Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD

By Day 7 of Week 4

Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis.

Incorporate the following into your responses in the template:

  • Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
  • Objective: What observations did you make during the psychiatric assessment?
  • Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
  • Reflection notes: What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD

Comprehensive Psychiatric Evaluation: Assessing and Diagnosing Patients with Anxiety Disorders, PTSD, and OCD

Patient Initials: I.F.     Age: 47 years         Gender: Female

Subjective

CC (chief complaint): “Ask My Husband, Greg.”

HPI:  Mrs. I.F, aged 47, was evaluated for an acute change in behavior and emotional state. According to her husband, these symptoms began following a school shooting three weeks earlier. Since the incident, she has demonstrated increased vigilance, frequent monitoring of news reports, disrupted sleep with minimal rest, and decreased appetite. There is no documented personal or family history of mental health disorders, substance use, legal issues, or psychiatric illness. The patient immigrated to the United States at age 15 with her parents and sister from Northern Ireland. She holds a master’s degree in education and resides in Charleston, South Carolina, with her husband and children.

Past Psychiatric History: No Prior mental illness

Support system: Husband is the primary care giver, and her neighbor that takes care of her kids when I.F not around.

Medication: None stated

Hospitalization: History of hysterectomy.

Psychotherapy or Previous Psychiatric Diagnosis: No prior mental illness

Substance Current Use and History: No history of substance abuse treatment.

Family Psychiatric/Substance Use History:  No family history of mental illness

Allergies:  No known medical allergies.

PLACE YOUR ORDER HERE

Psychosocial History

Mrs. I. F., a 47-year-old married woman, has exhibited significant emotional and behavioral changes following a school shooting that occurred near her community approximately three weeks ago. According to her husband, her behavior and emotional state changed abruptly after the incident. She is now preoccupied with the event, frequently watching television news reports, and actively seeking information about the shooting. Her husband reports that she spends most of the day and night watching news coverage.

      I.F reports significant sleep disturbances, including difficulty initiating and maintaining sleep, with a total sleep duration of 4 to 5 hours per night. She also notes a decreased appetite since the incident. These symptoms have persisted for three weeks and are adversely affecting her daily functioning and quality of life. Mrs. I. F. denies any prior psychiatric, substance use, or mental health treatment. There is no family history of mental illness. She has no known drug allergies. History of hysterectomy. No legal history is reported. The onset of symptoms following a traumatic event may indicate a trauma- and stressor-related disorder.

ROS:

General: The patient’s husband reports that the patient has exhibited hypervigilance following a recent school shooting. The patient experiences intermittent disruptive sleep, averaging 4-5 hours per night with frequent awakenings. There is also a noted decrease in appetite.

  • HEENT: No headaches, visual disturbances, hearing loss, nasal congestion, or difficulty swallowing reported.
  • SKIN: Warm and dry. No rashes, lesions, bruising, or itching reported.
  • CARDIOVASCULAR: No chest pain, palpitations, orthopnea, or peripheral edema reported
  • RESPIRATORY: No cough, wheezing, hemoptysis, or shortness of breath reported.
  • GASTROINTESTINAL: No nausea, vomiting, diarrhea, constipation, abdominal pain, or gastrointestinal bleeding reported
  • GENITOURINARY: No problems with urination reported
  • NEUROLOGICAL: Reports hypervigilance. No seizures, weakness, numbness, tremors, dizziness, or history of significant head injury reported.
  • MUSCULOSKELETAL: steady gait. No joint pain, muscle weakness, stiffness, or gait disturbances reported.
  • HEMATOLOGIC: no anemia, easy bruising, prolonged bleeding, or clotting disorders reported.
  • LYMPHATICS: No swollen lymph nodes or recurrent infections reported
  • ENDOCRINOLOGIC: no heat intolerance, cold intolerance, polyuria, polydipsia, polyphagia, or significant endocrine abnormalities reported.

Objective

General Appearance:  During psychiatric evaluation, I.F was alert and cooperative but showed significant anxiety and distress. She frequently referenced the recent school shooting and displayed hypervigilance and heightened emotional arousal when discussing the event. Her ongoing preoccupation with media coverage indicates continued psychological distress. I.F. showed no physical abnormalities to explain her symptoms. There was no evidence of intoxication, withdrawal, or underlying medical conditions. She maintained appropriate eye contact and answered questions relevantly during the interview.

Vital signs were normal; Temperature 98.0 °F; Blood Pressure 132/62 mmHg; Pulse 84 beats/minute; Respiratory Rate 18 breaths/minute; Height 5’0″; Weight 123 lbs.

