A 32-year-old black female presents for a psychiatric evaluation due to symptoms of depression since giving birth two months ago. She reports crying frequently, difficulty sleeping, loss of appetite, lack of interest in activities, and feelings of worthlessness. Her symptoms are impacting her ability to care for her infant and interact with others. Differential diagnoses include postpartum depression, major depressive disorder, and postpartum blues. A psychiatric assessment finds depressed mood but no signs of psychosis. The primary diagnosis is determined to be postpartum depression based on the timing of symptoms onset and presentation of diagnostic criteria.

1. 1
6
Assignment template
Subjective Section
Chief complainant
The patient starts by saying, "I can't stop crying, all the time."
The patient complains that since she gave birth to her child two
months ago, she has been experiencing mood disorders and
difficulties falling asleep even after the baby is already asleep.
She complains that especially when the baby cries, she loses her
appetite and is not comfortable with her new body shape and
size. She says nothing interests her, even writing, which was
one of the things she loved before she gave birth. She does not
want to contact her friends, and everything seems to be
upsetting her.
History of present illness (HPI)
L.T is a 32-year-old black female who resents for psychiatric
evaluation due to mood depression. The patient has not been
prescribed any psychotropic drugs recently.
Past psychiatric history
The patient has never been examined or treated for any mental

2. disorders in the past. Recently she was hospitalized for a
standard childbirth procedure.
Medication trials and current medication
She has not tried any medications in the past, neither is she
under any medication currently.
Psychotherapy or previous psychiatric diagnosis
The patient has no history of psychiatric illness and has not
been diagnosed or treated with any mental health disorder.
Pertinent substance use, social, and medical history
The patient denies any use of alcohol or cases of drug abuse in
the family. Although she says that her uncle was not an opioid
abuser, he committed suicide using GSW. She is married and
currently lives with her husband with their two kids. She has
been working in the retail business for the past five years, but
currently, she is a housewife. The patient grew up with her
sister together with her both parents. She has been diagnosed
with hypertension recently, and she is taking drugs labelled as
labetalol 100mg for HTN, which she says that she sometimes
forgets to take them. The patient has no legal history or any
issues related to violence.
Allergies
L.T is allergic to codeine. She gave birth two months ago,
which automatically means that she is lactating. Currently, she
is not using any form of contraceptive, and she has had no
desire for sex since she gave birth.
ROS
General: No weight loss, fatigue or chills experienced by
the patient.
HEET: Her vision is the same no issues of double vision or
jaundice. Her ears, nose and throat are okay.
Skin: Her skin has not changed either is she having rashes.
Cardiovascular: No chest discomfort or pains.
Respiratory: She is not coughing or producing sputum, implying
her respiratory is fine.
Gastrointestinal: She has eventually lost her appetite and wants
to lose weight, although she is not vomiting or feeling

3. abdominal pain.
Genitourinary: The urine colour or odour has not changed, and
she is not experiencing any burns during urination. No
headaches, no back or joint pains.
Hematologic: No bleeding realized or enlarged nodes.
Endocrinologic: she is not sweating or having any intolerance to
heat or cold. No polydipsia.
Objective Section
Physical examination of the documents
No physical examination was done.
Diagnosis results
No diagnosis results for the patient.
Assessment Section
Examination of mental status
The patient is appropriately dressed and fit for the occasion and
the weather. She is conscious of time and place. Her memory is
okay, although she appears to be distant during the assessment.
Her speech is okay, although she is using a low tone. Her moods
are depressed, and she confesses having suicidal thoughts but
has not attempted to do so and that she had had no intentions of
hurting the baby. No signs of hallucinations or delusions. We
can conclude that her critical and insights are okay.
Differential Diagnoses
Postpartum depression is an episode of depression that is
common between 4-6 weeks after delivery. It is often
characterized by mood disorders, excess anxiety, weight
changes, and insomnia (Sadock et al., 2015). Other stressors
connected to this depression include inadequate support from
family members. Individuals with this kind of depression often
feel a lack of interest in some activities and feelings of guilt,
suicidal thoughts (Sadock et al., 2015). The client reports signs
of this kind of depression as she says she can’t stop crying, she
has lost her appetite, has difficulties in sleeping, depressed
moods all the time, has no interest in her previous hobbies, and
her self-esteem has also gone down (Sherman & Ali, 2018).
Major depressant disorder: this disorder is characterized by

