ASSIGNMENT:

Respond to at least two of your colleagues by comparing the differential diagnostic features of the disorder you were assigned to the diagnostic features of the disorder your colleagues were assigned.

Support your responses with evidence-based literature with at least two references in each colleague’s response with proper citation in APA Format. 

Colleagues Response # 1

Differences between Adjustments Disorders and Anxiety Disorders

Adjustment disorder (AjD) and Anxiety disorders (AD) are among the most often diagnosed mental disorders in clinical practice. AjD is recognized as a stress-response syndrome, which is defined as a maladaptive reaction to an identifiable stressor (Zelviene & Kazlauskas, 2018). It is a condition that can occur when you have difficulty coping with a specific, stressful life event – for example, a death or illness in the family, getting fired or laid off from a job, significant relationship issues like break-ups or divorce, or sudden change in social settings such as the pandemic.  Five basic diagnostic criteria of AjD are presented in DSM-5. The first criterion indicates that AjD might only be diagnosed if symptoms occurred within 3 months in the context of identifiable stressor(s). The second criterion specifies clinical significance of AjD symptoms meaning that stress reactions should be out of proportion to the normal reactions of the identified stressor according to the social or cultural context, and there should be significant disturbances in important areas of life. The last 3 criteria point out that 3) the disturbance should not meet criteria or represent a worsening condition of another mental disorder; 4) AjD should not be considered in cases of normal bereavement reactions; and 5) AjD has a tendency to dissipate during 6 months after the stressor has ended (Zelviene & Kazlauskas, 2018).

           Individuals with AD often have a lengthy and consistent history of anxiety and excessive worry, whereas individuals with Adjustment Disorder only experience their symptoms in times of or in response to stress or change. Anxiety Disorder can be made worse by stressors such as change or adjusting to new routines. But if you have Adjustment Disorder, you’ll typically see a reduction in your anxiety as you adapt to the change or learn to cope with the stressor, while anxiety and related symptoms are continual for those with GAD.

Diagnostic Criteria for Generalized Anxiety Disorders (GAD)

According to the DSM IV, “GAD is defined by the following diagnostic criteria:

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance)

B. The individual finds it difficult to control the worry

C. The anxiety and worry are associated with three (or more) of the following six symptoms: Restlessness or feeling keyed up or on edge, being easily fatigued, difficulty concentrating or mind going blank, irritability, muscle tension, sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep)” (The history of generalized anxiety disorder as a diagnostic category, 2017).

The DSM IV makes it clear that GAD is largely an exclusion diagnosis. GAD cannot be diagnosed if the anxiety is better explained by other anxiety disorders (panic, phobic, social anxiety, or obsessive compulsive disorder) (The history of generalized anxiety disorder as a diagnostic category, 2017). Also, GAD cannot be caused directly by stressors or trauma, contrary to adjustment disorders and PTSD (The history of generalized anxiety disorder as a diagnostic category, 2017).

Evidenced-based Psychotherapy and Psychopharmacologic Treatment for GAD

All patients with anxiety disorders require supportive talks and attention to the emotional problems that are associated with the anxiety disorder. Psychoeducation includes information about the physiology of the bodily symptoms of anxiety reactions and the rationale of available treatment possibilities (Treatment of anxiety disorders, 2017). Cognitive-behavioral therapy (CBT) is also one of the best-established psychotherapy treatments for GAD.

Due to their positive benefit/risk balance, selective serotonin reuptake inhibitors (SSRIs) and selective serotonin norepinephrine reuptake inhibitors (SNRIs are recommended as first-line drugs (Treatment of anxiety disorders, 2017). SSRIs for GAD include: Escitalopram, Paroxetine and Sertraline. Pregabalin is a calcium modulator that is also effective in treating GAD (Treatment of anxiety disorders, 2017). However, there have been concerns about the abuse of pregabalin in individuals suffering from substance abuse and also withdrawal syndromes after abrupt discontinuation (Treatment of anxiety disorders, 2017). Buspirone, a 5-hydroxytryptamine receptor 1A (5HT1A) agonist, has been shown in some controlled studies to be effective in the treatment of GAD (Treatment of anxiety disorders, 2017).