  • HEENT: Head normocephalic and atraumatic. Pupils are equal, round, and respond to light and accommodation. EOM intact. External ear canals are open without any discharge. Bilateral intact tympanic membranes and pearly grey. No nasal congestion: nasal mucosa is moist and pink. Oral cavities moist and pink, no lesions noted. Dentition no decay.
  • Neck: No cervical lymphadenopathy. Trachea midline. Thyroid non-enlarged and without palpable nodules.
  • Skin: Warm, dry, and intact. No rashes, lesions, bruising noted.
  • Cardiovascular: Regular rate and rhythm. S1 and S2 present without murmurs, rubs, or gallops. Peripheral pulses 2+ bilaterally. No jugular venous distention or peripheral edema.
  • Respiratory: Lungs clear to auscultation bilaterally. Respirations even and unlabored. No wheezes, rales, or rhonchi.
  • Gastrointestinal: Abdomen soft, non-tender, and non-distended. Bowel sounds present in all four quadrants. No hepatosplenomegaly, masses, guarding, or rebound tenderness.
  • Genitourinary: No suprapubic tenderness or bladder distention. No costovertebral angle tenderness. Genital examination deferred. Patient denies genitourinary complaints.
  • Musculoskeletal: Normal posture and gait. Full active range of motion in all extremities. Muscle strength 5/5 bilaterally. No joint swelling, deformity, or tenderness.
  • Neurological: Alert and oriented to person, place, time, and situation. Cranial nerves II-XII grossly intact. Motor and sensory functions intact. Deep tendon reflexes 2+ and symmetrical. No tremors, rigidity, dystonia, or abnormal involuntary movements observed. Coordination and balance intact.
  • Lymphatic: No cervical, axillary, or inguinal lymphadenopathy. No abnormal bruising or bleeding.
  • Endocrine: No thyromegaly, tremors, diaphoresis, or other signs of endocrine dysfunction.

Mental Status Examination

Mrs. Flanagan appeared well-dressed and well-groomed. She was oriented to person, place, time, and situation. Speech was articulate, coherent, and purposeful. Mood was described as anxious, with affect congruent to mood. Thought processes were logical and organized, though primarily focused on the recent school shooting and its impact. No hallucinations, delusions, paranoia, or other indicators of psychosis were observed. Memory was intact, and cognitive functioning appeared grossly normal. Judgment and insight were intact. She denied suicidal ideation.

Differential Diagnoses

Post-Traumatic Stress Disorder (PTSD) (ICD-10: F43.11) appears to be the most likely diagnosis. According to the DSM-5-TR, PTSD can develop after someone experiences or witnesses’ death, serious injury, or violence, and is linked to symptoms like intrusion, avoidance, negative thoughts and feelings, and changes in arousal or reactivity (Brock, 2023). Mrs. I.F was psychologically affected by a nearby school shooting and later developed chronic anxiety, hypervigilance, sleep problems, loss of appetite, and felt overwhelmed by trauma-related information. The unusual timing between the traumatic event and the start of her symptoms suggests that this is likely a case of PTSD.

      Acute Stress Disorder (ASD) (ICD-10: F43.0) is diagnosed when symptoms manifest within three weeks following a traumatic event. According to the DSM-5-TR, ASD develops within three days to one month after trauma and is characterized by symptoms such as intrusion, negative mood, dissociation, avoidance, and arousal. Mrs. I.F. exhibits several indicators of ASD; however, she also presents symptoms suggestive of emerging Post-Traumatic Stress Disorder (PTSD), including persistent trauma-related thoughts and hyperarousal. ASD remains a provisional diagnosis, as her symptoms have not persisted beyond one month.

     Generalized Anxiety Disorder (GAD) (ICD-10: F41.1) was also considered. The DSM-5-TR states that GAD involves worry or anxiety about different activities and events for most days over at least six months. Mrs. Flanagan does have anxiety, sleep problems, and trouble functioning. However, all her symptoms are linked to a single traumatic event in her past, not to many different situations. She also does not meet the six-month duration requirement. For these reasons, GAD does not fit her clinical picture and is not the main diagnosis.

The timing, severity, and context of symptom development were systematically evaluated to determine the primary diagnosis (Atri et al., 2025). Positive findings included trauma exposure, Acute anxiety, hypervigilance, hypo-appetence, sleep disturbances, and significant impairment in daily functioning. Negative findings included the absence of psychotic symptoms, substance use, depression, generalized anxiety, or prior psychiatric history. The temporal association between symptom onset and the school shooting strongly indicates a trauma-related disorder. Posttraumatic stress disorder (PTSD) (ICD-10: F43.11) is the most probable diagnosis based on symptom duration, symptomatology, and clinical presentation.

Reflection Notes

I would like to collect more detailed information on intrusive memories, nightmares, avoidance behaviors, emotional numbing, and dissociative symptoms. The use of a validated screening tool, such as the PTSD Checklist for DSM-5, can support a more accurate diagnosis and provide a baseline for tracking treatment progress. Additionally, gathering further patient history from the husband may clarify the extent of functional impairment and behavioral changes.