4. depressed moods and a lack of interest in activities with
pleasure. It also includes crying all the time, insomnia, loss of
weight, feeling hopeless, feeling guilty all the time, lack of
energy and even concentration (American Psychiatric
Association, 2013). Our client has presented most of these
symptoms, which does not mean it is the diagnosis even if the
symptoms appeared four weeks after delivery.
Postpartum blues: this disorder is characterized by events
of low moods and severe depressive signs. These si gns include
crying, mood burden, dysphoria, irritability, lack of sleep and
concentration (Mullins IV, 2021). The condition primarily
affects 30-50% of women who give birth (Sadock et al., 2015).
These signs must appear within 2-3days after birth and
disappear after two weeks to meet the diagnosis criteria. This is
not the case for the patient since the symptoms persisted for
more than two weeks.
Reflection
I agree with the preceptor’s assessment and the diagnostic
impression of the patient since what the patient is going through
is not just ordinary. From this case, I have learned that various
mood disorders can have similar symptoms. For example, major
depressive disorder and postpartum blues seem to be displaying
similar symptoms with postpartum depression. To make the
correct diagnosis, one must analyze factors and other stressors
associated with the mood disorder (Sadock et al., 2015). I would
analyze all the mood disorders to be sure of my final diagnosis
for the patient. A legal factor to be considered would be drug
safety for both the patient and the baby. Medications pass
through breast milk, but the variations of the passage depend on
the drugs taken (Frieder et al., 2019)

5. References
American Psychiatric Association. (2013). DSM 5. American
Psychiatric Association, 70. Frieder, A., Fersh, M., Hainline,
R., & Deligiannidis, K. M. (2019). Pharmacotherapy of
postpartum depression: current approaches and novel drug
development. CNS drugs, 33(3), 265-282.
Mullins IV, C. H. (2021). Postpartum Blues. Patient Education
and Counseling.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan &
Sadock’s synopsis of psychiatry (11th ed.).Wolters Kluwer.
Sherman, L. J., & Ali, M. M. (2018). Diagnosis of postpartum
depression and timing and types of treatment received differ
for women with private and Medicaid coverage. Women's
Health Issues, 28(6), 524-529. 7 This study source was
downloaded by 100000798758000 from CourseHero.com
on 09-16-2021 12:13:21 GMT -05:00
https://www.coursehero.com/ file/98069366/WK3Assgn1Li
nusO-Assessing-and- Diagnosing-Patients-with-Mood-
Disorders-editeddocx/ This study resource was shared via
Course
Anxiety Disorders, PTSD, and OCD
Your own experiences might tell you that expectations from
family, friends, and work—as well as your own expectations
regarding achievement, success, and happiness—can create
stress. Stressors are a normal part of life, and stress
traditionally has been viewed as an adaptive function with a set
of physiological responses to a stressor. In a situation where
stress is perceived, the organism is physiologically prepared to
attack or flee from the threat. Those with effective fight or

6. flight responses tended to survive long enough to reproduce, so
we are descended from those who are genetically hardwired for
self-protection. When you experience stress, your biology,
emotions, social support, motivation, environment, attitude,
immune function, and wellness all feel the ripple effect.
This stress response is an adaptive response the human body has
to threats; however, stress can also be difficult to handle and—
depending upon the nature and intensity of the stress—can
result in anxiety disorders, obsessive-compulsive disorders, or
trauma- and stressor-related disorders. This week, you will
focus on these disorders and explore strategies to accurately
assess and diagnose them.
Objectives
· 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
lifespanAssessing and Diagnosing Patients With Anxiety
Disorders, PTSD, and OCD
“Fear,” according to the DSM-5, “is the emotional response to
real or perceived imminent threat, whereas anxiety is
anticipation of future threat” (APA, 2013). 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.

