Assignment: Assessing and Diagnosing Patients with Anxiety Disorders PTSD and OCD

Assignment: Assessing and Diagnosing Patients with Anxiety Disorders PTSD and OCD

Assignment: Assessing and Diagnosing Patients with Anxiety Disorders PTSD and OCD

Assessing and Diagnosing Patients with Anxiety Disorders PTSD and OCD Sample Paper

Subjective:

CC (chief complaint): “My fiancé demanded that I have an appointment.”

HPI:

Sergeant Berry Sullivan is a 27-year-old veteran who came to the psychiatric clinic after his fiancé demanded that he gets a psychiatric appointment. This was after Berry got scared to a level of escaping after hearing fireworks when they attended a county fair three nights ago. Berry states that the sounds of the firework reminded him of the days when he was at war. He felt like he had been returned to the middle of enemy fire. The client also reports being startled by loud noises since they take him back to the combat days. In addition, he states that he hates the smell of diesel fuel, chopper, and something being grilled. The smell of something burning reminds him of his colleagues who were burnt alive when their Humvee was blown in combat.

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Berry mentions that he dreams about the traumatic combat events every night and wishes not to sleep or close his eyes. He also states that he hates busy downtown traffic because it makes him nervous. He visualizes a person throwing an IED under his car and blowing him like what happened to his colleagues and two other vehicles he witnessed in combat. The client also reports that he gets irritated when his fiancé argues with her mother, which did not bother him before. Furthermore, he tries to run away from any negative situation and avoids public places. He stays in his room the whole day and avoids sleeping because he is afraid of nightmares.

Substance Current Use: Denies history of alcohol or illicit drug use.

Medical History:

• Current Medications: None
• Allergies: Positive for service-connected asthma and seasonal allergies.

• Reproductive Hx: None

Family Psychiatric/Substance Use History:

Berry’s father has a history of alcoholism that made him abusive. The father has DM, cirrhosis, and HTN and still drinks alcohol. The paternal grandfather was also a veteran and suffered from depression every so often.

Psychosocial History:

Berry is a veteran and joined the military after high school. He underwent three long tours of duty in war zones. He resigned from active duty in the Marines less than a year ago after eight years of military service. Berry is engaged and plans to get married in eight months and get kids someday. He is currently enrolled in an online college for accounting, where he is using his GI Education Bill. He has one younger brother and one older sister. He lives in a different state from his parents and siblings, about five hours from the family home. He moved with his fiancé after resigning from active military duty because the fiancé got a better opportunity.

ROS:

• GENERAL: Negative for low energy levels, fever, chills, or weight gain/loss.
• HEENT: Negative for blurred vision, eye pain, ear pain/discharge, hearing loss, nasal discharge, sneezing, or sore throat.
• SKIN: Negative for rash, discoloration, or bruises.
• CARDIOVASCULAR: Positive for breathlessness when anxious. Negative for chest pain, edema, or palpitations.
• RESPIRATORY: Positive for breathlessness when anxious. Negative for cough, sputum, or chest pain.
• GASTROINTESTINAL: Positive for nausea and abdominal pain. Negative for vomiting, epigastric pain, or bowel changes.
• GENITOURINARY: Negative for dysuria, penile discharge, or urinary frequency/urgency.
• NEUROLOGICAL: Negative for headache, dizziness, fatigue, muscle weakness, or tingling sensations.
• MUSCULOSKELETAL: Negative for muscle pain, joint stiffness, or joint pain.
• HEMATOLOGIC: Negative for bruising.
• LYMPHATICS: Negative for enlarged lymph nodes.
• ENDOCRINOLOGIC: Positive for excessive sweating when anxious. Negative for cold/heat intolerance, excessive thirst, hunger, or urine production. 

Objective:

Vital Signs: Temp- 98.8; P- 86; R-18; BP-122/70; Ht-5’8; Wt-160lbs

Diagnostic results: No test results available.

Assessment:

Mental Status Examination:

Male client in his 20’s. He is alert but appears anxious. He is well-groomed and appropriately dressed. He maintains adequate eye contact during the session, has positive body language, and uses facial expressions appropriately. The self-reported mood is nervous, and the affect is constricted. His speech is clear and goal-directed, but the volume and rate increase when discussing traumatic combat events. He has a logical and goal-directed thought process. No delusions, hallucinations, obsessions, or suicidal ideations/thoughts were observed. His short-term and long-term memory is intact, and he has a clear judgment.

Differential Diagnoses:

Post Traumatic Stress Disorder (PTSD)

PTSD is a syndrome characterized by recurrent, disturbing recollections of an overwhelmingly traumatic event. The recollections last more than one month and start within six months of the event. The symptoms of PTSD are subdivided into: intrusions, negative alterations in cognition and mood, avoidance, and alterations in arousal and reactivity (Miao et al., 2018). Individuals frequently have undesired memories replaying the traumatic event, and nightmares of the incidents are common. Persons with PTSD avoid stimuli connected with the trauma, often feel emotionally numb, and lack interest in daily activities (Miao et al., 2018).