Confidentiality and informed consent are important, but other legal and ethical considerations also apply. It is essential to minimize the risk of retraumatization during trauma discussions while still gathering information that will be needed for accurate diagnosis and effective treatment planning.

Cultural sensitivity is important, as Mrs. Flanagan’s Northern Irish background may affect her perception of trauma, coping strategies, and engagement with mental health services.        Psychoeducation on trauma responses, sleep hygiene, stress reduction, limiting exposure to distressing media, and building social support are key health promotion strategies (Lotzin et al., 2023). Early intervention helps prevent symptom escalation and improves outcomes. Consider additional factors such as age, stress, socioeconomic status, and available support networks, as these may influence recovery and treatment adherence.

References

Atri, A., Dickerson, B. C., Clevenger, C., Karlawish, J., Knopman, D., Lin, P. J., … & Carrillo, M. (2025). Alzheimer’s Association clinical practice guideline for the Diagnostic Evaluation, Testing, Counseling, and Disclosure of Suspected Alzheimer’s Disease and Related Disorders (DETeCD‐ADRD): Executive summary of recommendations for primary care. Alzheimer’s & Dementia, 21(6), e14333. https://alz-journals.onlinelibrary.wiley.com/doi/abs/10.1002/alz.14333

Lotzin, A., Franc de Pommereau, A., & Laskowsky, I. (2023). Promoting recovery from disasters, pandemics, and trauma: a systematic review of brief psychological interventions to reduce distress in adults, children, and adolescents. International journal of environmental research and public health, 20(7), 5339. https://www.mdpi.com/1660-4601/20/7/5339

Brock, S. E. (2023). Posttraumatic Stress Disorder in Children and Adolescents. Desk Reference in School Psychology, 361. https://books.google.com/books?hl=en&lr=&id=AJ_sEAAAQBAJ&oi=fnd&pg=PA361&dq=The+DSM-5-TR+says+that+PTSD+occurs+after+experiencing+or+witnessing+death,+serious+injury,+violence,+and+is+associated+with+experiences+of+intrusion,+avoidance,+negative+thoughts+and+feelings,+and+arousal/reactivity.+&ots=gHlBTX2_7k&sig=lTpcq1Z4o4Qj_SQz7c-awbEBpRg

 

Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD Assignment Instructions

“Fear,” according to the DSM-5-TR, “is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat” (APA, 2022). All anxiety disorders contain some degree of fear or anxiety symptoms (often in combination with avoidant behaviors), although their causes and severity differ. Trauma-related disorders may also, but not necessarily, contain fear and anxiety symptoms, but their primary distinguishing criterion is exposure to a traumatic event. Trauma can occur at any point in life. It might not surprise you to discover that traumatic events are likely to have a greater effect on children than on adults. Early-life traumatic experiences, such as childhood sexual abuse, may influence the physiology of the developing brain. Later in life, there is a chronic hyperarousal of the stress response, making the individual vulnerable to further stress and stress-related disease.

For this Assignment, you practice assessing and diagnosing patients with anxiety disorders, PTSD, and OCD. Review the DSM-5-TR  criteria for the disorders within these classifications before you get started, as you will be asked to justify your differential diagnosis with DSM-5-TR  criteria.

Resources

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To Prepare:

  • Review this week’s Learning Resources and consider the insights they provide about assessing and diagnosing anxiety, obsessive-compulsive, and trauma- and stressor-related disorders.
  • Download the Comprehensive Psychiatric Evaluation Template, which you will use to complete this Assignment. Also review the Comprehensive Psychiatric Evaluation Exemplar to see an example of a completed evaluation document.
  • By Day 1 of this week, select a specific video case study to use for this Assignment from the Video Case Selections choices in the Learning Resources. View your assigned video case and review the additional data for the case in the “Case History Reports” document, keeping the requirements of the evaluation template in mind.
  • Consider what history would be necessary to collect from this patient.
  • Consider what interview questions you would need to ask this patient.
  • Identify at least three possible differential diagnoses for the patient.

By Day 7 of Week 4

Complete and submit your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate primary diagnosis.

Incorporate the following into your responses in the template:

  • Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
  • Objective: What observations did you make during the psychiatric assessment?   Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD
  • Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
  • Reflection notes: What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

Submission information

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.

  1. To submit your completed assignment, save your Assignment as WK4Assgn_LastName_Firstinitial
  2. Then, click on Start Assignment near the top of the page.
  3. Next, click on Upload File and select Submit Assignment for review.

