Anxiety Case and Psych Management
Case Study
Ms. JN is a 24-year-old law student who presents to an outpatient psychiatry clinic accompanied by her husband. She feels “worried about everything!” She is “stressed out” about her academic workload and upcoming assignments. She feels fatigued and has difficulty concentrating on her assignments. She also complains of frequent headaches and associated neck muscle spasms, as well as difficulty falling asleep.
The patient’s husband describes her as “a worrier. She’ll worry about me getting into an accident, losing my job, not making enough money—the list goes on and on.”
Ms. JN reports that she has always had some degree of anxiety, but previously found that it motivated her. Over the last year, her symptoms have become debilitating and beyond her control.
Questions:Remember to answer these questions from your textbooks and clinical guidelines to create your evidence-based treatment plan. At all times, explain your answers.
Summarize the clinical case
Formulate a diagnosis
Create a list of the patient’s problems and prioritize them.
Which pharmacological treatment would you prescribe? Include the rationale for this treatment.
Which non-pharmacological treatment would you prescribe? Include the rationale for this treatment.
Include an assessment of treatment’s appropriateness, cost (exact a, effectiveness, safety, and potential for patient adherence.
Sample Solution
Summary of the Clinical Case: Ms. JN is a 24-year-old law student who presented to an outpatient psychiatry clinic with her husband. She experiences difficulty concentrating, headaches and associated neck muscle spasms, fatigue, and difficulty sleeping. Her husband noted that she worries excessively about many aspects of her life, including his safety and financial security. Ms. JN reports that her anxiety has become debilitating in the last year, far beyond her control.
Formulate a Diagnosis:
The diagnosis for this case would be Generalized Anxiety Disorder (GAD). GAD is characterized by excessive worry or tension about multiple topics for six months or more which leads to significant impairment in functioning (DSM-5). Ms. JN meets all criteria for GAD due to her excessive worrying and its effects on concentration, sleep quality, physical health issues such as headaches and muscle spasms, and impact on work/academic performance/functioning as reported by both herself as well as her husband.
Create a List of Patient’s Problems & Prioritize Them:
1) Difficulty Concentrating
2) Headaches & Neck Muscle Spasms
3) Fatigue
4) Difficulty Sleeping
5) Excessive Worrying About Multiple Topics Leading To Significant Impairment In Functioning
Which Pharmacological Treatment Would You Prescribe? Include The Rationale For This Treatment:
I would prescribe an SSRI antidepressant such as fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), escitalopram (Lexapro), or citalopram (Celexa). SSRIs are FDA approved treatments specifically indicated for treating GAD symptoms like chronic/excessive worrying; they have been found to reduce anxiety symptoms within 1–2 weeks of starting treatment with significant improvements seen after 8 weeks of use when coupled with cognitive behavioral therapy which I will discuss later on in non-pharmacological treatments section(Alshahrani et al., 2019). Additionally, these medications are generally well tolerated with few adverse side effects compared to other classes of antidepressants making them ideal candidates for treating GAD(Alshahrani et al., 2019).
Which Non-Pharmacological Treatment Would You Prescribe? Include The Rationale For This Treatment:
I would also recommend Cognitive Behavioral Therapy (CBT) as it has been shown to reduce levels of symptomatology including frequency and severity of excessive worrying in patients suffering from GAD(Hoffman & Smits ,2011). CBT works by teaching individuals how their thoughts can affect their behavior; through learning ways to interpret situations differently one can gradually gain greater control over the anxious responses they experience(Hoffman & Smits ,2011). As mentioned before when combined with pharmacotherapy it has been shown to greatly increase response rate among those afflicted with GAP(Boschen et al., 2017); thus making CBT an ideal addition when treating this disorder.
Assessment Of Treatment’s Appropriateness Cost Effectiveness Safety And Potential For Patient Adherence: SSRIs are relatively affordable medications that cost between $10-$50 per month depending on insurance coverage; thus making them highly cost effective relative other forms of antidepressants especially considering their high success rates among those affected by generalized anxiety disorders. Furthermore these drugs tend not be overly sedating so any disruption caused during the day should be minimal if any at all; additionally common side effects include nausea vomiting dry mouth insomnia headache dizziness fatigue etc however most people do not experience serious adverse reactions though its important that if any occur patient should contact prescribing physician immediately .Finally SSRIs have proven track record showing high rates patient adherence even long term use making them excellent option when deciding pharmacologic interventions treat disorder .In terms non pharmacologic approaches cognitive behavioural therapy arguably provides highest potential benefit however unlike SSRIs may require higher upfront expenses due costs associated visiting therapist frequent basis typically required best results ; additionally some patients find approach difficult engage due time commitment required result meaningful changes thought processes needed maintain lasting relief from disorder .Overall benefits therapies discussed outweigh potential disadvantages both cases providing justification recommendation either intervention given clinical presentation .