Critical thinking skills in the psychopathology of mental health patients Case Study: J.T.

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Purpose: Analyze and apply critical thinking skills in the psychopathology of mental health patients and provide treatment and health promotion while applying evidence-based research.
Scenario: J.T. is a 20 year-old who reports to you that he feels depressed and is experiencing a significant amount of stress about school, noting that he’ll “probably flunk out.” He spends much of his day in his dorm room playing video games and has a hard time identifying what, if anything, is enjoyable in a typical day. He rarely attends class and has avoided reaching out to his professors to try to salvage his grades this semester. J.T. has always been a self-described shy person and has had a very small and cohesive group of friends from elementary through high school. Notably, his level of stress significantly amplified when he began college.
You learn that when meeting new people, he has a hard time concentrating on the interaction because he is busy worrying about what they will think of him – he assumes they will find him “dumb,” “boring,” or a “loser.” When he loses his concentration, he stutters, is at a loss for words, and starts to sweat, which only serves to make him feel more uneasy. After the interaction, he replays the conversation over and over again, focusing on the “stupid” things he said. Similarly, he has a long-standing history of being uncomfortable with authority figures and has had a hard time raising his hand in class and approaching teachers. Since starting college, he has been isolating more, turning down invitations from his roommate to go eat or hang out, ignoring his cell phone when it rings, and habitually skipping class. His concerns about how others view him are what drive him to engage in these avoidance behaviors.
Questions: Remember to answer these questions from your textbooks and NP guidelines. At all times, explain your answers.
1. Generate a primary and differential diagnosis using the DSM-5 criteria.
2. Develop a biopsychosocial plan of care for this client.
3. Compare and contrast fear, worry, anxiety, and panic.

Sample Solution

Analyzing J.T.’s Case with Critical Thinking and Evidence-Based Practices

  1. Primary and Differential Diagnosis (DSM-5 Criteria):

Primary Diagnosis: Based on J.T.’s symptoms, the most likely primary diagnosis is Social Anxiety Disorder (SAD) (American Psychiatric Association, 2022). Here’s how his symptoms align with DSM-5 criteria:

  • Marked fear or anxiety in social situations: J.T. experiences significant anxiety when meeting new people and interacting with authority figures.
  • Fear of being scrutinized by others: He worries excessively about being judged negatively.
  • Fear of embarrassment: His anxiety intensifies in situations where he fears making mistakes or appearing incompetent.
  • Avoidance behaviors: He avoids social interactions, classes, and interactions with professors due to anxiety.
  • Symptoms interfere with daily life: His anxiety disrupts his academic performance and social life.

Differential Diagnoses: While SAD is the most likely diagnosis, other possibilities to consider include:

  • Major Depressive Disorder: J.T.’s feelings of worthlessness and loss of enjoyment could suggest depression. However, the prominent social anxiety seems to be the driving force behind his depressive symptoms.
  • Avoidant Personality Disorder: J.T.’s avoidance behaviors could be characteristic of this personality disorder. However, the intense anxiety experienced in social situations suggests SAD as a more appropriate diagnosis.
  1. Biopsychosocial Plan of Care:

A comprehensive care plan for J.T. should address the biological, psychological, and social factors contributing to his anxiety. This plan will incorporate evidence-based practices.

  • Biological: A medical evaluation by a physician can rule out any underlying medical conditions contributing to his anxiety. If warranted, medication like selective serotonin reuptake inhibitors (SSRIs) can be considered as an adjunct therapy alongside psychotherapy (National Institute of Mental Health, 2022).
  • Psychological: Cognitive-behavioral therapy (CBT) is the first-line treatment for SAD (National Institute of Mental Health, 2022). CBT will help J.T. identify and challenge negative thoughts and beliefs about himself and social situations. Exposure therapy can be used to gradually expose him to feared situations while practicing relaxation techniques to manage anxiety.
  • Social: Social skills training can help J.T. develop communication and conversation skills to feel more confident in social interactions. Group therapy can also provide a safe space to practice social skills and connect with others who share similar challenges.
  1. Fear, Worry, Anxiety, and Panic:

These terms are often used interchangeably, but crucial distinctions exist:

  • Fear: A natural emotional response to a perceived threat. It’s time-limited and prompts an immediate response (fight, flight, or freeze).
  • Worry: Apprehensive thinking about potential future negative events. While related to fear, it lacks the clear and present threat and can be more persistent.
  • Anxiety: A broader term encompassing feelings of nervousness, apprehension, and physical arousal (increased heart rate, sweating) associated with perceived threats or future uncertainties. Both fear and worry contribute to anxiety.
  • Panic: A sudden and intense episode of overwhelming fear and physical symptoms like rapid heart rate, chest tightness, and dizziness. Panic attacks can be a symptom of anxiety disorders like panic disorder.

Critical Thinking and Evidence-Based Practices:

Critical thinking skills are crucial in J.T.’s case by:

  • Considering all relevant information: Exploring his symptoms, history, and potential diagnoses.
  • Evaluating the evidence: Using established diagnostic criteria from DSM-5 and referencing evidence-based treatments for SAD.
  • Considering cultural context: While not explicitly mentioned, understanding J.T.’s cultural background might provide additional insights into social interactions.

Evidence-based practices underpin the proposed treatment plan. CBT is a well-established and effective treatment for SAD, supported by numerous clinical trials (National Institute of Mental Health, 2022).

Conclusion:

J.T.’s case demonstrates the importance of critical thinking skills to accurately assess his mental health needs. Utilizing evidence-based practices like CBT and considering biopsychosocial factors can create a comprehensive treatment plan to help him manage his social anxiety and improve his overall well-being.

 

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