Rubric

NRNP_6635_Week4_Assignment_Rubric
NRNP_6635_Week4_Assignment_Rubric
Criteria Ratings Pts

Create documentation in the Comprehensive Psychiatric Evaluation Template about the patient you selected. In the Subjective section, provide: • Chief complaint• History of present illness (HPI)• Past psychiatric history• Medication trials and current medications• Psychotherapy or previous psychiatric diagnosis• Pertinent substance use, family psychiatric/substance use, social, and medical history• Allergies• ROS
20 to >17.0 ptsExcellentThe response throughly and accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.
17 to >15.0 ptsGoodThe response accurately describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis.
15 to >13.0 ptsFairThe response describes the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis, but is somewhat vague or contains minor innacuracies.
13 to >0 ptsPoorThe response provides an incomplete or inaccurate description of the patient’s subjective complaint, history of present illness, past psychiatric history, medication trials and current medications, psychotherapy or previous psychiatric diagnosis, pertinent histories, allergies, and review of all systems that would inform a differential diagnosis. Or, subjective documentation is missing.
20 pts

In the Objective section, provide:• Physical exam documentation of systems pertinent to the chief complaint, HPI, and history• Diagnostic results, including any labs, imaging, validated rating scales, or other assessments needed to develop the differential diagnoses and include rationale for why these diagnostics are recommended. If no physical exam is formally completed in the video, you must include objective observation from the video and/or describe what the clinician should physically assess based on the case study. Additionally, if diagnostic information is not provided to you, you must describe what diagnostics the clinician should include based on the case study.
20 to >17.0 ptsExcellentThe response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.
17 to >15.0 ptsGoodThe response accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are accurately documented.
15 to >13.0 ptsFairDocumentation of the patient’s physical exam is somewhat vague or contains minor innacuracies. Diagnostic tests and their results are documented but contain minor innacuracies.
13 to >0 ptsPoorThe response provides incomplete or inaccurate documentation of the patient’s physical exam. Systems may have been unnecessarily reviewed, or, objective documentation is missing.
20 pts

In the Assessment section, provide:• Results of the mental status examination, presented in paragraph form.• At least three differentials with supporting evidence. List them from top priority to least priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
25 to >22.0 ptsExcellentThe response thoroughly and accurately documents the results of the mental status exam…. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected.
22 to >19.0 ptsGoodThe response accurately documents the results of the mental status exam…. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides an accurate justification for each of the disorders selected.
19 to >17.0 ptsFairThe response documents the results of the mental status exam with some vagueness or innacuracy…. Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vaguess or innacuracy.
17 to >0 ptsPoorThe response provides an incomplete or inaccurate description of the results of the mental status exam and explanation of the differential diagnoses. Or, assessment documentation is missing.
25 pts

Reflect on this case. Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), social determinates of health, health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
10 to >8.0 ptsExcellentReflections are thorough, thoughtful, and demonstrate critical thinking.
8 to >7.0 ptsGoodReflections demonstrate critical thinking.
7 to >6.0 ptsFairReflections are somewhat general or do not demonstrate critical thinking.
6 to >0 ptsPoorReflections are incomplete, inaccurate, or missing.
10 pts

Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).
15 to >13.0 ptsExcellentThe response provides at least three current, evidence-based resources from the literature to support the assessment and diagnosis of the patient in the assigned case study. The resources reflect the latest clinical guidelines and provide strong justification for decision making.
13 to >11.0 ptsGoodThe response provides at least three current, evidence-based resources from the literature that appropriately support the assessment and diagnosis of the patient in the assigned case study.
11 to >10.0 ptsFairThree evidence-based resources are provided to support assessment and diagnosis of the patient in the assigned case study, but they may only provide vague or weak justification.
10 to >0 ptsPoorTwo or fewer resources are provided to support assessment and diagnosis decisions. The resources may not be current or evidence based.
15 pts

Written Expression and Formatting—Paragraph development and organization:Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.
5 to >4.0 ptsExcellentA clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. …Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
4 to >3.5 ptsGoodPurpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive. …Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.
3.5 to >3.0 ptsFairPurpose, introduction, and conclusion of the assignment is vague or off topic. … Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%-79% of the time.
3 to >0 ptsPoorNo purpose statement, introduction, or conclusion were provided. … Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.
5 pts

Written Expression and Formatting—English writing standards: Correct grammar, mechanics, and punctuation Assessing and Diagnosing Patients With Anxiety Disorders, PTSD, and OCD
5 to >4.0 ptsExcellentUses correct grammar, spelling, and punctuation with no errors
4 to >3.0 ptsGoodContains a few (one or two) grammar, spelling, and punctuation errors
3 to >2.0 ptsFairContains several (three or four) grammar, spelling, and punctuation errors
2 to >0 ptsPoorContains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
5 pts
Total Points: 100

related articles