Assessment of a Patent with Anxiety Disorder
PMHNP Care Across the Lifespan I
Assignment Due Date
CC (chief complaint):
History of Present Illness (HPI): The client, B. L. is a female aged 59. She presents herself to the healthcare facilty with anxiety problems. She says that she has experienced carjacking in two instances, both at gun point. The experience has increased her paranoid thoughts and she tends to feel quite anxious whenever she goes out. The clent admits to going through a lot of stress together with substantially high level of anxiety. According t B. L., she is always looking at her surroundings and lwsys feels that someone is watching her following the carjacking encounters and she has become paranoid. Her physical wellbeing has been also affected as she has lost 40 lbs within the last eight months and her blood sugar is uncontrollable. The drastic weight loss has raised the client’s anxiety levels and constantly feels as if she is losing energy from her muscles. The patient is orented and alert, cooperative with medical practitioners, and communicates well during the assessment exercise. Though she is slim, her appearance is age appropriate.
Substance Current Use: The client’s condition has not led her into substance use or abuse.
Medical History: No known medical problem reported by the client.
· Current Medications:
Vistaril 25 mg BID PRN
No known allergies to drugs, food, latex, or environment.
· Reproductive Hx: Although reproductive information about the client is unavailable, her age suggests a high likelihood of having at least one child and/or a family.
Review of Systems (ROS):
· GENERAL: The client is alert, and experiences high anxiety levels.
· HEENT: No headaches, good visual and hearing capabilities, normal nose sensitivity, and no soar throat.
· SKIN: No reported skin itching or rashes.
· CARDIOVASCULAR: Client occasionally experiences chest pains and heart palpitations.
· RESPIRATORY: Patient does not experience shortness of breath or coughing.
· GASTROINTESTINAL: No reported abdominal discomfort or abnormal bowel patterns.
· GENITOURINARY: Normal functioning of the urinary organs and genitals.
· NEUROLOGICAL: No reported sensation loss or focal strength loss.
· MUSCULOSKELETAL: Denies swelling of joints, facial droop, or focal weakness.
· HEMATOLOGIC: No bleeding, anemia, or bruising.
· LYMPHATICS: No splenectomy history. Nodes are normal.
· ENDOCRINOLOGIC: Client occasionally experiences abnormal sweating especially when she goes out.
The client is seems to experience constant reminders about the carjacking incidences, especially when she drives alone. Additionally, she exhibits feelings of fear when she is travelling in a vehicle and sees people alongside the road. A mental assessment of the client revealed that her mental condition was directly affected by the two carjacking experiences. Indeed, her carjacking events caused significant panic and anxiety, and hence potential panic disorder. The client experienced intense and sudden panic attacks characterized by stronger feelings that are directly linked to the carjacking experience triggers.
· To identify the mental health problem that the client is suffering from based on her carjacking incidences.
· To establish the best possible treatment intervention to the client’s mental health disorder.
· To create clinical insights regarding various mental issues that the client could be experiencing through differentil diagnosis.
· Depression mood
· Adjustment Disorder
Mental Status Examination: Following an examination of the client’s mental health, it was revealed that there was a great likelihood that the patient was suffering from an anxiety disorder. However, potential diffierential diagnoses included depression mood and adjustment disorder.
1. Anxiety Disorder: According to Riva and Serino (2020), an anxiety disorder is a mental health problem that affects how an individual responds to specific situations or things, with those suffering from the disorder frequently experiencing persistent, excessive, and intense fear and worry about daily situations. There numerous types of anxiety disorder, which include generalized anxiety disorder, panic disorder, phobias, and separation anxiety. Based on the subjective and objective analysis of B. L., it is clear that she is suffering from panic disorder (Gensichen & Domschke, 2018). In such instances, the patient may experience such symptoms as sweating, heart palpitations, and chest pains. According to Bandelow et al. (2022), anxiety disorders may be triggered by environmental factors like experiencing a traumatic event. The client under examination was involved in two carjacking encounters twice at gun point, which offers more evidence to the possibility of suffering from an anxiety disorder, particularly panic disorder.
