For this patient, it is observed that she has an extreme and paralyzing fear of all types of reptiles, including but not limited to snakes and lizards. Her fear is so extreme that she begins to experience symptoms related to anxiety that impact her general wellbeing and her general ability to focus and concentrate. Therefore, she faces a difficult situation because her livelihood as a geology student requires her to be in the field from time to time and to potentially be exposed to different types of reptiles. This is a frightening premise for this patient and is requiring her to potentially rethink her current situation and where she might live and work once she has graduated from college. This has become such a debilitating fear that it is also impacting her relationship with her fiancée to some degree. It is believed that an experience involving almost stepping on a rattlesnake, which has contributed to her current incapacitating feelings. Therefore, this appears to be a standard case of specific phobia that requires further consideration and treatment so that the patient is able to cope with her fear at a level so that she is able to move on with her life. Other possible conditions include Panic Disorder and Personality Disorders, but her specific fear of an animal determines that this is a specific phobia that must be managed.

Diagnostic Workup

Other Conditions That May Be a Focus of Clinical Attention: This patient experienced a number of physical symptoms such as rapid heartbeat, as she endured a number of traumatic experiences during her time in the Army Reserves in Iraq. These experiences were particularly challenging for that patient that required a physical examination to determine if there were any other clinical issues to be addressed.

Rationale

This patient experienced a difficult set of circumstances during her time in Iraq, particularly during her direct exposure to the injured, the dying, and the dead. In addition, her experience with family members was also traumatic because she found it difficult to endure what had happened to her colleagues and how it has affected their families in different ways. These traumatic experiences have been difficult for the patient and have contributed to her extreme frustration, sadness, rage, and anxiety over the past several months. It has become so serious that she now requires a psychiatric evaluation in order to determine the nature of her episodes and how she might better cope with her situation and what she has endured during her time in the Army Reserves. This is a difficult situation to endure and requires her strength and commitment to understanding why she feels this way and why her reactions are so intense. This is a challenging situation that has been a learning experience for the patient, but it is necessary to make a formal diagnosis and to begin a treatment plan and/or therapy that will provide her with a different perspective regarding her situation. Differential diagnoses include Panic Disorder and Generalized Anxiety Disorder; however, PTSD is the most likely cause based on her participation in the Army and her specific symptoms.

Rationale

Based on the patient’s current status, he appears to be suffering from a case of Obsessive Compulsive Disorder, whereby he is experiencing difficult challenges in his efforts to complete the work required by his graduate studies. He questions his work and his performance on a continuous basis and has gotten into a routine where he reviews it seven times in order to determine if the experiments are correct. Based upon this set of circumstances, it appears that the patient faces a considerable set of circumstances in which his obsession to be correct has influenced his entire being on many levels. For this patient, his obsession to be correct has been his ultimate downfall, and he continues to struggle to manage his studies under the weight of his condition. This is a difficult challenge for the client and has become increasingly debilitating because he cannot complete new work as a result of his need to check older work on a continuous basis. Therefore, the patient requires further evaluation and guidance in order to overcome his condition and to be effective in his graduate studies so that he is able to complete them in a timely manner without further delays. It is important to address this condition as quickly as possible so that the patient is able to move forward with his studies without the pressure that he has put on himself to be accurate and precise at an almost impossible level that has not been effective for him. Differential diagnoses include Major depressive disorder, Panic Disorder, and Social Phobia, but his symptoms indicate Obsessive Compulsive Disorder.

Rationale

This patient is experiencing a bout of emotional distress and tension that she cannot overcome, regardless of what she tries to do to make her situation better. She is struggling with a fear and worry about almost everything in her life and this has been debilitating and is affecting her work performance and her marriage. As a result, the patient continues to struggle and to face difficult challenges at home and in her job. She is experiencing anxiety and worry regarding her husband’s love and commitment towards her. Her worries and fears have gotten to the point that she is unsure of her future and what will happen when she is in a place where there is significant fear and worry of all things in her life. She finds it difficult to cope with these thoughts and has been largely disconnected from her husband, family, and job because of them. Since others have responded to her with disdain and frustration, this has made the situation even worse and has created a dynamic within the home environment that is impossible to ignore. The patient’s overall health status and her ability to understand the extent of her condition has also been very difficult to manage, thereby creating an environment in which she feels deep discomfort and almost hatred of her own circumstances. This is the primary diagnosis because the case does not provide any other specifics that could indicate a different type of condition beyond generalized anxiety disorder. Differential diagnoses include Panic Disorder and Major depressive disorder.

Diagnostic Workup

Other Conditions That May Be a Focus of Clinical Attention: For this patient, there are a number of concerns to consider that should be addressed by a physician, such as chest pain, increased heart rate, and his increased drinking habits in recent months that seem to have contributed to his anxiety and panic attacks on a frequent basis.

Rationale

For this patient, it is important to recognize his numerous symptoms and how they have impacted his health recently, such as chest pain, increased heart rate, anxiety, and sense of overall panic. These issues have plagued the patient for some time and appear to be related to his lack of exercise, which is a contradiction to his past life when he was fit and very athletic. These circumstances, coupled with the stressors of his job and his habit of going out for drinks with friends or coworkers. This habit has become increasingly problematic in recent months, particularly as the client has experienced challenges related to long hours, significant travel, and other issues for which he has sought to escape with weekly drinking binges. This has been difficult situation for the patient because he has also noticed that his episodes of anxiety and panic appear to be related to his drinking episodes. Therefore, it is important to note that the patient’s situation could be alleviated to some degree if he tapered off his drinking habits in order to prevent further complications. This patient is experiencing Substance Use Disorder with Alcohol Dependence, but Anxiety Disorders, Depression, and Bipolar Affective Disorder are differential diagnoses.