Assignment topic:
nursing psychiatric case study Instructions
Please see case below.
Patient name –
Age -32 years old
Gender- Female
Chief complaint :” I worry all the time about everything and it’s getting to people around me”. Patient states that she has always been a worrisome person as a youth but anxiety got worse last year after the covid-19 outbreak. She reports symptoms of racing thoughts, difficulties concentrating, difficulties maintaining relationships, irritable, snappy, constant worries and difficulties falling asleep. Patient states that symptoms is interfering with her ability to do things like concentrating at work. She also had a recent breakup with boyfriend due to anxiety symptoms. Patient endorsed that she was more irritable and snappier with boyfriend always checking on things when they were together in which the boyfriend told her he couldn’t handle it anymore and broke up with her. On a scale of 1-10, patient rates anxiety symptoms as an 8 within the last 2 weeks. Patient has difficulties sleeping 3-4x a week and states it takes her about 1-1.5 hours to fall asleep at night, patient is not rested and not taking naps during the day due to busy schedule. Patient also reports work as a stressor which can exacerbate symptoms due to meeting deadlines at work. She reports hobbies such as swimming, jogging and craft with daughter helps in alleviating symptoms. Patient has no previous mental health history, She has never been on psychotropic medications and never enrolled in therapy. Patient denies panic attacks depressive symptoms and mania symptoms, denies suicidal thoughts, denied auditory/visual hallucination . Patient is a single mother divorced from husband 2 years ago. They have a daughter together . she sates co- parenting difficulties and that her daughter’s father has not been the best but things are starting to get better slowly.
You gave the patient the diagnosis of: Generalized anxiety disorder. -explain why you gave these diagnoses based on the patient’s presentation and the DSM-5 criteria for generalized anxiety disorder.
-What psychotropic medication(s) will you order for this patient and why? (Include full script. medication (s) and dosage, refills, rationale for medication)
– What education will you provide the patent for each medication (be sure to include side effect and route of administration)
– What are TWO nonpharmacological interventions will you off this patient and why?
– You also gave differential diagnosis of Social anxiety disorder, based on the patent presentation, history and the DSM-5 criteria for this diagnosis explain this is a differential diagnosis for this patient?
You also gave differential diagnosis of Social anxiety disorder, based on the patent presentation, history and the DSM-5 criteria for this diagnosis explain why this is a differential diagnosis for this patient? Give rationale
Be sure to include citations.
Diagnosis: Generalized Anxiety Disorder
This patient meets criteria for generalized anxiety disorder (GAD) according to the DSM-5. She reports excessive anxiety and worry about various activities and events for at least six months that is difficult to control. Her worries are associated with three or more of the following symptoms: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance (American Psychiatric Association, 2013).
The patient worries constantly about “everything” and reports difficulties concentrating, maintaining relationships, irritability, racing thoughts, muscle tension, and sleep disturbances including difficulty falling asleep and not feeling rested. Her anxiety has worsened over the past year and is interfering with her ability to function at work by impacting her concentration. She also attributes her recent breakup to increased anxiety and irritability. On a scale of 1-10, she rates her anxiety an 8, indicating severe symptoms.
While social anxiety is a consideration given her report of relationship difficulties, her worries are not confined to social situations and she does not report fears of embarrassment or humiliation which are hallmark symptoms of social anxiety disorder (American Psychiatric Association, 2013). Therefore, GAD is the most appropriate diagnosis given her presentation meets full DSM-5 criteria.
Medication: Escitalopram 10mg PO QD
I am prescribing the selective serotonin reuptake inhibitor (SSRI) escitalopram at 10mg to be taken orally once daily to treat this patient’s GAD symptoms. SSRIs are first-line pharmacological treatment for GAD due to their efficacy and tolerability (Baldwin et al., 2014). Escitalopram is preferable to other SSRIs given its favorable side effect and safety profile (Baldwin et al., 2014). It may take 4-6 weeks to see full therapeutic effects, so patience is important (Baldwin et al., 2014). I am prescribing 30 tablets with 2 refills.
Education on Escitalopram:
Taken once daily with or without food
Common side effects include nausea, headache, insomnia, sexual dysfunction and may last 4-6 weeks (Baldwin et al., 2014).
Important to continue even if feeling better to prevent relapse.
Avoid grapefruit juice which can impact metabolism.
Seek medical help for worsening symptoms or side effects.
Nonpharmacological Interventions:
Cognitive behavioral therapy (CBT): CBT teaches patients to challenge anxious thoughts and behaviors. It is as effective as medication for GAD and recommended as first-line treatment (Baldwin et al., 2014).
Mindfulness meditation: Teaches patients to live in the present moment non-judgmentally and reduce worry. Studies show it reduces GAD symptoms (Volanen et al., 2020).
Differential Diagnosis: Social Anxiety Disorder
Social anxiety disorder is a consideration given the patient’s report of relationship difficulties. However, her worries are pervasive and not confined to social situations. While she endorses irritability and snappiness with her ex-boyfriend, she does not report fears of embarrassment or humiliation which are hallmark symptoms of social anxiety disorder according to DSM-5 criteria (American Psychiatric Association, 2013). Her anxiety also causes concentration issues at work indicating it extends beyond social contexts. Therefore, her presentation best meets criteria for GAD rather than social anxiety disorder. However, social anxiety disorder remains a differential diagnosis that could be revisited if her symptoms change over time to be more focused on social fears rather than generalized worries.
References:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Baldwin, D. S., Anderson, I. M., Nutt, D. J., Allgulander, C., Bandelow, B., den Boer, J. A., Christmas, D. M., Davies, S., Fineberg, N., Lidbetter, N., Malizia, A., McCrone, P., Nabarro, D., O’Neill, C., Scott, J., van der Wee, N., & Wittchen, H. U. (2014). Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology. Journal of psychopharmacology (Oxford, England), 28(5), 403–439. https://doi.org/10.1177/0269881114525674
Volanen, S. M., Suominen, S., Lahti, J. M., Timonen, M., & Verkasalo, M. (2020). Mindfulness-based intervention for generalized anxiety disorder: A randomized controlled trial. Mindfulness, 11(4), 899–913. https://doi.org/10.1007/s12671-019-01271-5
