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Running Head: Benchmark Presentation
Benchmark Case Presentation
Author Note
I have no known conflict of interest to disclose. Correspondence concerning this article should be
addressed to
Identifying Information
Juan Cortez is a thirty-four year old Hispanic male. He is a high school math teacher, and
lives with his wife of five years and their four small children. Juan was forced by his wife to
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come in for an assessment and to receive treatment for what she believes are panic attacks he has
been experiencing recently. Juan states, “I don’t know what it is but it come out of nowhere. It
started about four months ago. I will start to sweat, shake, have a hard time breathing, and some
times faint. When it happens it scares my wife and the kids. My wife is threatening to take the
kids and leave if I don’t get professional help to get this under control.” Juan shares ”I have
always been healthy and my family has always been happy and loving. I have never felt or
experienced anything like this before. It was not until recently these intense feelings have started
to be physically uncontrollable. I have been constantly thinks about a decision I made and
something I have to do, and now I get these strong feeling of fear about how my choices might
affect me and my family.” Juan states he tried to manage the problem on his own, but “for the
past two months it has only gotten worse.” He knows if he does not get professional help, his
wife will get upset, take the children, and move back to Mexico with her family.
Presenting Problem
Six months ago, Juan was stopping at the bank to make a deposit. When he arrived to the
bank he saw two masked men running out the bank with guns and a large duffle bag. He
witnessed the men get into a blue Ford Explore and take off their mask, with another unmasked
male driving. Juan recognized the driver and the masked men as his former students. Juan
quickly realized the men in the vehicle had just robbed the bank. Within seconds of the vehicle
driving off, the police arrived. Juan told the police what he had saw and the direction the vehicle
went. Because of the information Juan was able to provide to the police, they were able to
quickly catch the suspects. After talking to the police, Juan learned that a security officer was
shot and killed during the robbery. The police asked Juan would he go to the station and identify
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the suspects in a lineup. Juan agreed, and he identified his former students the suspects. This
resulted in all three of the men being arrested.
Since Juan is the key witness that helped law enforcement catch the suspects, he has been
subpoenaed to testify. This case has brought a lot of news coverage to the area. Four months ago
Juan’s identity has been leaked to the media, which has brought unwanted attention to his family.
Individuals from both the suspect and victims family and friends have directly and indirectly
reached out to Juan. The victims family has thanked him, while the friends and family of the
suspects have made indirect threats and negative comments about Juan. “I feel like I was doing
the right thing by helping the police, but it has really brought a lot of attention to my family.
These past few months have been heavy on me physically and emotionally. Once, someone went
up to my wife at the grocery store calling her disgraceful names. Then three weeks ago before
sixth period, someone wrote Mr. Snitch Cortez on the blackboard in my classroom. When I saw
it, I felt as if my body had frozen. I remember feeling like I couldn’t catch my breath, as if I was
suffocating, and feeling light headed. I didn’t know what happened until I heard a student yell
“Quick quick Mr. Cortez passed out.” I realized I had fainted.”
Juan states he first noticed he started feeling heat sensations and his heart beating fast
ever since the news media coverage four months ago. “At first, that was all I would feel when the
news would come on and they would cover the story. But then the media crews would drive by
my home, and I would start to sweat, my heart would start pounding, and I would have shortness
of breath. All those feeling go away shortly after. Then one day the news crew approached me as
I was walking to me car after school. I felt like I was choking. My chest started to tighten, I felt
dizzy, and as thought I was going to vomit. My heart was pounding and beating so fast and I was
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shaking uncontrollably. I could barely get my car door open. Once I got in the car my body felt
completely numb. I was unable to drive. Thankfully the school security saw what was going on
and got them away. That was terrifying, I felt like I was going crazy.”
Juan states the closer the time comes to having to testify, the heavier and more persistent
the feelings becoming. “At the beginning about four months ago, I would only have these
feelings once every couple of weeks, but now it’s happening almost everyday, sometimes even
twice times a day. I could be anywhere and the intense feeling of fear will start to overwhelm me.
It has happened at my son’s baseball game, picking my daughter up from day care, and at an
anniversary dinner with my wife. I am scared someone will try to harm me and my family. I am
scared of dying behind all of this and leaving my wife and kids here alone. We completely
stopped watching the news about two weeks ago because one time my chest starting to cause me
so much pain, I became dizzy, my stance became unsteady, and I stumbled to the ground. My
wife thought I was having a heart attack and my children were screaming and crying. She called
911 and they took me to the hospital. The doctor said he believed I had a panic attack, and
advised me try to relax, and get some rest. Our lives have completely changed. I am worried
about my safety, and my families safety. This is a small town, everyone knows us.”
