- You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)
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Anxiety Case Study
Summarize the Clinical Case
Ms. Jane is a 24-year-old student who presents herself to the outpatient psychiatric clinic with her husband. On history taking, she says she is stressed about most things in her life, unable to concentrate in academics, finds it difficult to fall asleep, and has frequent headaches. Her husband says she is worried about anything and everything in her life. In the past, she had mild anxiety that provided a positive motivation to her; however, the current form of anxiety is making her unproductive in the things that she enjoyed doing in the past.
Formulate a Diagnosis
The diagnosis is generalized anxiety disorder (GAD). It is a disorder which presents with excessive worry persistently for the past six months. For one to be diagnosed with GAD, he has to have any three of the following symptoms; restlessness, easily fatigued with o considerable cause, inability to concentrate on the things that someone used to concentrate on before, muscle tension, and difficulty falling asleep (DeMartini, Patel, & Fancher, 2019). Children are required to have only one of the mentioned symptoms. In the case of Ms. JN, she presents with all of the symptoms needed to diagnose one with GAD.
Create a list of potential problems and prioritize them
The patient experiences anxiety, fatigue, frequent headaches, muscle spasms, and difficulty falling asleep.
- Anxiety: She worries about everything, even things that should not be stressing her. The goal would be to help the patient develop coping mechanisms. The use of psychotherapy and anxiolytics is the best intervention that should be taken (Saramago et al., 2021).
- Fatigue: Lack of energy with no explainable cause makes it difficult for her to concentrate on her daily activities. The goal would be to ensure the patient regains her optimum energy levels (Stein et al., 2018). The best intervention would involve health education and psychotherapy.
- Headache: It is caused by excessive worrying. The goal would be to ensure the patient does not have those frequent headaches. The intervention would involve helping the patient gain insight into the stressors that may be causing those frequent headaches.
- Muscle spasms: This is a stress response mechanism. The goal would be to stop the muscle spasms. The intervention would involve helping patients reduce their tension levels by discussing their challenges in a group or individual therapy session (DeMartini, Patel, & Fancher, 2019).
- Muscle spasms, fatigue, and anxiety cause difficulty falling asleep. The goal would be to help the patient regain good sleeping patterns. The interventions would be identifying the cause of the anxiety and taking the patient through different forms of therapy.
Pharmacological Treatment and its Rationale
Generalized Anxiety Disorder is managed using Selective Serotonin Reuptake Inhibitors (SSRI). They are medications that are concerned with mood and behavior. A serotonin deficiency in the brain is believed to cause anxiety, stress, and depression. SSRIs prevent serotonin reuptake at nerve junctions; thus, most of it concentrates in the brain, thus lowering stress, anxiety, and depression (Saramago et al., 2021). An example is citalopram, which comes in 10,20,40mgs tablets or a 10mg/5ml solution.
Non-pharmacological Treatment and Rationale
The patient should be managed non-pharmacologically using individual psychotherapy, cognitive therapy, and family therapy. Individual therapy would allow Ms. Jane to discuss his challenges with a therapist. Cognitive therapy would help her reduce anxiety by altering cognitive distortions through positive appraisal by the therapist (Stein et al., 2018). Family therapy is meant to help Ms. Jane have a supportive environment to handle her challenges without facing stigmatization or demoralization from her husband.
Include an assessment of treatment appropriateness, cost, effectiveness, safety, and potential for patient adherence.
Treatment cost is crucial in psychiatric conditions because most treatment modalities are expensive. Individual psychotherapy, cognitive therapy, and family therapy require multiple weekly sessions; therefore, they may be too expensive for Ms. Jane. However, a nurse must prepare an individualized nursing care plan to help meet all her needs (DeMartini, Patel, & Fancher, 2019). The effectiveness of treatment is not similar for all patients. Every patient is different from the others, so in most cases, they respond differently. However, regardless of the responses, the nurse should ensure they are positive. Even though some side effects relate to different treatment modalities, the medications are usually safe. Besides, with the cost of citalopram oral tablet 20 mg being around $19 for a supply of 14 tablets, the drug can be termed cost-effective (Saramago et al., 2021). However, psychiatric medications require strict adherence, so the patient and family members are encouraged to provide a supportive environment to ensure that the patient takes the medications religiously.
In conclusion, Ms. Jane's condition is common in the current world due to the many responsibilities that people have to handle. However, the community can care for its people through community members being concerned about the well-being of each other, then that can be the best form of therapy. Still, if people continue to overwork themselves and fail to live as social animals, they will continue to seek psychiatric services.
References
DeMartini, J., Patel, G., & Fancher, T. L. (2019). Generalized anxiety disorder. Annals of internal medicine, 170(7), ITC49-ITC64. https://doi.org/10.7326/AITC201904020Links to an external site.
Saramago, P., Gega, L., Marshall, D., Nikolaidis, G. F., Jankovic, D., Melton, H., … & Bojke, L. (2021). Digital interventions for Generalized Anxiety Disorder (GAD): systematic review and
network meta-analysis. Frontiers in psychiatry, 2158. https://doi.org/10.3389/fpsyt.2021.726222Links to an external site.
Stein, M. B., & Sareen, J. (2018). Generalized anxiety disorder. New England Journal of Medicine, 373(21), 2059-2068. https://doi.org/10.1056/NEJMcp1502514Links to an external site.