Training Title 21
Name: Sergeant Berry Sullivan
Gender: male
Age:27 years old
T- 98.8 P- 86 R 18 B/P 122/7 Ht 5’8 Wt 160lbs
Background: He entered the military just after high school and did three long tours of duty in
warzones. He separated from active duty in the Marines (MOS 0800 Field Artillery) six months
ago after eight years of service. He is engaged to be married in 8 months and is using his GI
Education Bill to attend online college for accounting. He said he grew up poor and would not do
much else if he didn’t go into the military. He denies ever using any drugs and avoids alcohol
because his father was “abusive when he was drunk.” Father is still alive, unwell (DM, cirrhosis,
HTN), still drinking. Paternal grandfather was also a veteran and suffered depression at times
though he never told anyone except the patient because of their combat connection. He has one
younger brother and one older sister. He lives in a different state, approximately five hours from
his parents and siblings. After the military, he and his fiancé moved because she got a much
better opportunity. They want kids someday. Has service-connected asthma, seasonal allergies;
no hx of psychiatric or substance use treatment.
Symptom Media. (Producer). (2016). Training title 21 [Video].
https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/wa
tch/training-title-21

1. Introduction
Patient: Sergeant Berry Sullivan, 27‑year‑old male.

Context: Case study from Symptom Media video (2016).

Clinical Focus: Anxiety disorders, PTSD, and OCD in military veterans.

Importance: Veterans often face unique psychosocial stressors and trauma exposure that predispose them to anxiety and PTSD.

2. Demographics and Background
Age: 27 years old.

Gender: Male.

Vitals: T 98.8, P 86, R 18, BP 122/70 (normal).

Height/Weight: 5’8”, 160 lbs (BMI ~24.3 → normal).

Military History:

Joined Marines after high school.

MOS 0800 Field Artillery.

Completed three long tours in warzones.

Separated from active duty six months ago after eight years of service.

Family: Engaged, wedding planned in 8 months. One younger brother, one older sister. Parents live five hours away.

Education/Occupation: Using GI Bill to attend online college for accounting.

Medical History: Service‑connected asthma, seasonal allergies.

Psychiatric History: No prior psychiatric or substance use treatment.

Substance Use: Denies drugs, avoids alcohol due to father’s abuse.

Family Psychiatric History:

Father: alcohol abuse, medical comorbidities (DM, cirrhosis, HTN).

Paternal grandfather: veteran, history of depression.

Social History: Grew up poor, limited opportunities outside military.

3. Psychosocial Stressors
Transition Stress: Adjustment to civilian life after military service.

Family Stress: Father’s ongoing alcohol abuse and illness.

Relationship Stress: Preparing for marriage, planning future children.

Educational Stress: Online college coursework.

Occupational Identity: Loss of military role, redefining self in civilian context.

Trauma Exposure: Three tours in warzones → risk for PTSD.

4. Clinical Presentation (Anxiety/PTSD Features)
Possible Symptoms (from case context):

Hypervigilance, exaggerated startle response.

Intrusive memories or nightmares of combat.

Avoidance of reminders of war.

Irritability, restlessness.

Difficulty concentrating.

Somatic symptoms (palpitations, sweating, muscle tension).

Risk Factors:

Combat exposure.

Family history of depression and substance abuse.

Transition stress.

Lack of prior psychiatric treatment (untreated symptoms may worsen).

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, possible irritability.

Affect: Constricted, tense.

Thought Process: Logical, coherent.

Thought Content: Preoccupation with military experiences.

Cognition: Alert, oriented ×3.

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

6. Differential Diagnosis
Post‑Traumatic Stress Disorder (PTSD): Trauma exposure with intrusive symptoms, avoidance, hyperarousal.

Generalized Anxiety Disorder (GAD): Excessive worry for ≥6 months, multiple domains.

Adjustment Disorder with Anxiety: Symptoms linked to transition stress.

Obsessive‑Compulsive Disorder (OCD): Must rule out compulsions/obsessions.

Depression: Possible comorbidity given family history.

7. Diagnostic Considerations (DSM‑5)
PTSD Criteria:

Exposure to trauma.

Intrusive symptoms (memories, nightmares).

Avoidance of reminders.

Negative alterations in mood/cognition.

Hyperarousal (sleep disturbance, irritability, hypervigilance).

GAD Criteria: Persistent worry ≥6 months, difficult to control, associated with restlessness, fatigue, irritability, muscle tension, sleep disturbance.

Adjustment Disorder: Emotional/behavioral symptoms within 3 months of stressor, disproportionate distress.

Berry’s Case:

Combat exposure strongly supports PTSD risk.

Transition stress may contribute to adjustment disorder features.

8. Assessment Tools
PCL‑5: PTSD Checklist for DSM‑5.

CAPS‑5: Clinician‑Administered PTSD Scale.

GAD‑7: Screens for generalized anxiety.

HAM‑A: Hamilton Anxiety Rating Scale.

PHQ‑9: Screens for depression.

C‑SSRS: Suicide risk assessment.

9. Treatment Plan
Pharmacological:

SSRIs (sertraline, paroxetine) → FDA‑approved for PTSD.

SNRIs (venlafaxine) for anxiety/PTSD.

Prazosin for nightmares.

Benzodiazepines (short‑term, caution in veterans).

Psychotherapy:

Trauma‑focused CBT.

Prolonged Exposure Therapy.

Eye Movement Desensitization and Reprocessing (EMDR).

Stress management techniques.

Lifestyle Interventions:

Exercise, relaxation techniques.

Sleep hygiene.

Mindfulness practices.

Supportive Measures:

Family involvement.

Veteran support groups.

Coordination with VA healthcare services.

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

Medication monitoring every 2–4 weeks.

Suicide risk reassessment.

Collaboration with military/veteran healthcare team.

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

Transition Stress: Adjusting to civilian life.

Family Stress: Father’s ongoing alcohol abuse and illness.

Limited Coping Skills: No prior psychiatric treatment.

Risk of Escalation: PTSD symptoms may worsen without intervention.

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

Consent: Informed consent for treatment.

Safety: Suicide risk management.

Cultural Sensitivity: Address stigma in military populations.

13. Case Summary
Sergeant Berry Sullivan: 27‑year‑old male veteran with anxiety/PTSD symptoms triggered by combat exposure and transition stress.

Likely Diagnosis: PTSD with possible comorbid anxiety.

Treatment: Combination of psychotherapy, pharmacological interventions, lifestyle changes, and veteran support services.

Outcome Goal: Symptom reduction, improved functioning, resilience building, prevention of relapse.

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

What is Berry’s age? a) 25 b) 27 c) 29 d) 31

What military branch did Berry serve in? a) Army b) Navy c) Marines d) Air Force

What was his MOS? a) Infantry b) Field Artillery (0800) c) Medic d) Logistics

How many tours of duty did Berry complete? a) One b) Two c) Three d) Four

When did Berry separate from active duty? a) 3 months ago b) 6 months ago c) 1 year ago d) 2 years ago

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

Which tool screens for PTSD symptoms? a) PCL‑5 b) GAD‑7 c) PHQ‑9 d) HAM‑A

Which medication is FDA‑approved for PTSD? a) Sertraline b) Lithium c) Haloperidol d) Buspirone

Which therapy is trauma‑focused? a) CBT b) EMDR c) Prolonged Exposure d) All of the above

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

Which family member has alcohol abuse history? a) Father b) Mother