Training Title 15
Name: Mr. Ralph Newsome
Gender: male
Age:19 years old
T- 97.0 P- 70 R 18 116/68 Ht 5’9 Wt 175lbs
Background: Lives in Columbus, OH with his dog Chance, only child. Parents live locally.
Works part time in Construction. Not currently partnered. No previous psychiatric history.
Symptoms began in the last 2 months when he discovered he is being activated with the Navy
Reserves. His MOS is CM3 Construction Mechanic; no medical illnesses, no legal hx. Allergies:
NKDA; sleeps 8hrs; appetite good
Symptom Media. (Producer). (2017). Training title 15 [Video].
https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/wa
tch/training-title-15

1. Introduction
Patient: Mr. Ralph Newsome, 19‑year‑old male.

Context: Case study from Symptom Media video (2017).

Clinical Focus: Anxiety disorders in young adults, diagnostic reasoning, treatment planning.

Importance: Highlights how situational stressors (military activation) can precipitate anxiety symptoms in otherwise healthy individuals.

2. Demographics and Background
Age: 19 years old.

Gender: Male.

Vitals: T 97.0, P 70, R 18, BP 116/68 (normal).

Height/Weight: 5’9”, 175 lbs (BMI ~25.8 → borderline overweight).

Family: Only child, lives in Columbus, OH with his dog; parents live locally.

Education/Occupation: Works part‑time in construction.

Relationship Status: Not partnered.

Medical History: No medical illnesses.

Psychiatric History: None prior to current episode.

Legal History: None.

Allergies: NKDA.

Lifestyle: Sleeps 8 hours, appetite good.

Trigger: Symptoms began 2 months ago after learning of activation with Navy Reserves (MOS CM3 Construction Mechanic).

3. Psychosocial Stressors
Military Activation: Anticipation of deployment, uncertainty about future.

Life Transition: Young adult adjusting to responsibilities of military service.

Social Isolation: Only child, limited peer support.

Occupational Stress: Balancing construction work with military obligations.

Family Dynamics: Parents live locally but unclear level of involvement/support.

4. Clinical Presentation (Anxiety Features)
Reported Symptoms (likely from case context):

Excessive worry about military activation.

Restlessness, irritability.

Difficulty concentrating.

Somatic symptoms (palpitations, sweating, muscle tension).

Anticipatory anxiety.

Risk Factors:

Young age, limited coping skills.

Major life transition.

Anticipation of stressful military environment.

No prior psychiatric history (sudden onset).

5. Mental Status Examination (MSE)
Appearance: Appropriate grooming, normal weight.

Behavior: Cooperative, anxious demeanor.

Speech: Normal rate/volume, may be pressured when discussing stressors.

Mood: Reports anxiety, worry.

Affect: Constricted, tense.

Thought Process: Logical, coherent.

Thought Content: Preoccupation with military activation.

Cognition: Alert, oriented ×3.

Insight/Judgment: Fair, recognizes anxiety but limited coping strategies.

6. Differential Diagnosis
Generalized Anxiety Disorder (GAD): Excessive worry for ≥6 months, difficult to control.

Adjustment Disorder with Anxiety: Symptoms linked to identifiable stressor (military activation).

Panic Disorder: Must rule out recurrent unexpected panic attacks.

PTSD: No trauma exposure yet, but risk if deployment occurs.

Obsessive‑Compulsive Disorder (OCD): No compulsions or obsessions reported.

Medical Causes: Thyroid dysfunction, arrhythmia (unlikely given normal vitals).

7. Diagnostic Considerations (DSM‑5)
Adjustment Disorder with Anxiety: Emotional/behavioral symptoms within 3 months of stressor, disproportionate distress.

GAD: Persistent worry, ≥6 months, multiple domains.

Ralph’s Case:

Symptoms began after military activation (clear stressor).

Duration 2 months → fits Adjustment Disorder with Anxiety more than GAD.