Colleagues Response # 2

Anxiety disorders are among the most prevalent psychiatric and mental health discoveries globally. Specific phobia is an anxiety disorder characterized by persistent fear and avoidance. Specific phobias are associated with childhood-onset (Eaton, Bienvenu, & Miloyan, 2018). It has high comorbidity with other mental health illnesses and can be highly disabling if left untreated. The most common types of specific phobias include fear of the different types of animals, fear of heights, and claustrophobia.

Adjustment disorders vs. anxiety disorders

The main cause of adjustment disorder is external stressors and life changes whereas anxiety disorder are caused by a combination of genetics, developmental, and behavioral factors. Individuals living with anxiety disorder tend to present with a repeated and persistent pattern of excessive worrying whereas those with adjustment disorders only have excessive worry when experiencing a stressful life event. Better coping and adaptation to the stressor among people living with adjustment disorder tend to reduce the excessive worry as opposed to those with an anxiety disorder as their symptoms are continuous in nature. For example, to make a diagnosis of adjustment disorder the client must present with distress that is out of proportion with expected reactions to the stressor within 3 months of the onset of the stressor (APA, 2013). When the stressor is removed, the client begins to cope and the symptoms reduce within 6 months. On the other hand, anxiety disorders is characterized by excessive fear and anxiety.

Diagnostic criteria for Specific Phobia

According to the DSM V diagnostic criteria (APA, 2013), Specific Phobia is characterized by marked fear or anxiety about a specific situation or object. The dreaded situation or object elicits

intense fear or anxiety. The phobic object or situation is avoided or at times endured with intense fear/anxiety. The fear is always excessive and out of proportion in relation to the threat of danger posed. The excessive worrying or fear must be present for a period of at least 6 months. The fear, excessive anxiety, and avoidance of the dreaded situation or object must be attributed to significant interference in the person’s social and occupational functioning among other important areas of functioning. The presenting symptoms should not be attributed to other mental disorders such as Social Phobia, OCD, PTSD, and separation anxiety disorder.

Evidence based-psychotherapy and psychopharmacologic treatment of Specific Phobia

Specific Phobia is treatable through the use of both psychotherapy and psychopharmacology. Treatment of the disorder aims at minimizing fear, phobic avoidance, and improve impaired functionality (Eaton, Bienvenu, & Miloyan, 2018). The use of psychotherapy is a first-line treatment followed by pharmacotherapy. The evidence-based psychotherapy for the disorder involves the use of Exposure Therapy which is the treatment of choice (Thng, et al., 2020). The use of Cognitive Behavioral Therapy is another psychotherapy approach used in the management of specific phobias. Exposure therapy involves gradual exposure to the feared situation/object repeatedly until the object/situation does not elicit a fear response. The use of exposure therapy is based on the rationale that continuous and gradual exposure to a safe but frightening situation or object result in reduced anxiety levels thus reducing avoidance behavior (Böhnlein, et al., 2020). Exposure therapy is also used in combination with Cognitive Behavioral Therapy for increased efficacy. CBT is essential in helping the client identify the irrational thoughts and beliefs that may contribute to symptom presentation (Eaton, Bienvenu, & Miloyan, 2018). Irrational thoughts such as catastrophizing are identified through the use of CBT thus helping the client appreciate new realistic and rational thinking.

Pharmacological treatment is used to complement exposure therapy. The various pharmacological modalities that are used in the treatment of specific phobias include beta-blockers and psychotropic medications such as benzodiazepines (Amray, et al 2019). The beta-blockers are used to control increased heart rate associated with specific phobia. The psychotropic is administered to minimize the emotional disturbance associated with the disorder.

HA4050D – Healthcare Law

Discussion 01.3: Creating a Duty of Care

Read the Discussion 01.3 Scenario. Refer to the scenario as you answer the questions below. 

1.Remember that, to state a negligence claim, we must have all four elements of the tort of negligence: 1. Duty, 2. Breach of duty, 3. Causation, AND 4. Damages. In this case, was there a sufficient doctor-patient relationship to create a duty of care on the part of the orthopedist? After all, the patient was never actually seen or treated by your physician. What advice would you give your supervisor?

