Understanding Extreme Anxiety: A Case Study of Social Fear
School
East Carolina University**We aren't endorsed by this school
Course
NURS 3280
Subject
Nursing
Date
Dec 10, 2024
Pages
4
Uploaded by shaddymb266
Z1CC: “I am having an extreme and uncontrollable fear and worry about my social life. I no longer concentrate in my workplace as before.”HPI: T.P., a 36-year-old female patient visits the psychiatric health unit complaining of extreme and uncontrollable worry, anxiety, and fear about various social life incidents. She complained of restlessness, hypervigilance, lightheadedness, inability to fall asleep, and irritability. The female client says that the abnormal feelings and behaviors have adversely affected her performance in the workplace and her social and intimate interactions with her husband. The patient reports childhood sexual abuse, something which has significantly impacted her sexual relationship with her partner. She also confirms inability to focus in public and other social settings because of profuse sweating, undesiredthoughts, emotional distress, severe headaches, trembling, and repeatedly going over thoughts. She denies taking medications to manage her psychological condition. The pt. does not confirm suicidal ideations, or intentions to harm others. Substance: The pt. does not confirm abuse of alcohol, illicit substances, or drugs.Medical: She reports childhood obesity. Current: The pt. reports taking Orlistat to manage his health condition.Allergies: She denies food, drug, and seasonal allergies. Reproductive: The pt. is sexually active, heterosexual, and has a sexual partner. She confirms the regular menstruation cycle. ROS: GENERAL: The pt. reports increased fatigue, reduced concentration, restlessness, and excessive fear. Shedenies fever, weight or appetite changes, and chills. • HEENT: She reports severe headaches, denies head trauma, blurred vision, eyesight loss, and hearing impairments. T.P. reports lack of nasal congestion or a runny nose. She denies sore throat or swallowing problems. • SKIN: The patient denies itches, cellulitis, abscesses, or rashes. • CARDIOVASCULAR: T.P. does not report painful or pressured chest, edema, or cardiovascular diseases. She confirms palpitations. • RESPIRATORY: The patient denies wheezing, sneezing, shortness of breath or dry cough. • GASTROINTESTINAL: She reports nausea, but denies diarrhea, vomiting, abdominal discomfort, or constipation. • GENITOURINARY: The pt. reports a burning or painful sensation when urinating, urination hesitancy, frequency, or urgency. She does not report abnormal urine odor or color. • NEUROLOGICAL: The patient reports emotional stress, occasional dizziness, severe anxiety, extreme worry, unwanted thoughts, trembling, and tremors. • MUSCULOSKELETAL: She denies muscle stiffness or joint soreness. T.P. reports persistent back pain.
Z2• HEMATOLOGIC: The patient denies blood transfusion, clotting, anemia, or extreme blood loss. • LYMPHATICS: She denies swollen lymph nodes, splenectomy, or lymphatic diseases. • ENDOCRINOLOGIC: She confirms excessive and persistent sweating. She does not report heat or cold intolerance.O:Physical exam:Vital Signs: T- 96.7; P-77.2; R- 17.4; B/P- 121/62; Ht-5’7”; Wt.-125.lbs; BMI-23.1GENERAL: The client appears extremely worried, emotionally distressed, and trembled throughout the interview. She seems well-oriented to place, and person. Her concentration was poor and exhibited hypervigilance and irritable behavior. Diagnostic results:PANSS—Pending results.AUDIT—Negative for alcohol use.CBC—Normal.GAD-7—Positive for anxiety disorder.PHQ-9—Negative for major depression.MDQ Test—Deferred.Assessment:Mental Status Examination:The female patient aged 36 came for a comprehensive mental assessment at the mental health facility with complaints of extreme and uncontrollable worry, fear, and irritability. She further complained of aggression, social isolation, hypervigilance, emotional distress, palpitations, and cognitive impairments. She was oriented x3 and could not concentrate properly during the physical assessment. Her affect was depressed and illogical and her behavior was disorganized. She could not cooperate and communicate appropriately during the interview. The patient was unable to maintain direct eye contact and her speech and tone were unclear and slurred. She denied auditory and visual hallucinations, delusions, and anhedonia. P.T. does not confirm suicidal thoughts, or plans to harm others. Diagnostic Impression:Generalized Anxiety Disorder (GAD)This is a psychological health issue associated with excessive and uncontrollable fear, anxiety, or worry of social and life circumstances. Patients with the illness report signs and symptoms such as restlessness,extreme sweating, increased fatigue, lack of concentration, irritable behavior, inability to sleep well, emotional stress, nausea, trembling, and hypervigilance. According to the DSM-5-TR diagnostic criteria for generalized anxiety disorder, an individual should report excessive and uncontrollable worry, and