8. Assessment Tools
GAD‑7: Screens for generalized anxiety.

Hamilton Anxiety Rating Scale (HAM‑A): Measures severity.

PHQ‑9: Screens for comorbid depression.

C‑SSRS: Suicide risk assessment (though no self‑harm reported).

Collateral Information: Family input may clarify functioning.

9. Treatment Plan
Pharmacological:

SSRIs (sertraline, escitalopram) → first‑line for anxiety.

Benzodiazepines (short‑term, acute relief).

Buspirone for chronic anxiety.

Psychotherapy:

Cognitive Behavioral Therapy (CBT).

Stress management techniques.

Psychoeducation about anxiety and coping.

Lifestyle Interventions:

Exercise, relaxation techniques.

Sleep hygiene.

Mindfulness practices.

Supportive Measures:

Family involvement.

Military counseling services.

Peer support groups.

10. Monitoring and Follow‑Up
Weekly therapy sessions initially.

Medication monitoring every 2–4 weeks.

Suicide risk reassessment.

Collaboration with military healthcare team.

11. Challenges
Stigma: Military culture may discourage mental health disclosure.

Transition Stress: Young adult adjusting to military responsibilities.

Limited Coping Skills: No prior psychiatric history.

Risk of Escalation: Anxiety may worsen with deployment.

12. Ethical and Cultural Considerations
Confidentiality: Respect patient privacy within military system.

Consent: Informed consent for treatment.

Safety: Suicide risk management.

Cultural Sensitivity: Address stigma in military populations.

13. Case Summary
Mr. Ralph Newsome: 19‑year‑old male with anxiety symptoms triggered by military activation.

Likely Diagnosis: Adjustment Disorder with Anxiety.

Treatment: Combination of psychotherapy, possible SSRI, lifestyle interventions, military support services.

Outcome Goal: Symptom reduction, improved functioning, resilience building, prevention of escalation to chronic anxiety or PTSD.

📝 Quiz (15 Questions)
Multiple Choice – Select the best answer.

What is Ralph’s age? a) 18 b) 19 c) 20 d) 21

What event triggered Ralph’s symptoms? a) Divorce b) Military activation c) Job loss d) Illness

What is Ralph’s MOS in the Navy Reserves? a) Infantry b) Construction Mechanic (CM3) c) Medic d) Logistics

Which diagnosis involves symptoms linked to a stressor within 3 months? a) Adjustment Disorder with Anxiety b) GAD c) PTSD d) OCD

Which diagnosis requires ≥6 months of worry? a) GAD b) Adjustment Disorder c) Panic Disorder d) PTSD

Which tool screens for anxiety severity? a) GAD‑7 b) PHQ‑9 c) C‑SSRS d) MDQ

Which therapy targets negative thought patterns? a) CBT b) DBT c) IPT d) Psychoanalysis

Which medication class is first‑line for anxiety? a) SSRIs b) TCAs c) MAOIs d) Benzodiazepines

Which lifestyle intervention is appropriate? a) Sleep hygiene b) Smoking cessation c) Alcohol detox d) Dialysis

Which risk must be monitored in military populations? a) Suicide b) Diabetes c) Asthma d) Cancer

Which diagnosis involves trauma exposure with intrusive symptoms? a) PTSD b) MDD c) GAD d) Adjustment Disorder

Which lab should be considered for medical causes of anxiety? a) Thyroid function b) Liver enzymes c) Vitamin D d) All of the above

Which challenge is unique to Ralph’s case? a) Military activation stress b) Parenting stress c) Financial stress only d) Legal issues

Which ethical issue is key in military mental health care? a) Confidentiality b) Profit maximization c) Ignoring culture d) Withholding information

Why are case history reports important in NRNP 6635? a) They emphasize structured assessment and clinical reasoning b) They replace therapy sessions c) They eliminate need for diagnosis d) They focus only on pharmacology

Answer Key: 1‑b, 2‑b, 3‑b, 4‑a,