PTSD is a presumptive diagnosis owing to the client’s positive features of intrusions, avoidance, and alterations in arousal and reactivity. The client reports having intrusive thoughts about the traumatic combat events and has nightmares about them. Besides, he avoids stimuli associated with combat, like avoiding traffic and public places. Alterations in arousal and reactivity are evident, with the client getting startled and aroused by fireworks, loud noises, and diesel, chopper, and burn smells (Miao et al., 2018). The client also has negative alterations in mood, as seen by getting nervous in situations that remind him of combat and getting irritated with his fiancé’s arguments.  

Panic Disorder:

Panic disorder is diagnosed based on the presence of recurring panic attacks. A panic attack is a sudden period of extreme fear or discomfort accompanied by at least four of the following symptoms: Palpitations, Sweating, Trembling or shaking, Feeling of shortness of breath, Chest pain, dizziness, feeling of choking, Numbness or tingling sensation, chills, hot flashes, nausea, or abdominal pains (Manjunatha & Ram, 2022). Patients usually adopt maladaptive responses to panic attacks, like avoiding social situations.

The client presents with panic disorder symptoms, including episodes of intense anxiety, where he experiences profuse sweating, shaking, and breathlessness. He also reports feeling nauseated, abdominal discomfort, and general body numbness (Kim, 2019). The anxiety episodes have led to the client’s avoidance of public places. However, the client’s anxiety episodes are related to intrusive memories of traumatic combat events, which make Panic disorder an unlikely primary diagnosis.  

Social Phobia:

Social phobia is characterized by marked and persistent fear of social or performance situations in which a person is exposed to potential scrutiny by others. The fear is intense to a level of impairing one’s occupational and social performance. Besides, exposure to social or performance situations often results in fear or anxiety (Leigh & Clark, 2018). The client reports avoiding public places since he gets extremely anxious and thus prefers to stay in his room the whole day. Nevertheless, the anxiety in social places is due to the client avoiding triggers of combat events, making social phobia an unlikely primary diagnosis.

Reflections:

From this assessment, I learned that situations likely to trigger PTSD are those that invoke feelings of helplessness, fear, or horror. I learned that PTSD is only diagnosed after one month has passed since the traumatic event. It is considered acute stress disorder if the symptoms occur in the first month. In a different situation, I would assess the patient for depression, anxiety disorders, and substance use since they are common among persons with chronic PTSD (Watkins et al., 2018). The PMHNP should uphold ethical and legal factors by ensuring the treatment interventions selected for the patient are established to promote the best outcomes with minimal or no adverse effects on the patient (Watkins et al., 2018). The PMHNP should also involve the client in developing the treatment plan to uphold the patient’s right to autonomy.

References

Kim, Y. K. (2019). Panic Disorder: Current Research and Management Approaches. Psychiatry investigation, 16(1), 1–3. https://doi.org/10.30773/pi.2019.01.08

Leigh, E., & Clark, D. M. (2018). Understanding Social Anxiety Disorder in Adolescents and Improving Treatment Outcomes: Applying the Cognitive Model of Clark and Wells (1995). Clinical child and family psychology review, 21(3), 388–414. https://doi.org/10.1007/s10567-018-0258-5

Manjunatha, N., & Ram, D. (2022). Panic disorder in general medical practice- A narrative review. Journal of family medicine and primary care, 11(3), 861–869. https://doi.org/10.4103/jfmpc.jfmpc_888_21

Miao, X. R., Chen, Q. B., Wei, K., Tao, K. M., & Lu, Z. J. (2018). Posttraumatic stress disorder: from diagnosis to prevention. Military Medical Research, 5(1), 32. https://doi.org/10.1186/s40779-018-0179-0

Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A review of evidence-based psychotherapy interventions. Frontiers in behavioral neuroscience, pp. 12, 258. https://doi.org/10.3389/fnbeh.2018.00258

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Assignment Assessing and Diagnosing Patients With Anxiety Disorders PTSD and OCD
“Fear,” according to the DSM-5-TR, “is the emotional response to a real or perceived imminent threat, whereas anxiety is the 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.

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? 
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.).
Rubric Detail
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–
Excellent 18 (18%) – 20 (20%)
The 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.
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.–
Excellent 18 (18%) – 20 (20%)
The response thoroughly and accurately documents the patient’s physical exam for pertinent systems. Diagnostic tests and their results are thoroughly and accurately documented.
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.–
Excellent 23 (23%) – 25 (25%)
The 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.
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.).–
Excellent 9 (9%) – 10 (10%)
Reflections are thorough, thoughtful, and demonstrate critical thinking.
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).–
Excellent 14 (14%) – 15 (15%)
The 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.
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.–

Excellent 5 (5%) – 5 (5%)
A 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.
Written Expression and Formatting—English writing standards:
Correct grammar, mechanics, and punctuation–

Excellent 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors
Total Points: 100
Name: NRNP_6635_Week4_Assignment_Rubric
 
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
• 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-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.
• 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!), 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.).
(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 seeking symptoms that may align with many DSM-5-TR 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 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
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 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 diagnostic impression 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 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!), 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.).
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.