PANIC/AGORAPHOBIA 223 C. The client has been following up on the recommendations from the medical evaluation. D. The client has not regularly followed up on his/her medical evaluation r ecommendations and was redirected to do so. 8. Review Psychoactive Chemicals (8) A. The client's use of psychoactive chemicals, such as nicotine, caffeine, alcohol, or street drugs was reviewed. B. The client's pattern of psychoactive chemical use was c onnected to his/her symptoms. C. The client was supported as he/she identified that his/her psychoactive chemical use is affecting his/her anxiety symptoms. D. As the client has decreased his/her psychoactive chemical use, anxiety symptoms have been noted to decrease as well. E. The client denies any connection between his/her psychoactive chemical use and his/her anxiety symptoms and has continued to utilize psychoactive chemicals, despite encouragement to discontinue this. 9. Recommend Substance Abuse Evaluation and/or Termination (9) A. It was recommended to the client that he/she terminate the consumption of substances that could contribute to anxiety. B. The client was referred for a substance abuse evaluation to more completely assess his/her substance abuse concerns and how they may trigger anxiety. C. The client was referred for substance abuse treatment to assist him/her in discontinuing his/her consumption of substances. D. As the client has decreased his/her use of trigger substances, he/sh e has experienced a decrease in anxiety, and this was reviewed. E. The client has declined any evaluation or treatment related to his/her substance use and was encouraged to seek this out at a later time. 10. Differentiate Anxiety Symptoms (10) A. The cl ient was assisted in differentiating anxiety symptoms that are a direct affect of his/her severe and persistent mental illness, as opposed to a separate diagnosis of an anxiety disorder. B. The client was provided with feedback regarding his/her different iation of symptoms that are related to his/her severe and persistent mental illness, as opposed to a separate diagnosis. C. The client has identified a specific anxiety disorder, which is freestanding from his/her severe and persistent mental illness, and this was reviewed within the session. D. The client has been unsuccessful in identifying ways in which his/her anxiety symptoms are related to his/her mental illness or a separate anxiety disorder. 11. Acknowledge Anxiety Related to Delusional Experience s (11) A. It was acknowledged that both real and delusional experiences could cause anxiety. B. The client was provided with support regarding his/her anxieties and worries, which are related to both the real experiences and delusional experiences. C. The client described a decreased pattern of anxiety due to the support provided to him/her. 