2.Your boss asks for your thoughts on how we can prevent a situation like this from ever happening again. What else could the orthopedist have done to protect himself from any legal liability to a patient whom he had never actually seen or treated? What procedures might the hospital put in place to protect itself from future liability?

DISCUSSION 01.3: CREATING A DUTY OF CARE

SCENARIO (BASED ON A REAL ILLINOIS CASE)

You are a hospital administrator. Your supervisor comes to talk with you about the potential liability of

one of your physicians.

While on vacation in another state, a patient presented to a local emergency room and was examined

by a plastic surgeon. A review of an X-ray taken of the patient’s knee revealed a possible malignant

neoplasm. Consequently, the plastic surgeon referred the patient to an orthopedist at your facility, Dr.

Johnson, for further review when the patient returned home. The examining physician did not advise

the patient as to the purpose or nature of the referral.

After the patient did not keep any of the three appointments he scheduled with Dr. Johnson at your

facility, Dr. Johnson refused to reschedule him any further. The patient never sought treatment

elsewhere. Ultimately, the patient died of cancer due to this condition and his estate has sued both the

out-of-state physician and your facility. Obviously, there was no intent to harm this patient, but the

lawsuit is claiming that negligence was committed. Your boss has come to discuss with you whether

your facility actually committed all the elements of negligence.

(Note: If you would like to see the real case this scenario is based upon, check out Davis v. Weiskopf,

439 N.E.2d 60 (Ill.App. 1982). Be warned—the scenario has altered the facts from the original case. Do

not rely upon the real case opinion in formulating your answer to the fictional scenario in the discussion

question.)

As you plan, develop, implement and evaluate your nursing practicum project, reflect on how this project and your graduate education have prepared you to meet the growing needs of healthcare and the diverse populations we serve.  400 words, at least one scholarly site. 

Essential I: Background for Practice from Sciences and Humanities

o Recognizes that the master’s-prepared nurse integrates scientific findings

from nursing, biopsychosocial fields, genetics, public health, quality

improvement, and organizational sciences for the continual improvement

of nursing care across diverse settings.

1. Critically appraise current and innovative practices in nursing, including monitoring quality of education practices among diverse learners.
2. Analyze institutional purposes and goals in nursing at all levels as related to professional and societal issues

Please respond for below discussion one paragraph with proper intext citation and reference to further the dialogue by providing more information and clarification 

According to Jacobus and Martin (2019) “We need a study that will increase our sensitivity to ourselves, others, and the values in our world”(p.3). I believe that there is a lot of value in studying humanities for health care professionals.  Studying humanities can help us to understand others better. It can also open our minds to not just the bright side of things but the darker side, the side that no one really wants to talk about, but it needs to be explored (Jacobus and Martin, 2019) 

I think literature from another time period could enhance my career by reading things that were done in the past and see how it compares to how things are done now.  Just because times have changed and ways of doing things have evolved doesn’t mean that we can’t still learn from things done in the past.  As far as my personal life I enjoy listening to music from the 60s and 70s.  I find it interesting in the way music has changed and how styles have changed.  

One aspect of the humanities that I find meaningful to my career is drama.  I think that since drama can help with communication both verbal and non verbal it will be very beneficial for me as a nurse.  Communication is key in order to talk to your co workers, other physicians but most importantly our patients (Macnaughton, 2000). As for my personal life I love music.  It is my escape in a way.  I can turn on my favorite songs and sing and dance.  I may not be the best at it but it allows me to express myself and feel better.

The Broadway show Wicked is a favorite of mine.  I grew up in Kansas, where of course we all know the Wizard of Oz takes place.  Living in Ohio now I always here “You’re not in Kansas anymore” and many other quotes from the movie.  I think the play Wicked is meaningful to me because it brings back those memories of the original movie and my life back in Kansas.  

Martin, F. D., & Jacobus, L. A. (2018). The humanities through the arts. New York, NY: McGraw-Hill Education.

Macnaughton, J. (2000). The humanities in medical education: context, outcomes and structures. Med Ethics: Medical Humanities, 26, 23–30. https://mh.bmj.com/content/medhum/26/1/23.full.pdf