Disorders are at a higher risk for attempting and

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disorders are at a higher risk for attempting and committing suicide (American Psychiatric Association, 2015). Ninety per cent of those who successfully commit suicide meet the diagnostic criteria for one or more psychiatric disorder (American Psychiatric Association, 2015). Evaluation is a critical first step to help clinicians assess the risk of suicide and other suicidal behaviors (American Psychiatric Association, 2015). Next the clinician uses this information to create a treatment plan and estimate the risk for suicide and suicidal behaviors (American Psychiatric Association, 2015). There is
10 no evidence that suicide risk is increased by asking the patient about suicide symptoms or experiences (American Psychiatric Association, 2015). Command hallucinations or visual hallucinations may be a factor for wanting to commit suicide (American Psychiatric Association, 2015). Differential Diagnoses: 1. PTSD Combat Veteran : PTSD is one of the most common diagnosis for disability in veterans (Guina et al., 2016). There are eight diagnostic criterions in the DSM V for PTSD (Sareen, 2021). A patient must have been exposed to an actual or threatened death or other serious events to be diagnosed (Sareen, 2021). This can include being directly affected by the experience, being a witness to the event, learning about the event from a person close to the patient and experiencing repeated exposure of traumatic events (Sareen, 2021). Repeated exposure of events could be a patient who is a soldier, a police officer, or an EMT (Sareen, 2021). One or more of the following symptoms that may be experienced must be present (Sareen, 2021). These include repeated, unwanted, and intrusive thoughts about the event, nightmares, and flashbacks (Sareen, 2021). Internal or external stressors, such as loud noises or large crowds, that trigger psychological distress and/or severe physiological reactions (Sareen, 2021). A patient must be purposely and persistently avoiding situations that remind them of the event (Sareen, 2021). For example, memories, thoughts, people, places, or other stimuli that reminds them of the event (Sareen, 2021). There must be at least one symptom of “negative alterations in cognitions and mood” in relation to the traumatic event (Sareen, 2021). This may include feeling like they are a horrible person, being in a continuous negative state, severely decreased interest in activities or feeling detached, among others (Sareen, 2021).
11 Substantial fluctuations in alertness and responsiveness as evidenced by at least two of the following symptoms: reckless behavior, concentration issues, sleep difficulties, hypervigilance, or irritable behavior (Sareen, 2021). The disturbances must be present for at least a month, it must cause significant distress in their lives, and it cannot be caused by a substance like alcohol, medication, or another medical diagnosis (Sareen, 2021). This is the most likely diagnosis for PF. He mentions being exposed to multiple significant events while being deployed overseas and he has difficulty discussing them in the interview because the memories are very vivid. He endorses having nightmares and difficulty sleeping. He expresses those loud noises like from a car, a saw or being in traffic seem to trigger psychological distress in him. He also calls himself a wimp and

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