Juan’Family History
Juan Cortez is a native Mexican. He was born and raised in Monterrey. He is the
youngest of five children. He has three older brothers, and one older sister. Juan’s father was
murdered when he was nine years old. Juan learned from his mother that his father was murdered
while being a bystander, working at an auto repair shop, during an altercation between two rival
gangs. After the death of Juan’s father, his mother felt it would be safer for them all to move in
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with his grandparents in Nuevo Laredo, closer to the Texas boarder. Juan and his siblings grew
up living with his mother and grandparents, until they all because of age and went off to school.
During this time Juan’s mother later became an elementary teacher, and continued to live with
his grandparents, and care for them.
All of Juan’s older siblings went off to school and relocated in Mexico City. When Juan
turned eighteen he followed his siblings and moved to Mexico City to attend a University. He
received a degree in Mathematics and became a teacher, like his mother. Juan states he and his
siblings have always had a close bond. “We are a very close family. I think a lot of it has to do
with my father dying.” Even thought Juan does not live close to his siblings, he talks with them
daily, and visits them four to six times a year. Juan was twenty-nine when he met his wife. They
have 4 children, a four year old son, a three year old daughter, and twin daughters that are eleven
months old. “My family is my world, they mean everything to me.” Because of issues with the
Mexican government, Juan decided to apply for American citizenship. Two years ago he moved
his family to Laredo, Texas, just on the other side of the United States boarder from where he
grew up, and where his mother and grandparents live. Juan felt that moving to Laredo would
allow them to still see his family often, while still being able to move to the United States. “My
grandparents and my mother are getting older, so I want to be close enough to help, and so my
children can grow up knowing them.”
Juan’s Physical and Medical History
Juan is a healthy male. He works out multiple times a week, trains for and runs marathons
yearly, he has taken up golf as a new hobby, and he is active in his community, coaching his
son’s little league baseball team. Juan’s medical history consist two sports related injuries. Juan
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suffered a broken arm while playing basketball in high school, and tore his ACL playing soccer
in college. Juan has no history of any other injuries, health concerns, or mental health concerns.
Besides having a glass of wine for special occasions, Juan does not drink, and he has never used
or abused any type of substances. Juan was recently taken to the hospital, for an incident that
caused him chest discomfort and to falling to the ground. He was told he possibly had a panic
attack, advised to get some rest, and was released that same night.
Juan’s Occupational History
Juan’s first job was as a staff member at a youth summer day camp his sophomore year in
college. After he graduated, he started his teaching career as an eight grade math teacher. After a
couple of terms, he transitioned to a high school level math teacher. For the past two years he has
been teaching high school math Laredo, Texas. Juan has always been an exceptional teacher. His
first year teaching in Laredo, Juan received the Rookie Teacher of the Year award. In the past few
months, his performance has been noticeably different. Juan has been absent or late multiple
times. The assistant principal was concerned after noticing a pattern in him between fifth and
sixth period. Juan states “She noticed I would sweat profusely and seem spaced out at the start of
sixth period. She was concerned something was wrong and asked if I needed the nurse or to go
home. There has also been two occasions where I would become so nauseated I would have to
leave during the middle of class to get myself together.” Juan states he knows there are students
in the school that are friends and relatives of the suspects. “Seeing the students at times make me
worry about the consequences of me testifying.”
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Juan’s Spiritual Background
Juan grew up Christian. He currently, and has always attended church regularly. During
the past few months, Juan states he has been more spiritually connected than ever before. He is
praying more and reading his bible more, seeking peace and clarity on thus whole ordeal. He
states that his faith is one of the main reason he agreed to testify. Juan states he struggled with
the fear of the consequences of testifying and his faith. “I can not lie, I am nervous about
testifying. I have talked with my minister and church family about this. But an innocent man loss
his life that day. His children will never see their father again. I know that feeling, and I think
God put me at that place for a reason. God wants me to tell the truth. I would not be able to live
with myself if I didn’t testify. I believe if I didn’t, I would be just as guilty. Im doing this for the
victim’s family, and to please God.”