7. For this Assignment, you practice assessing and diagnosing
patients with anxiety disorders, PTSD, and OCD. Review
the DSM-5 criteria for the disorders within these classifications
before you get started, as you will be asked to justify your
differential diagnosis with DSM-5 criteria. To Prepare:
· 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.
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 diagnostic criteria for each differential diagnosis
and explain what DSM-5 criteria rules out the differential

8. 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.).
You are required to include at least 5 evidence based peer-
reviewed journal articles or evidenced based guidelines which
relates to this case to support your diagnostics and differentials
diagnoses. Be sure to use correct APA 6th edition formatting.
NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation
Exemplar
INSTRUCTIONS ON HOW TO USE EXEMPLAR AND
TEMPLATE—READ CAREFULLY
If you are struggling with the format or remembering what to
include, follow the Comprehensive Psychiatric Evaluation
Template AND the Rubric as your guide. It is also helpful to
review the rubric in detail in order not to lose points
unnecessarily because you missed something required. Below
highlights by category are taken directly from the grading rubric
for the assignment in Weeks 4–10. After reviewing the full
details of the rubric, you can use it as a guide.
In the Subjective section, provide:
· Chief complaint

9. · 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
· Read rating descriptions to see the grading standards!
In the Objective section, provide:
· Physical exam documentation of systems pertinent to the chief
complaint, HPI, and history
· Diagnostic results, including any labs, imaging, or other
assessments needed to develop the differential diagnoses.
· Read rating descriptions to see the grading standards!
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
diagnostic criteria for each differential diagnosis and explain
what DSM-5 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.
· Read rating descriptions to see the grading standards!
Reflect on this case. Include: 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!), 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. (The comprehensive evaluation is typically the initial new
patient evaluation. You will practice writing this type of note in
this course. You will be ruling out other mental illnesses so
often you will write up what symptoms are present and what
symptoms are not present from illnesses to demonstrate you
have indeed assessed for all illnesses which could be impacting
your patient. For example, anxiety symptoms, depressive
symptoms, bipolar symptoms, psychosis symptoms, substance
use, etc.)
EXEMPLAR BEGINS HERE
CC (chief complaint): A brief statement identifying why the
patient is here. This statement is verbatim of the patient’s own
words about why presenting for assessment. For a patient with
dementia or other cognitive deficits, this statement can be
obtained from a family member.
HPI: Begin this section with patient’s initials, age, race, gender,
purpose of evaluation, current medication and referral reason.
For example:
N.M. is a 34-year-old Asian male presents for psychiatric
evaluation for anxiety. He is currently prescribed sertraline
which he finds ineffective. His PCP referred him for evaluation
and treatment.
Or
P.H., a 16-year-old Hispanic female, presents for psychiatric
evaluation for concentration difficulty. She is not currently
prescribed psychotropic medications. She is referred by her
therapist for medication evaluation and treatment.
Then, this section continues with the symptom analysis for your
note. Thorough documentation in this section is essential for
patient care, coding, and billing analysis.
Paint a picture of what is wrong with the patient. First what is
bringing the patient to your evaluation. Then, include a
PSYCHIATRIC REVIEW OF SYMPTOMS. The symptoms
onset, duration, frequency, severity, and impact. Your
description here will guide your differential diagnoses. You are

11. seeking symptoms that may align with many DSM-5 diagnoses,
narrowing to what aligns with diagnostic criteria for mental
health and substance use disorders.
Past Psychiatric History: This section documents the patient’s
past treatments. Use the mnemonic Go Cha MP.
General Statement: Typically, this is a statement of the patients
first treatment experience. For example: The patient entered
treatment at the age of 10 with counseling for depression during
her parents’ divorce. OR The patient entered treatment for detox
at age 26 after abusing alcohol since age 13.
Caregivers are listed if applicable.
Hospitalizations: How many hospitalizations? When and where
was last hospitalization? How many detox? How many
residential treatments? When and where was last
detox/residential treatment? Any history of suicidal or
homicidal behaviors? Any history of self-harm behaviors?
Medication trials: What are the previous psychotropic
medications the patient has tried and what was their reaction?
Effective, Not Effective, Adverse Reaction? Some examples:
Haloperidol (dystonic reaction), risperidone
(hyperprolactinemia), olanzapine (effective, insurance wouldn’t
pay for it)
Psychotherapy or Previous Psychiatric Diagnosis: This section
can be completed one of two ways depending on what you want
to capture to support the evaluation. First, does the patient
know what type? Did they find psychotherapy helpful or not?
Why? Second, what are the previous diagnosis for the client
noted from previous treatments and other providers. Thirdly,
you could document both.
Substance Use History: This section contains any history or
current use of caffeine, nicotine, illicit substance (including
marijuana), and alcohol. Include the daily amount of use and
last known use. Include type of use such as inhales, snorts, IV,
etc. Include any histories of withdrawal complications from
tremors, Delirium Tremens, or seizures.
Family Psychiatric/Substance Use History: This section contains

