Case Study: Name: Ms. Connie Weidre Gender: female Age: 53 years old T- 99.0 P- 102 R 24 156/86 Ht 5’4 Wt 1lbs73 Background: Lives with her husband in Memphis, TN, has one daughter age 25. She has never worked. Raised by mother, she never knew her father. Mother with hx of generalized anxiety and was verbally abusive, abused benzodiazepines; no substance hx for patient. No previous psychiatric treatment. Has one glass red wine with dinner. Sleeps 12-13 hrs.; appetite decreased. Has overactive bladder, untreated. Allergic to Zofran; complains of headaches, takes prn Tylenol, has diarrhea 2-3 times weekly, takes OTC Imodium. Symptom Media. (Producer). (2016). Training title 40 [Video]
Transcript of Video:
00:00:00TRANSCRIPT OF VIDEO FILE:
00:00:00______________________________________________________________________________
00:00:00BEGIN TRANSCRIPT:
00:00:00[sil.]
00:00:15[She nervously plays with her scarf as she breathes anxiously]
00:00:25OFF CAMERA Hello Mrs. Weidre. Are you ok? Do you want some water or something?
00:00:30MRS. WEIDRE I’m ok. I’m fine.
00:00:35OFF CAMERA I understand you wanted to see me today.
00:00:40[She breathes anxiously]
00:00:40MRS. WEIDRE I just really needed to sit and talk.
00:00:40OFF CAMERA Well, tell me what’s wrong, what are you feeling?
00:00:50MRS. WEIDRE I’m just so… so unsure. I’m tired of being stuck in my house. I don’t like it.
00:01:00OFF CAMERA Stuck in your house? Do you have difficultly leaving your house?
00:01:05MRS. WEIDRE Yes. All the time.
00:01:05OFF CAMERA When do you go out?
00:01:10MRS. WEIDRE …maybe, once or twice.
00:01:15OFF CAMERA A day?
00:01:15[She clutches her hands to her chest]
00:01:15MRS. WEIDRE A week. Tuesdays and Saturdays.
00:01:20OFF CAMERA Why Tuesday and Saturday?
00:01:30MRS. WEIDRE Because when my husband gets home, he can go with me.
00:01:35OFF CAMERA What do you do when you go out?
00:01:40MRS. WEIDRE I take walks.
00:01:40OFF CAMERA Where do you walk?
00:01:40MRS. WEIDRE I only go to the end of the block, and then I cross the street, and turn around, and I go back around the cul-de-sac. I’ll do that three times. [Losing breathe] No more, then I have to go back inside… I also go in my backyard. That’s usually okay.
00:02:15OFF CAMERA On the walks, why do you have to go back after three times? What happens?
00:02:20MRS. WEIDRE [She nervously looks around] I just can’t go any further.
00:02:25OFF CAMERA Is this a physical problem, knees or something?
00:02:30[She plays with her scarf]
00:02:30MRS. WEIDRE No. No. Well… maybe. I just can’t breathe if I’m out any longer.
00:02:40OFF CAMERA Oh, breathing?
00:02:40MRS. WEIDRE Yeah.
00:02:40OFF CAMERA What do you feel?
00:02:45MRS. WEIDRE [Her voice quivering] I’m just so frightened. Really, really scared. You don’t realize what it took for me to get here today. I really had to. I willed it. I closed my eyes and my husband turned the radio up all the way as he drove. And then he lead me into the building.
00:03:20OFF CAMERA Is there something that triggers this, anything in particular?
00:03:30MRS. WEIDRE I don’t like people. Maybe that’s it. I mean I can tolerate them. Ethan, the little boy next door, I’ll bake things for him and say hello. Sometimes, sometimes I watch him when his parents are gone. I mean I can be around people. Maybe that’s not that’s not what I meant.
00:04:00OFF CAMERA Ok, can you walk me through what happens when you do leave the house?
00:04:05MRS. WEIDRE I get shortness of breathe, everything, the world just seems to close in on me, and everything gets feels really tight, the air in my body, my chest. I get dizzy. I don’t know what’s wrong… I could be sick. What is this?
00:04:30OFF CAMERA There can be many different causes for this. What is it that frightens you?
00:04:40MRS. WEIDRE [She’s short of breathe] Death. I’m afraid to die.
00:04:45OFF CAMERA You’re afraid you might die?
00:04:50MRS. WEIDRE Yes. Among other things but that’s what pops into my head.
00:04:55OFF CAMERA Is there other stuff?
00:05:00[sil.]
00:05:05MRS. WEIDRE Cars go to fast. And there’s murders and rapes that I see on the news. And flashfloods. I just think its close, its safer to stay close to home.
00:05:15OFF CAMERA How long have you had this fear?
00:05:20MRS. WEIDRE I don’t really know.
00:05:20OFF CAMERA Do you know when it all started?
00:05:25MRS. WEIDRE I’m not sure.
00:05:30OFF CAMERA Do you know what started it?
00:05:30MRS. WEIDRE No.
00:05:35OFF CAMERA When was the last time you really ventured out for any length of time?
00:05:40MRS. WEIDRE Fifteen years.
00:05:45[She nervously shifts in her chair]
00:05:45OFF CAMERA That long. Is this the farthest you’ve been in fifteen years? What happened fifteen years ago?
00:06:00MRS. WEIDRE I don’t really know.
00:06:05OFF CAMERA There is nothing that happened to you personally that could have made you afraid of dying?
00:06:10MRS. WEIDRE I always was. My mother died the year before that. But it happened little by little. First it was planes. And then I couldn’t drive on the freeway, then I couldn’t drive at all, then errands, then it was going out… and soon… here I am.
00:06:40OFF CAMERA It must have taken you extraordinary courage to come here today. What finally brought you to see me?
00:06:50MRS. WEIDRE My grandson was born. But I couldn’t go and see him. I still haven’t seen him. My daughter gave birth last week and she’s not going to bring him to see me for several months and I don’t want to wait that long.
00:07:10OFF CAMERA You miss out.
00:07:15MRS. WEIDRE Yes! Of course I do! My grandson is a thousand miles away and I can’t leave the God damned house.
00:07:25[sil.]
00:07:25END TRANSCRIPT
Assignment:
Incorporate the following into your responses in the template: Comprehensive Psychiatric Evaluation
- 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.
- 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.).
References :
- American Psychiatric Association. (2022). Anxiety disorders. In Diagnostic and statistical manual of mental disordersLinks to an external site. (5th ed., text rev.).
- MedEasy. (2017). Anxiety, OCD, PTSD and related psychiatric disorders | USMLE & COMLEXLinks to an external site. [Video]. YouTube.