Z3fear of life and social situations persistently for at least six months. They must also have a history of traumatic life incident, which acts as a stressor to the psychological issue. The client reports nearly all these symptoms, making generalized anxiety disorder the priority clinical diagnosis for the patient in thiscase. Major Depressive Disorder (MDD)It is a mental illness characterized by depressed mood, irritability, loss of interest in routine activities, sadness, poor concentration, low self-worth, hopelessness or worthlessness about the future, disrupted sleep, changes in weight or appetite, and fatigue. To be diagnosed with major depression according to the DSM-5 diagnostic guideline, the client must exhibit at least five of the above symptoms including loss of interest in pleasurable things and depressed mood, and must persist most of the day for at least two weeks. T.P. depicts some of these clinical manifestations including irritability and poor sleeping patterns. Nevertheless, she denies changes in weight or appetite and reports extreme and uncontrollable worry and fear. Thus, she does not meet the diagnostic criteria for the mental disorder.Bipolar Disorder (BP)It is a mood disorder that might present with symptoms such as depressed mood, loss of interest in dailyactivities, reduced motivation, poor sleeping pattern, loss of touch with reality, sadness, anger outbursts, feelings of hopelessness, irritability, aggression, apathy, mood swings, euphoria, risk-taking behaviors, disorganized behavior, unwanted thoughts, fatigue, weight changes, and restlessness. Based on the DSM-5 diagnostic guidelines and standards for bipolar disorder, an individual must have experienced at least an episode of hypomanic or mania, and depressed mood which persists for at least a week, and should occur most of the day, almost daily to meet the diagnostic criteria. While P.T. reports some of these symptoms, she denies weight changes, manic episodes, and mood swings, hence ruling out the possibility of having the mood disorder. Reflections:The available patient information is adequate to conclude that the patient has generalized anxiety disorder. However, if I could conduct the patient's session over, I would assess her family psychiatric history to determine if any family members had mental illness. Due to her psychological condition, I must develop a follow-up schedule to assess the patient's response to the prescribed medications and identify and manage potential side effects. Successful treatment interventions would improve her symptoms, and enhance her psychological wellness and general health. Thus, she would develop interest in her routine activities, and reduce her irritability, and extreme worries. Case:Appropriate treatment plan would be crucial for the patient to manage her underlying symptoms and improve her psychological well-being. Based on contemporary nursing theories and evidence-based practices (EBPs), pharmacological and nonpharmacological treatment interventions would help manage the patient's mental illness. In this case, the FDA-approved medication for this psychological health condition is Escitalopram 10 mg orally once per day, preferably in the morning or evening. The SSRI would alleviate the underlying symptoms and improve the patient’s mental wellness. Alternative treatment approaches include cognitive-behavioral therapy (CBT) and mindfulness therapies. These are suitable psychotherapy interventions since they would enable the patient identify her negative thoughts, feelings, and behaviors and change them to positive ones. They are also appropriate
Z4interventions encompassing regular physical exercise, stress management techniques, relaxation strategies, and coping skills. A follow-up plan after two weeks or sooner would be paramount to evaluate the patient's response to the care plan, identify possible drug side effects, make dosage adjustments if necessary, and modify treatment. In case of the severity of the presenting symptoms, a clinical referral would be appropriate to seek advanced counseling therapies or visit a competent psychotherapist for contemporary care services. Subsequently, one social determinant of health based on HealthyPeople 2030 is low socioeconomic status. People with low incomes have challenges accessing and receiving quality mental care. This critically applies to patient care and generally to the world of mental health. As a future advanced care provider, I would encourage the patient to engage in regular physical exercise and consume a balanced diet as a health promotion activity. This will help manage her mental illness and maintain her physical fitness. I would also educate her to comply with drug prescriptions to avoid adverse events and engage in community health programs for people with psychological health issues to gain coping skills and self-care techniques for her mental condition. This is an appropriate way to improve health inequities and disparities in the mental health system. References