Analyze and apply critical thinking skills in the psychopathology of mental health patients and provide treatment and health promotion while applying evidence-based research.Scenario:
J.T. is a 20 year-old who reports to you that he feels depressed and is experiencing a significant amount of stress about school, noting that he’ll “probably flunk out.” He spends much of his day in his dorm room playing video games and has a hard time identifying what, if anything, is enjoyable in a typical day. He rarely attends class and has avoided reaching out to his professors to try to salvage his grades this semester. J.T. has always been a self-described shy person and has had a very small and cohesive group of friends from elementary through high school. Notably, his level of stress significantly amplified when he began college.
You learn that when meeting new people, he has a hard time concentrating on the interaction because he is busy worrying about what they will think of him – he assumes they will find him “dumb,” “boring,” or a “loser.” When he loses his concentration, he stutters, is at a loss for words, and starts to sweat, which only serves to make him feel more uneasy. After the interaction, he replays the conversation over and over again, focusing on the “stupid” things he said. Similarly, he has a long-standing history of being uncomfortable with authority figures and has had a hard time raising his hand in class and approaching teachers. Since starting college, he has been isolating more, turning down invitations from his roommate to go eat or hang out, ignoring his cell phone when it rings, and habitually skipping class. His concerns about how others view him are what drive him to engage in these avoidance behaviors.
Questions:
Remember to answer these questions from your textbooks and NP guidelines. At all times, explain your answers.
Generate a primary and differential diagnosis using the DSM-5 criteria.
Develop a biopsychosocial plan of care for this client.
Compare and contrast fear, worry, anxiety, and pani
Guide On Rating System
Vote
Primary diagnosis: Social Anxiety Disorder (Social Phobia)
Criteria for Social Anxiety Disorder:
1. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others, lasting for at least 6 months.
2. Fear that they will act in a way or show anxiety symptoms that will be negatively evaluated by others.
3. Social situations are avoided or endured with intense fear or anxiety.
4. The fear or anxiety is disproportionate to the actual threat posed by the social situation.
5. The fear, anxiety, or avoidance is persistent, lasting for an extended period of time.
6. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other areas of functioning.
7. The fear, anxiety, or avoidance is not attributable to the physiological effects of a substance or another medical condition.
8. The fear, anxiety, or avoidance is not better explained by another mental disorder.
Differential diagnosis:
1. Generalized Anxiety Disorder (GAD)
2. Major Depressive Disorder (MDD)
3. Avoidant Personality Disorder
Biopsychosocial plan of care for J.T.:
Biological:
1. Medication: Consider prescribing selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) to alleviate symptoms of social anxiety.
2. Physical health: Encourage regular exercise, adequate sleep, and a balanced diet to promote overall well-being.
Psychological:
1. Cognitive-Behavioral Therapy (CBT): Implement CBT techniques, such as cognitive restructuring, to challenge and modify negative thoughts and beliefs about oneself in social situations.
2. Exposure therapy: Gradual exposure to feared social situations, starting with easier scenarios and progressively increasing difficulty, can help reduce anxiety and build confidence.
3. Relaxation techniques: Teach J.T. relaxation exercises, such as deep breathing and progressive muscle relaxation, to manage anxiety symptoms.
4. Social skills training: Provide guidance and practice opportunities to improve social skills, assertiveness, and self-confidence.
Social:
1. Group therapy or support groups: Engage J.T. in group therapy with others experiencing social anxiety to provide a supportive environment and facilitate shared experiences.
2. Social integration: Encourage J.T. to accept social invitations and engage in activities with peers to gradually increase his comfort and improve his social connections.
3. Education and psychoeducation: Educate J.T. about social anxiety, its causes, and effective coping strategies to enhance his understanding and ability to manage his symptoms.
Comparison of fear, worry, anxiety, and panic:
Fear: an emotional response to a specific, present threat, often accompanied by a physiological fight-or-flight response. It is an immediate reaction to danger.
Worry: experiencing persistent and excessive thoughts and concerns about various issues, often future-oriented, but not necessarily associated with a specific threat. It is typically characterized by a sense of unease and anticipation of negative outcomes.
Anxiety: a general term referring to a persistent state of apprehension or uneasiness. It involves excessive worrying, physical symptoms (e.g., restlessness, difficulty concentrating), and can be associated with specific triggers or be more generalized.
Panic: an intense, sudden onset of fear or discomfort, accompanied by physical symptoms such as rapid heartbeat, shortness of breath, and feelings of impending doom. Panic attacks are typically time-limited but can be very distressing.
In J.T.'s case, he experiences anxiety characterized by excessive worry and fear related to social situations, leading to avoidance behaviors. His symptoms are specific to social interactions and are consistent with Social Anxiety Disorder.
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