2. Depressive Mood Disorder: Simply known as depression, depressive mood disorder is a serious mood disorder that is associated with severe symptoms affecting how an individual feels, thinks, and executes daily endeavors like working, eating, and sleeping (Riva & Serino, 2020). People suffering from depression either experience loss of pleasure or interest, or depressed mood. Other common symptoms of depression include diminished pleasure or interest in activities, depressed mood for a better part of the day, appetite changes leading to weight gains or losses, sleeping pattern changes, increased fatigue/energy loss, irritability or restlessness, anxiety feelings, feelings of hopelessness/helplessness/worthlessness, difficulty thinking, concentrating, or making decisions, as well as thoughts of death or suicide attempts (Varker et al., 2019).
3. Adjustment Disorder: According to O’Donnell et al. (2019), adjustment disorders include excessive reactions to stress and are associated with strong emotions, negative thoughts, and changes in behavior. Such reactions are more intense than expected and may lead to diverse problems when affected individuals try to get along with others. It is also important to note that people with adjustment disorders continue to experience behavioral or emotional responses that make them feel more depressed or anxious. Some of the common symptoms of adjustment disorder include crying often, feeling hopeless or sad, feeling anxious or stressed out, irritability, and trouble sleeping, among others (O’Donnell et al., 2019).
Case Formulation and Treatment Plan:
Like any other health problem, the anxiety disorder experienced by the patient will require treatment. The first line of action would be to recommend psychotherapy sessions for the client, particularly cognitive behavioral therapy (CBT). According to Bandelow, Michaelis and Wedekind (2022), CBT is an effective method in treating anxiety disorders as it helps patients recognize their behaviors and though patterns that contribute to troublesome feelings, thus ensuring that patients effectively work towards changing those unprecedented feelings and behaviors. In this regard, the patient will be involved in counseling sessions for CBT sessions to help change her panic behaviors related to the carjacking experiences. In addition to CBT, the proposed treatment plan will include the use of pharmacology interventions, particularly anti-anxiety medications like benzodiazepines. Using anti-anxiety medications are effective in decreasing worry, panic, and anxiety (Gensichen & Domschke, 2018). Combining CBT and benzodiazepine medications will go a long way in ensuring that the client resumes her normal activities without panicking or experiencing negative thoughts about the carjacking incidences.
I have a strong conviction that the assessment of the client was quite conclusive towards realizing the disorder she is suffering from. However, I feel like I was have collected more subjective data about the client. For instance, I should have obtained more information regarding whether the client was experiencing the current symptoms before the first carjacking incident. I should also have obtained past medical history of the client, especially those relating to mental health. More information about her family and reproductive history would have also surfaced because it could have provided more insights regarding other experiences that could have contributed to her current mental health status.
· The assessment confirmed that the patient was suffering from panic disorder. What is the possibility of the client experiencing other Generalized Anxiety Disorder (GAD) and what would the diagnosis be?
· Would combining anti-anxiety medications and antidepressants be more effective as part of the pharmacology intervention recommended in the treatment plan?
· Why should the assessment have included information about the family history of the client?
Bandelow, B., Michaelis, S., & Wedekind, D. (2022). Treatment of anxiety disorders. Dialogues in clinical neuroscience. https://doi.org/10.31887/DCNS.2017.19.2/bbandelow
O’Donnell, M. L., Agathos, J. A., Metcalf, O., Gibson, K., & Lau, W. (2019). Adjustment disorder: Current developments and future directions. International journal of environmental research and public health, 16(14), 2537. https://doi.org/10.3390/ijerph16142537
Riva, G., & Serino, S. (2020). Virtual reality in the assessment, understanding and treatment of mental health disorders. Journal of clinical medicine, 9(11), 3434. https://doi.org/10.3390/jcm9113434
Ströhle, A., Gensichen, J., & Domschke, K. (2018). The diagnosis and treatment of anxiety disorders. Deutsches Ärzteblatt International, 115(37), 611. https://doi.org/10.3238%2Farztebl.2018.0611
Varker, T., Brand, R. M., Ward, J., Terhaag, S., & Phelps, A. (2019). Efficacy of synchronous telepsychology interventions for people with anxiety, depression, posttraumatic stress disorder, and adjustment disorder: A rapid evidence assessment. Psychological services, 16(4), 621. https://psycnet.apa.org/doi/10.1037/ser0000239