12. any family history of psychiatric illness, substance use
illnesses, and family suicides. You may choose to use a
genogram to depict this information. Be sure to include a
reader’s key to your genogram or write up in narrative form.
Social History: This section may be lengthy if completing an
evaluation for psychotherapy or shorter if completing an
evaluation for psychopharmacology. However, at a minimum,
please include:
Where patient was born, who raised the patient
Number of brothers/sisters (what order is the patient within
siblings)
Who the patient currently lives with in a home? Are they single,
married, divorced, widowed? How many children?
Educational Level
Hobbies:
Work History: currently working/profession, disabled,
unemployed, retired?
Legal history: past hx, any current issues?
Trauma history: Any childhood or adult history of trauma?
Violence Hx:Concern or issues about safety (personal, home,
community, sexual (current & historical)
Medical History: This section contains any illnesses, surgeries,
include any hx of seizures, head injuries.
Current Medications: Include dosage, frequency, length of time
used, and reason for use. Also include OTC or homeopathic
products.
Allergies:Include medication, food, and environmental allergies
separately. Provide a description of what the allergy is (e.g.,
angioedema, anaphylaxis). This will help determine a true
reaction vs. intolerance.
Reproductive Hx:Menstrual history (date of LMP), Pregnant
(yes or no), Nursing/lactating (yes or no), contraceptive use
(method used), types of intercourse: oral, anal, vaginal, other,
any sexual concerns

13. ROS: Cover all body systems that may help you include or rule
out a differential diagnosis. Please note: THIS IS DIFFERENT
from a physical examination!
You should list each system as follows: General:Head: EENT:
etc. You should list these in bullet format and document the
systems in order from head to toe.
Example of Complete ROS:
GENERAL: No weight loss, fever, chills, weakness, or fatigue.
HEENT: Eyes: No visual loss, blurred vision, double vision, or
yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing,
congestion, runny nose, or sore throat.
SKIN: No rash or itching.
CARDIOVASCULAR: No chest pain, chest pressure, or chest
discomfort. No palpitations or edema.
RESPIRATORY: No shortness of breath, cough, or sputum.
GASTROINTESTINAL: No anorexia, nausea, vomiting, or
diarrhea. No abdominal pain or blood.
GENITOURINARY: Burning on urination, urgency, hesitancy,
odor, odd color
NEUROLOGICAL: No headache, dizziness, syncope, paralysis,
ataxia, numbness, or tingling in the extremities. No change in
bowel or bladder control.
MUSCULOSKELETAL: No muscle, back pain, joint pain, or
stiffness.
HEMATOLOGIC: No anemia, bleeding, or bruising.
LYMPHATICS: No enlarged nodes. No history of splenectomy.
ENDOCRINOLOGIC: No reports of sweating, cold, or heat
intolerance. No polyuria or polydipsia.
Physical exam (If applicable and if you have opportunity to
perform—document if exam is completed by PCP): From head
to toe, include what you see, hear, and feel when doing your
physical exam. You only need to examine the systems that are
pertinent to the CC, HPI, and History. Do not use “WNL” or
“normal.” You must describe what you see. Always document in
head-to-toe format i.e., General: Head: EENT: etc.
Diagnostic results: Include any labs, X-rays, or other

14. diagnostics that are needed to develop the differential diagnoses
(support with evidenced and guidelines).
Assessment
Mental Status Examination: For the purposes of your courses,
this section must be presented in paragraph form and not use of
a checklist! This section you will describe the patient’s
appearance, attitude, behavior, mood and affect, speech, thought
processes, thought content, perceptions (hallucinations,
pseudohallucinations, illusions, etc.)., cognition, insight,
judgment, and SI/HI. See an example below. You will modify to
include the specifics for your patient on the above elements —
DO NOT just copy the example. You may use a preceptor’s way
of organizing the information if the MSE is in paragraph form.
He is an 8-year-old African American male who looks his stated
age. He is cooperative with examiner. He is neatly groomed and
clean, dressed appropriately. There is no evidence of any
abnormal motor activity. His speech is clear, coherent, normal
in volume and tone. His thought process is goal directed and
logical. There is no evidence of looseness of association or
flight of ideas. His mood is euthymic, and his affect appropriate
to his mood. He was smiling at times in an appropriate manner.
He denies any auditory or visual hallucinations. There is no
evidence of any delusional thinking. He denies any current
suicidal or homicidal ideation. Cognitively, he is alert and
oriented. His recent and remote memory is intact. His
concentration is good. His insight is good.
Differential Diagnoses:You must have at least three
differentials with supporting evidence. Explain what rules each
differential in or out and justify your primary diagnosis
selection. You will use supporting evidence from the literature
to support your rationale. Include pertinent positives and
pertinent negatives for the specific patient case.
Also included in this section is the reflection. Reflect on this
case and discuss whether or not you agree with your preceptor’s
assessment and diagnostic impression of the patient and why or

