Free Essay Sample - Generalized Anxiety Disorder

Symptoms: several headaches as the chief complaint

Characteristics: anxiety particularly at the workplace, sleeplessness, irritation, on edge, frequently shouts, palpitations, difficulties in paying attention, tingling sensation

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Onset: six months ago

Location: mostly the head due to headaches and her hands

Duration: six months

Severity: severe enough to interfere with her daily activities and her workplace environment.

Pattern: regular

Associated factors: insomnia, body tension and shakiness

Stressors: life stressors include being overly concerned about her children's wellbeing, and the constant worry of finding another partner.

Objective:

Staff observations: Miss S shows signs of restlessness, shakiness, and agitation.

Review of system:

Cardiac: Elevated heart rate and rhythm

Respiratory: chest appears to be symmetrical with mildly increased respiratory rate.

Musculoskeletal: positive for muscle tension and muscle aches.

Neurological: nerve pains

Medications: No medical history over the past six months

Other treatments: No previous reported treatments.

Vital signs- Blood Pressure: 126/80

Pulse: 68

RR: 16

T: 97.7 F

Appearance: gait, natural, posture Erect, clothes Tidy, grooming Average, Hygiene Good

General behaviour:

Mannerisms poor, gestures repetition, psychomotor activity agitation, expression irrational worry.Eye contact: The patient had difficulties in following requests and compulsions

Attitude: The attitude is evasive, and the patient is easily distracted.

LOC: asleep, tiredness, and fluctuating.

Attention: distractible

Orientation: Mss. S' orientation tends to be both person- and situation-centered.

Memory: The patient's memory is recent.

Intellectual: The patient's fund of knowledge appears to be average but her command of vocabulary is accurate.

MMSE: 10 points out of 30 achieved, missing the following tasks

Speech: The patient's speech echoes a loud tone that can be rated as normal with paucity. Finally the rhythm of the speech sounds slurred.

Mood (inquired): The patient's mood indicates a depressed, irritable, and anxious person.

Affect (observed): The patients looks congruent in addition to the labile fluctuations that are extensive with range. The Intensity is blunted, and the quality appears sad, indifferent, detached, anxious, and irritable.

Thought process/form: The patient's thought process appears to be racing and evasive.

Thought content: The patient thoughts signify delusions with paranoia due to anxiety and constant irrational worry concerning her children and spouse.

Ideas of reference: The patient has constant rational thoughts concerning her family and spouse.

Illusions/hallucinations: The patient exhibits both auditory and visual hallucination

Suicide/homicide: No reported incident of attempting to commit suicide; however, her thoughts seem to command hallucinations.

Phobias: Miss S experiences agoraphobia, which puts her in a panicking situation.

Obsessions: The Patient is highly obsessed with her family, which exacerbates her condition.

Insight/Judgement: The patient does not seem to be aware of her problem as she is unable to understand the facts of her condition and draw a conclusion.

Laboratory & other tests requested for analysis:

Complete blood cell count

Thyroid function test

Urinalysis test

Chemistry profile test

Assessment:

Working primary diagnosis: Generalized anxiety disorder (GAD)

Current differential diagnosis: Panic disorder, (PD), and separation anxiety disorder based on separation from attachment figures. Mss. S has been separated from her husband, whom she divorced twelve months ago.

Other diagnoses: Borderline personality disorder

DSM-V: GAD-ICD-10 F41.1

DSM-V: PD (episodic paroxysmal anxiety) - ICD-10 F41.0

DSM-V: Anxiety disorder (Unspecified)-ICD-10 F41.9

DSM-V: Separation anxiety disorder -ICD-10 F93.0

Plan:

Diagnostic:

Based on the symptomatic information as well as the findings from the laboratory tests, it is evident that Mss. S tests positive for generalized anxiety disorder (GAD) that is accompanied by non-recurrent panic attacks and agoraphobia. The diagnosis of the panic attack was based on the physical examination of the patient which revealed findings including mildly increased respiratory rate, Mss. S' distress is exhibited through her fear of not being able to take care of her children as well as the presence of an elevated heart rate.

Specific treatment:

The targeted particular therapy for Mss. S involves pharmacotherapy regimes for the management of GAD, the panic attacks as well as the eradication of agoraphobia. The patient will be initiated with selective serotonin receptor inhibitors as the first-line treatment medication. Specifically, Mss. S will be administered with Fluoxetine also known as Prozac to manage both the GAD and the Panic Attacks. Additionally, since the patient appears to exhibit frequent panic attacks causing agoraphobia, a long-acting benzodiazepine medication specifically diazepam will be prescribed as an adjunct to fluoxetine on a standing basis due to its lower potential for addiction. The dose will then be steadily elevated after every two to three days up until the symptoms associated with the panic attacks are eradicated.

General treatment:

The general therapy for Mss. S will involve initiating a discussion that incorporates compassionate listening and educating the patient on essential ways of minimizing anxiety and panic attacks. The patient will be educated on the significance of physical activity in ensuring she improves her physical health, psychological well-being cognitive functioning, and ultimately life satisfaction. Moreover, any possible triggers for exacerbating the anxiety-related symptoms will be identified and eliminated. Such triggers could include stress and dietary triggers like caffeine and other stimulants.

Counseling/therapy:

Psychotherapy is also very essential for the treatment of Mss. S' condition. Structured cognitive-behavioral therapy (CBT) will be performed alongside pharmacological treatment once a week for two months to assess its impact on the patient.

I have had a comprehensive discussion with the patient concerning the benefits as well as the risks associated with the psychotropic medications, and she has agreed to take them with the utmost precaution. Additionally, I have also educated the patient about the dangers of seizures, NMS, metabolic changes and TD which may result from the utilization of neuroleptic agents particularly the use of diazepam.

Disposition:

The next source of care for Mss. S will be at the hospital in the next two days from today. A follow-up plan will be put in place to organize for the frequent visits expected from Mss. S for adjusting her dosage of the prescribed medication. Mss. S is scheduled to visit the health care facility every two to three days at least until her panic symptoms have been eradicated.