((A female patient presents to your office with a chief complaint of
intense anxiety and fear of driving a car after a history of a serious
car accident. Her anxiety is becoming more disruptive and is now
affecting all elements of her life. She won go to the store unless
someone else drives her, she quit her job, and she stopped seeing
friends. ))

Respond to your peers with the following:

What are 3 questions you would ask to help determine if the patient meets criteria for one of the differentials?

Post 1-

With the patientàhistory of the direct involvement in a serious car accident, along with the subsequent anxiety and fear that she has been having revolving around driving, an appropriate diagnosis for the patient could be Post-Traumatic Stress Disorder (PTSD). Post-Traumatic Stress Disorder occurs following one or more traumatic events. The typical characteristic symptoms are shown following exposure to these traumatic events. The time between the trauma and symptom presentation can vary from 3 months to a year after event (NIMH, 2022). The patient exhibits symptoms that correlate with DSM-V criteria for Post-Traumatic Stress Disorder. These symptoms include being exposed directly to the traumatic event and the resulting multiple disturbances and changes in her life, as expressed by the patient. Specifically, this involves the consistent avoidance of factors related to the motor vehicle accident as well as the social, occupational, and overall deterioration in personal functioning (APA, 2022).

Acute stress disorder can be ruled out as a
differential diagnosis depending on the amount of time following the
traumatic event exposure. According to the American Psychiatric
Association (2022), acute stress disorder is limited to 3 days to 1
month following the trauma, which would differentiate it from PTSD. The
patient would need to indicate when her symptoms started as well as how
long she has been feeling exhibiting symptoms. Another differential
diagnosis could be specific phobia. Because the patient began
experiencing her fear and anxiety following and as a result of the car
accident, the diagnosis of specific phobia would not be sufficient for
the patient. Additionally, with the specific phobia diagnosis, the
fear, anxiety, and avoidance usually last for 6 months or more (APA,
2022).

References

American Psychiatric Association. (2022). Neurodevelopmental disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.).

National Institute of Mental Health. (2022). Post-Traumatic Stress
Disorder.
https://www.nimh.nih.gov/health/topics/post-trauma…

Post 2-

A patient presents with complaints of intense anxiety and fear of
driving following a serious car accident. Her anxiety begins to affect
all elements of her life. She is unable to drive, quitting her job, and
isolating herself from her friends. After reviewing her complaints and
her history, the patient could be experiencing post-traumatic stress
disorder (PTSD).

Post-traumatic stress disorder is when a patient experiences either
personally or witnessing a traumatic event that causes the patient to
avoid reminders of the traumatic event, inability to focus,
self-isolation, and repeated memories of the event (Coleman, 2022). The
traumatic stressor creates alterations in the function of the
hippocampus and amygdala due to the release of high levels of
glucocorticoids in the amygdala and hippocampus (2022).

In order for the patient to be diagnosed with PTSD, certain criteria
must be met from different categories. First, the patient must have
either directly experienced or witnessed the traumatic stressor, learned
of a traumatic event occurring to a close family member or friend, or
experienced repeated or have experienced extreme exposure to traumatic
stressors. Secondly, the patient must have at least one intrusive
symptom related to the traumatic stressor, such as recurrent distressing
memories or dreams of the event, and intense psychological distress
related to the stressor (American Psychiatric Association, 2022). Third,
the patient must have persistent avoidance of the stimuli that caused
the traumatic event (2022). Finally, the patient must have two or more
negative alterations in thoughts and mood and marked alterations in
arousal and activity related to the trauma that began or became worse
after the event occurred (2022). The patient must be experiencing these
symptoms from each category for more than a month and it must be leading
to significant distress, social and occupational impairment, and
impairment in functioning that is not caused by substances or medical
conditions.

As stated above, the patient presents with a chief complaint of
intense anxiety and fear of driving after a history of a serious car
accident that has led to the patient being unable to drive, quitting her
job, and isolating herself from friends. The patient experienced a
traumatic event (the car accident) that has caused intense psychological
distress which is evidenced by her avoiding driving (persistent
avoidance) that has led her to quit her job and isolate herself from her
friends (negative and marked alterations).

If the patient does not meet the full criteria of post-traumatic
stress disorder, the patient could be experiencing acute stress
disorder. Acute stress disorder has a shorter duration, usually
occurring three days after the event but not lasting for more than a
month, and the patient must have a minimum of nine symptoms of PTSD but
the criteria to be diagnosed does not have to include all categories
(Boland et al, 2021). The patient could also be diagnosed with
adjustment disorder if the patient has been experiencing reactions to
the stressor beginning more than 3 months after the stressor but
resolving within 6 months of the traumatic event. The patient must be
experiencing emotional changes and marked distress. It is important to
ask when the event occurred and how long has the patient been
experiencing the symptoms. In addition, the therapist must determine if
other mood disorders are present, such as depression if the patient has
had a low mood or feelings of hopelessness.

References:

Association, A. P. (2022). Diagnostic and Statistical Manual of
Mental Disorders, Text Revision (DSM-5-TR) (5th ed.). American
Psychiatric Publishing, Inc.. https://online.vitalsource.com/books/9780890425770

Boland, R., Verdiun, M., & Ruiz, P. (2021). Kaplan & SadockÊSynopsis of Psychiatry (12th ed.). Wolters Kluwer Health.
https://online.vitalsource.com/books/9781975145583

Coleman, K. L. (2022). Post-traumatic Stress Disorder and Its Effects on the Brain. Radiologic Technology, 93(6), 556u9.x`