15. why not. What did you learn from this case? What would you do
differently?
Also include in your reflection a discussion related to
legal/ethical considerations (demonstrating 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.).
References (move to begin on next page)
You are required to include at least three evidence-based, peer-
reviewed journal articles or evidenced-based guidelines which
relate to this case to support your diagnostics and differentials
diagnoses. Be sure to use correct APA 7th edition formatting.
© 2021 Walden University
Page 1 of 3
00:00:00TRANSCRIPT OF VIDEO FILE:
00:00:00_____________________________________________
_________________________________
00:00:00BEGIN TRANSCRIPT:
00:00:00[sil.]
00:00:15OFF CAMERA Nice to meet you Sergeant. I'm Dr.
Schwartz.
00:00:20SERGEANT Nice to meet you, sir.
00:00:25OFF CAMERA Can you tell me why you came here
today.
00:00:30SERGEANT My fiance suggested, well demanded that I
make an appointment.
00:00:40OFF CAMERA Why was she concerned?
00:00:45[Sighs]
00:00:45SERGEANT Three nights ago, we went with her sister
and husband to a county fair. Carnival rides, cotton candy, toss
balls at bottles, and win big panda bears, all that silly, old-
fashioned stuff, but we were having a good enough time.

16. 00:01:15OFF CAMERA So all was going well.
00:01:20SERGEANT Then these fire works go off. No
warning. Just big, full sky explosions.
00:01:30OFF CAMERA Like county fairs do.
00:01:35SERGEANT I didn't know they did that.
00:01:40OFF CAMERA Then what happened?
00:01:45SERGEANT I took off running. Fast as I could. Tried
to find cover.
00:01:55OFF CAMERA Frightened?
00:02:00SERGEANT [Sighs] Yeah, scared the... you know, out
of me.
00:02:10OFF CAMERA You didn't expect the fire works.
00:02:10SERGEANT These two cops saw me running, I guess
they thought I pickpocketed someone, maybe tried to rob a poor
country person and I was running away. They took me down,
tried to cuff me.
00:02:30OFF CAMERA Wow.
00:02:35SERGEANT So I yelled "I'm a combat veteran
sir." Immediately they backed off. They were veterans,
understood.
00:02:50OFF CAMERA They understood that the fireworks
sounded like combat fire?
00:02:55SERGEANT Yeah, exactly sir. God. [Sighs, quivering].
They helped me to my feet, gave me some cold water. I
was shaking pretty bad.
00:03:10OFF CAMERA So they were helpful?
00:03:15SERGEANT Yeah, absolutely.
00:03:20OFF CAMERA The explosive sounds took you back in
time.
00:03:25SERGEANT I was... I was right back in the middle of
enemy fire, sir.
00:03:35OFF CAMERA What about other loud noises?
00:03:40SERGEANT The same. Last week, a car backfired, I
jumped behind a magazine rack. Even a sudden circular saw
cutting into wood and I'm... right back there.
00:04:05OFF CAMERA Are there any smells that set you off?

