Oppositional defiant vs Conduct disorder and post traumatic stress vs Adjustment disorder essays

Oppositional defiant vs Conduct disorder and post traumatic stress vs Adjustment disorder essays

Discussion 1

In this discussion, we will explore and address questions related to the case presentation. Additionally, we will consider the time frame necessary to differentiate adjustment disorders from post-traumatic stress disorders.

As per the American Psychiatric Association (2013) guidelines, posttraumatic stress disorder (PTSD) is defined by symptoms persisting for more than one month. In contrast, adjustment disorder entails the development of emotional or behavioral symptoms within three months of the onset of a stressor (American Psychiatric Association, 2013).

Differentiating Oppositional Defiant Disorder and Conduct Disorder

Oppositional Defiant Disorder (ODD), according to the American Psychiatric Association (2013), involves meeting at least four out of several specified symptoms that persist for at least six months. These symptoms pertain to categories such as an angry/irritable mood, argumentative/defiant behavior, and vindictiveness (American Psychiatric Association, 2013).

Conduct Disorder (CD) is diagnosed when a patient meets at least three out of the 15 criteria within the past 12 months, with at least one criterion present in the past six months (American Psychiatric Association, 2013). CD involves physically destructive acts, theft, and bullying/physical fights (American Psychiatric Association, 2013).

NRNP-6665 Comprehensive Integrated Psychiatric Assessment Discussion Example

In contrast, ODD primarily involves verbal defiance without physical destruction (American Psychiatric Association, 2013).

For our discussions this term, please include any potential differential diagnoses.

Differential Diagnosis

Acute stress disorder might be considered as a differential diagnosis due to the stress the patient experienced during the traumatic event. However, acute stress disorder typically lasts from 3 days to 1 month following exposure to the traumatic event (American Psychiatric Association, 2013). If the patient’s symptoms persist beyond one month, acute stress disorder would not be an appropriate diagnosis (American Psychiatric Association, 2013).

Additionally, other posttraumatic disorders and conditions could be considered as differential diagnoses based on the patient’s symptoms in the days following the traumatic event (American Psychiatric Association, 2013). If the patient’s symptoms resolve, the diagnosis might be another mental disorder rather than PTSD (American Psychiatric Association, 2013).

Your Diagnosis and Reasoning

The patient’s diagnosis is posttraumatic stress disorder (PTSD) in accordance with the American Psychiatric Association (2013) criteria. To diagnose PTSD, the patient fulfills criteria A, which involves exposure to actual or threatened death, serious injury, or sexual violence through various means. Specifically, the patient meets criterion A1 by directly experiencing the traumatic event (American Psychiatric Association, 2013).

Additional Questions to Ask

I would inquire about the presence of flashbacks or nightmares related to the traumatic incident. Additionally, I would explore potential triggers that evoke memories of the traumatic event. Other questions would address the patient’s sleep patterns, eating habits, and overall well-being, including personal hygiene.

Medication Recommendations and Rationale

For this patient, I would recommend starting with sertraline (Zoloft) at a dose of 25 mg orally once daily for PTSD. Zoloft is a selective serotonin reuptake inhibitor (SSRI) commonly used to treat PTSD. It can help alleviate symptoms such as anxiety, depression, and intrusive thoughts (Stahl, 2021).

The potential side effects of Zoloft include gastrointestinal issues like decreased appetite, nausea, diarrhea, constipation, or dry mouth. Central nervous system effects like insomnia, sedation, agitation, tremors, headache, or dizziness may also occur. Additionally, rare side effects include hyponatremia, hypotension, and seizures. It’s essential to be vigilant for the black box warning regarding suicidal ideation, especially in children and young adults (Stahl, 2021).

Indicated Labs

There are no specific labs required before initiating Zoloft for this patient. However, obtaining a baseline complete blood count (CBC) and urine toxicology screen would be prudent. Monitoring electrolyte imbalances, particularly hyponatremia, is essential, as Zoloft can affect sodium levels (Stahl, 2021).

Beneficial Screener Scales or Diagnostic Tools

Several scales and questionnaires can aid in diagnosing PTSD. These include the brief trauma questionnaire, trauma assessment for adults-self report, and traumatic life events questionnaire (Lancaster et al., 2016). Additionally, symptom severity can be assessed using scales like the PTSD checklist for DSM-5 and posttraumatic diagnostic scale for DSM-5 (Lancaster et al., 2016).

Additional Resources

Psychotherapeutic interventions for PTSD encompass behavior therapy, cognitive therapy, and hypnosis (Sadock et al., 2017). Group and family therapy have also proven effective in PTSD cases (Sadock et al., 2017). Encouraging the patient to engage in relaxation techniques, deep breathing exercises, or yoga can be beneficial (Mayo Clinic, 2018).

Discussion 2

In this discussion, we will continue to address the time frame for distinguishing adjustment disorders from PTSD.

Differential Diagnosis

The patient’s symptoms last only for a short period, typically not exceeding 6 months, and commence within 3 months of the stressor. Thus, disruptive mood dysregulation, antisocial personality disorder, borderline personality disorder, delirium, major neurocognitive disorder, and substance intoxication or withdrawal can be ruled out (American Psychiatric Association, 2013).

Your Diagnosis and Reasoning

Based on the patient’s recurrent aggressive outbursts, inability to control impulses, and instant relief following the outbursts, the diagnosis is Intermittent Explosive Disorder (IED) 312.34 (F63.81) (American Psychiatric Association, 2013). The patient meets all the diagnostic criteria for IED (American Psychiatric Association, 2013).

Additional Questions to Ask

I would inquire about any family history of IED or mental health disorders, potential triggers for violence, the patient’s sleep patterns, and whether they engage in regular physical exercise, as these factors could contribute to their symptoms.

Medication Recommendations and Rationale

Consent for treatment should be obtained before prescribing medications. I recommend a combination of Sertraline and Buspirone. SSRI combined with Buspar has been shown to be effective for treating IED, particularly in reducing impulsivity and aggression (Sadock et al., 2017).

– Sertraline: 25 mg orally once daily with food or milk. Potential side effects include headache, nausea, diarrhea, drowsiness, dry mouth, anxiety, nervousness, vomiting, constipation, and sexual dysfunction. Adverse effects such as serotonin syndrome, neuroleptic malignant syndrome, and suicidal ideation should be monitored (Kizior and Hodgson, 2019).

– Buspirone: 5 mg orally twice a day. Side effects include dizziness, drowsiness, nervousness, fatigue, insomnia, dry mouth, and diarrhea. Rarely, muscle pain/stiffness, chest pain, and involuntary movements can occur. Patients should avoid tasks requiring alertness until the medication’s effects are established (Kizior and Hodgson, 2019).

Indicated Labs

There are no labs that need to be started to start on Zoloft. Getting a baseline CBC, and urine tox screen would be good for this patient. Checking the patients’ labs for electrolyte imbalances because Zoloft can cause hyponatremia. Also, a urine tox screen to make sure the patient isn’t using any other substances before starting on Zoloft.