Panic Disorder

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Introduction
Substantial research has aimed to elucidate the most effective method for practitioners to formulate a patient’s diagnosis. Engel (1977) proposed a bio psychosocial model to be used by a practitioner to investigate the many dimensions of a mental disorder and arrive at a fully comprehensive approach to treat the patient. Engel proposed that in order to properly diagnose mental disorders, practitioners should consider biological, social, psychological and behavioural dysfunction of the presenting illness. Additionally, Nurcombe and Fitzhenry-Coor (1987) direct practitioners to address all facets pertaining to the patient, in order to ascertain a detailed picture of the patient and the disorder, and improve the formulation of the patient’s diagnosis. Specifically, assessment of the patient should include the patient’s health history, underlying personality constitution, collection of symptoms and perpetuating factors as well as prognostic potential. Clearly the process of correctly identifying a presenting mental health issue in a patient includes ascertaining its cause, and involves the health practitioner developing clear diagnostic and reasoning skills (Vickery, Samuels & Ropper, 2010). Nurcombe and Fitzhenry-Coor’s (1987) method incorporates the biopsychosocial elements of the patient, and can be referred to as the seven P’s; predisposition, precipitation, pattern, perpetuation, presentation, prognosis, potentials. The ideology underpinning this reasoning is a deviation from the unitary theory of placing the root of dysfunction at a single cause, and has been found to improve the accuracy in provisional diagnosis of trainee professionals in clinic (Nurcombe and Fitzhenry-Coor’s, 1987). Vickery, Samuels & Ropper (2010) use the model of heuristics to highlight some of the critical errors that many practitioners are prone to. They discuss many of the common faults that occur with the use of short cuts such as becoming attached to a provisional diagnosis despite new data that may not support it, being influenced by the ease of recalling past cases and not adjusting diagnostic probabilities with new data. They aim to reduce the bias that is intrinsic in the heuristics of diagnosing mental disorders by increasing awareness and implementing certain behavioural strategies, potentially avoiding many of the pitfalls a practitioner can fall into when making a provisional diagnosis. The objective of this paper was to apply Nurcombe and Fitzhenry-Coor’s (1987) diagnostic and reasoning skills in order to investigate the case study of patient Joan, and assess any psychopathology that may be present. As per Nurcombe & Fitzhenry-Coor’s (1987) recommendations, the case study of Joan was assessed from a behavioural, social, biological and psychological perspective, to ascertain the most accurate provisional diagnosis possible as per Axis 1 of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR; American Psychiatric Association [APA], 2000). A differential diagnosis was presented, including a discussion of the process taken to obtain a provisional diagnosis. This paper concludes with a discussion of Joan’s prognosis and an analysis of some treatment strategies. Joan is a 22-year-old University student presenting with panic attack symptoms of nausea, sweating and palpitations, indicating an overactivity of the autonomic nervous system (Li, Chokka and Tibbo, 2001). Joan appears uncomfortable with social interaction and requires a close companion nearby to attenuate anxiety feelings. Panic attack symptoms have occurred four times over a three month period, and have caused significant distress as Joan fears that a medical disorder may be causing them. Symptoms are causing considerable disruption to occupational and social functioning, however no depressive symptoms are noted. A full case history for Joan is provided in Appendix A. According to the DSM-IV-TR (APA,...
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