Juan’s Barriers and Social Justice Factors
Juan and his family are in the process of gaining his citizenship, he is concerned how this
experience will overall affect his future in America. He feels that if he does not testify, it could
impact his approval for citizenship. The client states “In Mexico, the government can be corrupt,
if you do not go along with then, they can sabotage you. The criminals are also very intimidating.
Many time people do not speak up because they fear for their lives. I don’t want to make the
United States government mad, because I want to live here. But I also do not want to make the
community mad either, because they can bother me and my family.”
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Mental Status Exam- Appearance
Juan Cortez arrived for his first assessment regarding his panic attacks on September 22,
2021. Mr. Cortez is a thirty four year old Hispanic male. He is approximately five feet, nine
inches tall, and slender built. He has no visible tattoos, physical impairments, or physical
disabilities. Mr. Cortez appears to be well kept, and have good hygiene. He has a clean shaven
face, and a neatly combed over styled hair. He was wearing a light blue golfer style polo shirt
and khaki jeans. His teeth and face appears to be clean, and he did not smell of foul body odor.
Mental Status Exam- Manner and Approach
Juan was open to discussing his life, his family, and the what he has been experiencing.
He appears to genuinely care about his family, career, and future. He was able to discuss the
events that happened during the robbery, and the events after. During that time he because visibly
uncomfortable. He started to tremble, his breathing appeared to be a little labored, and the client
stated he was starting to feel hot. Juan was able to communicate well, and had appropriate eye
contact. Overtime, Juan’s discomfort became visibly subsided once we started discussing goals
to help him overcome his current challenges.
Mental Status Exam- Orientation, Alertness, and Thought Process
Juan appeared to be alert, oriented, and in an undisturbed state of mind. He was able to
discuss things in detail, his thought process and conversation did not appear to be unfocused or
lack concentration, and he understood and was aware of what was going on around his and the
process that was taking place.
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Mental Status Exam- Mood and Affect
Juan states that recently his mood and physical state has been affected more often. Within
the past couple of weeks he has been experiences the symptoms mentioned multiple times a
week, and sometimes multiple times a day. Juan states he tries to control his emotions, especially
when he is at work or spending time with his family. He does not want these panic attacks to
interfere with things that are important to him. Sometimes he is able to manage things on his
own, however, sometimes it happens unexpectedly and he can not control some of the symptoms
that happen. Juan did not present as suicidal, in a crisis, or as a potential threat to himself for
others.
Treatment Recommendations
When comparing Juan Cortez’s symptoms to the criteria of the DSM-5, it appears he is
experiencing panic attacks, which is a specifier for the Panic Disorder (300.01). The first
recommendation I would suggest for treatment would be cognitive behavior therapy. Cognitive
Behavior Therapy, also known as CBT, is a therapeutic approach that is widely used with
individuals that are suffering from panic disorder. The use of Cognitive Behavior Therapy helps
individuals develop healthy ways to respond in situations that create the overwhelming feeling
associated with panic attacks (Memon, 2018.)
The second treatment recommendation I would suggest for Juan would be prescription
medication. There are a few different medications that can help Juan reduce the severity of the
symptoms he is experiencing. Medications such as antidepressants and central nervous system
depressants are commonly used to help individuals whom suffer with panic attacks and are
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diagnosed with panic disorders. In Juan’s case, such medications can help calm his emotions,
which will also minimize the severity of his symptoms, and overall help him manage the panic
attacks and panic disorder better.
Answer Key
• Diagnosis that include full name and ICD 10 code: Panic Disorder with Panic Attack specifier
300.01 (F41.0)
• Key issues in order of importance: Constant worry, Chest pain, Shaking, Sweating, Shortness
of breath, Faint, Feelings of choking.
• All the signs and symptoms presented in the case presentation: Sweat, Shaking, Shortness of
breath, Faint, Constant worry, Nausea, Unsteadiness, Feeling of going crazy, Numbing
sensation, and Heat sensation.
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• All signs and symptoms that were present but not part of the presentation: Fear of dying and
Derealization
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Reference
American Psychiatric Association, (2013). Diagnostic and Statistical Manual of Mental
Disorders (5th ed.). Arlington, VA.
Memon, M. (2018). Panic Disorder Treatment & Management: Approach Considerations,
Emergency Department Management, Cognitive-Behavioral Therapy. https://
emedicine.medscape.com/article/287913-treatment.
Case Benchmark Paper 13