17. 00:04:10SERGEANT Yeah, it's funny you should ask. Yes sir.
Diesel fuel. I hate smelling diesel fuel. Chopper smells. And
last week, Charlie, my neighbor, was grilling for Jenna's
birthday and he singed some hair on his arm. No injury
but... the smell... I had to leave the party pretty fast.
00:04:55OFF CAMERA What came to mind?
00:05:00[He pauses, struggling to hold back tears].
00:05:10SERGEANT Two of my buddies, they got burned when
their Humvee was blown and I smelled their... I'd rather not talk
about that, sir.
00:05:40OFF CAMERA Memories are too strong?
00:05:45SERGEANT Yeah, way too strong.
00:05:50[sil.]
00:05:55OFF CAMERA Do you ever dream about these events?
00:06:00SERGEANT Every night, sir. Yeah, makes me not want
to crawl in bed, not close my eyes.
00:06:10OFF CAMERA So you have nightmares. You startle
easily. Are there any other problems that you've noticed?
00:06:20SERGEANT Like what, sir?
00:06:25OFF CAMERA Other cues that cause flashbacks or
make you anxious?
00:06:35SERGEANT Traffic. I hate real busy, downtown
traffic. Stopping at a traffic light, with people in front of you
and behind you, on both sides of you. I can't stand that. I start
breaking out in a sweat, I start shaking, and I can't catch my
breath.
00:07:05OFF CAMERA What about traffic is so bad?
00:07:10SERGEANT Someone could roll an IED under your
car. You're trapped. You can't get out.
00:07:25OFF CAMERA That happened overseas?
00:07:25SERGEANT Yeah. Yeah, to four of my
buddies. Blew'em to hell. And I saw it happen to two other
vehicles. I didn't know the guys but... God several times we'd be
stuck in traffic, and people were staring at us. And I knew we
were going down. Men, women, children. I mean, any of 'em
could'a rolled an IED under us.

18. 00:08:10[He breathes heavily]
00:08:15OFF CAMERA You look like you're breathing heavily
right now just talking about it.
00:08:20[Holding back]
00:08:20SERGEANT Yeah, sorry, sir. I can't help it.
00:08:30OFF CAMERA Any other difficulties?
00:08:40SERGEANT Sometimes my fiance argues with her
mother. It used to not matter. Now I can't handle it. It seems
like any negative situation and I just want to crawl into a hole
and hide. I'm a wimp, a freaking coward. I don't, I don't want to
go anywhere. I don't want to go out to restaurants, or shopping
or even to baseball parks. I just stay in my room all day. Afraid
to sleep. It's bad.
00:09:40OFF CAMERA Have you talked to anyone else about
this?
00:09:45SERGEANT Just you. Just now. I don't want to
remember.
00:09:55OFF CAMERA You're very brave for sharing your
story with me. I know that must be horribly difficult for you.
00:10:05SERGEANT Sometimes my stomach muscles get
tight. I start getting nauseated.
00:10:15OFF CAMERA Your body is reacting normally to bad
events that you've experienced.
00:10:20SERGEANT I don't want to be a whiner.
00:10:25OFF CAMERA You know, talking can actually help
your brain to heal. Talking takes it out of the feeling mode and
puts it into the thinking mode so that you don't hear those same
stories over and over again. So in a way you feel like you're in
control. We could work on this together.
00:10:55SERGEANT I would like that, sir. Very much.
00:11:00OFF CAMERA Good. Let's get you scheduled for an
appointment then.
00:11:05SERGEANT Thank you, sir. Sometimes I feel like it's
never going to end. You know I thought I was going to
crazy. Sometimes my mind just sinks back into itself, like I
can't see or hear or move. It's like I'm numb all over. Lose track

19. of time.
00:11:40SymptomMedia Visual Learning for Behavioral Health
www.symptommedia.com
00:11:40END TRANSCRIPT
“Case History Reports”
Training Title 21 Name: Sergeant Patrick Flanrey Gender: male
Age:27 years old T- 97.4 P- 84 R 18 B/P134/88 Ht 5’8 Wt
167lbs Background: He entered the military just after high
school and did three long tours of duty in warzones. He
separated from active duty in the Marines (MOS 0800 Field
Artillery) less than a year ago after eight years of service. He is
engaged to be married (no date set) and is currently working as
a furniture salesman. He said he grew up poor and would not do
much else if he didn’t go into the military. He denies ever using
any drugs and avoids alcohol because his father was “sloppy
drunk.” Father is still alive, unwell (DM, liver disease, HTN),
still drinking. Paternal grandfather was also a veteran and
suffered depression at times though he never told anyone except
the patient because of their combat connection. Mother is alive
and well, still “caring for dad.” He has one younger and one
older sister. He lives in a different state, approximately five
hours from his parents and siblings. After the military, he and
his fiancé moved because she got a much better opportunity.
They want kids someday and hope to marry in a year or two.
Has service-connected asthma, seasonal allergies; no hx of
psychiatric or substance use treatment. Symptom Media.
(Producer). (2016). Training title 21 [Video]. https://video-
alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-
21
Anxiety disorders.Required reading
American Psychiatric Association. (2013). Anxiety disorders. In
Diagnostic and statistical manual of mental disorders (5th ed.).
Arlington, VA: Author.

20. 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