Training Title 95
Name: Ms. Serenity Jackson
Gender: female
Age: 24years old
T- 97.5 P- 80 R 18 118/74 Ht 5’2 Wt 136lbs
Background: Born and raised in Gainesville, FL with her mother and 4 older brothers; her
mother has hx of panic disorder, 2 brothers hx of cannabis; father abandoned the family when
she was 3 years old. One brother is in prison for burglary. no previous mental health treatment,
no medications; NKDA; no legal hx; sleeping 9 hrs.; Appetite is good. She has an associate of
arts degree and works for Leaders furniture warehouse. She has DX of diabetes since age 8. She
recalls having great difficulty with her medical condition (uncontrolled blood sugar, fighting
with mother over needle sticks, “kids want candy, and I was so different because of my diet”).
She recalls having a difficult relationship with her mother who was a nurse and really worked
hard to control her daughter’s diabetes. She is not in a relationship, identifies as lesbian but has
not come out to the family. Only her closest co-workers know She stated, “I don’t see why I
would, they wouldn’t understand, and this is not important right now.”
Symptom Media. (Producer). (2018). Training title 95 [Video].
https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/wa
tch/training-title-95

1. Introduction
Patient: Ms. Serenity Jackson, 24‑year‑old female.

Context: Case study from Symptom Media video (2018).

Clinical Focus: Anxiety disorders and psychosocial stressors in young adults with chronic medical illness.

Importance: Demonstrates how family dynamics, chronic illness (diabetes), and identity stressors can contribute to anxiety disorders and psychosocial maladjustment.

2. Demographics and Background
Age: 24 years old.

Gender: Female.

Vitals: T 97.5, P 80, R 18, BP 118/74 (normal).

Height/Weight: 5’2”, 136 lbs (BMI ~24.9 → normal).

Family: Born and raised in Gainesville, FL with mother and 4 older brothers.

Parental History: Father abandoned family when Serenity was 3.

Family Psychiatric/Substance Use History:

Mother: panic disorder.

Two brothers: cannabis use.

One brother: in prison for burglary.

Education/Occupation: Associate of Arts degree; works at Leaders Furniture Warehouse.

Medical History: Type 1 diabetes diagnosed at age 8.

Psychiatric History: No prior treatment, no medications.

Allergies: NKDA.

Legal History: None.

Lifestyle: Sleeps 9 hours, appetite good.

Identity: Lesbian, not disclosed to family; only close co‑workers aware.

3. Psychosocial Stressors
Family Conflict: Difficult relationship with mother, who was controlling about diabetes management.

Medical Burden: Childhood struggles with insulin injections, dietary restrictions, peer differences.

Parental Abandonment: Father’s absence may contribute to attachment issues and insecurity.

Sibling Issues: Brothers with substance use and criminal behavior → unstable family environment.

Identity Stress: Concealed sexual orientation, fear of rejection by family.

Occupational Stress: Warehouse work may provide limited fulfillment, financial strain.

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

Anxiety related to family dynamics and chronic illness.

Possible avoidance of disclosure (sexual orientation).

Somatic vigilance due to diabetes.

Internalized stress from childhood experiences.

Behavioral Indicators:

Concealment of identity.

Avoidance of conflict with mother.

Overemphasis on routine (sleep, meals).

Risk Factors:

Family history of panic disorder.

Chronic medical illness.

Parental abandonment.

Identity concealment.

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

Behavior: Cooperative, anxious undertone.

Speech: Normal rate/volume, hesitant when discussing family.

Mood: Reports anxiety, worry.

Affect: Constricted, tense.

Thought Process: Logical, coherent.

Thought Content: Preoccupation with family conflict, medical history, identity concealment.

Cognition: Alert, oriented ×3.

Insight/Judgment: Fair, recognizes stress but avoids disclosure.

6. Differential Diagnosis
Generalized Anxiety Disorder (GAD): Excessive worry, family history of panic disorder.

Adjustment Disorder with Anxiety: Symptoms linked to family conflict and identity stress.

Panic Disorder: Family history, but no clear panic attacks reported.

PTSD: Childhood trauma from medical struggles and parental abandonment may contribute.

OCD: No compulsions or obsessions reported.

Depression: Concealment, family conflict, decreased self‑esteem may overlap.

7. Diagnostic Considerations (DSM‑5)
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.

Panic Disorder: Recurrent unexpected panic attacks, worry about future attacks.

PTSD Criteria: Trauma exposure, intrusive symptoms, avoidance, negative mood, hyperarousal.

Serenity’s Case:

Likely GAD or Adjustment Disorder with Anxiety.

PTSD possible due to childhood trauma with diabetes and parental abandonment.

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

HAM‑A: Hamilton Anxiety Rating Scale.

PHQ‑9: Screens for depression.

C‑SSRS: Suicide risk assessment.

ACE Questionnaire: Assesses adverse childhood experiences.

Collateral Information: Family and co‑worker reports may clarify functioning.

9. Treatment Plan
Pharmacological:

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

SNRIs (duloxetine, venlafaxine).

Buspirone for chronic anxiety.

Careful monitoring due to diabetes (drug interactions, metabolic effects).

Psychotherapy:

Cognitive Behavioral Therapy (CBT).

Trauma‑focused CBT if PTSD features present.

Family therapy (if willing).

Supportive therapy for identity disclosure.

Lifestyle Interventions:

Structured routine for diabetes management.

Sleep hygiene.

Nutrition counseling.

Stress management techniques.

Supportive Measures:

Peer support groups (LGBTQ+, chronic illness).

Occupational counseling.

Coordination with endocrinologist for diabetes.

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

Medication monitoring every 2–4 weeks.

Suicide risk reassessment.

Collaboration with family and healthcare team.

11. Challenges
Medication Adherence: Must balance psychiatric and diabetes treatments.

Family Stress: Mother’s panic disorder, controlling behavior.

Medical Comorbidity: Diabetes since childhood.

Identity Concealment: Fear of rejection by family.

Stigma: Mental health stigma in young adults.

12. Ethical and Cultural Considerations
Confidentiality: Respect patient privacy, especially regarding sexual orientation.

Consent: Informed consent for treatment.

Safety: Suicide risk management.

Cultural Sensitivity: Address stigma around LGBTQ+ identity and chronic illness.

13. Case Summary
Ms. Serenity Jackson: 24‑year‑old female with anxiety symptoms, family conflict, chronic diabetes, and concealed sexual orientation.

Likely Diagnosis: Generalized Anxiety Disorder or Adjustment Disorder with Anxiety; possible PTSD features.

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

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

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

What is Serenity’s age? a) 22 b) 24 c) 26 d) 28

Where was Serenity born and raised? a) Orlando, FL b) Gainesville, FL c) Charleston, SC d) Dallas, TX

What chronic medical condition does Serenity have? a) Asthma b) Diabetes c) Hypertension d) Thyroid disease

At what age was Serenity diagnosed with diabetes? a) 6 b) 8 c) 10 d) 12

What family history is relevant? a) Mother with panic disorder, brothers with cannabis use b) Father with diabetes c) Sister with depression d) None

Which sibling is in prison? a) Oldest brother b) One brother for burglary c) Sister d) None

What is Serenity’s occupation? a) Teacher b) Warehouse worker c) Nurse d) Accountant

Which diagnosis involves excessive worry ≥6 months? a) GAD b) Adjustment Disorder c) PTSD d) OCD

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