Case Study Questions – Anxiety Disorder

Case Study Questions – Anxiety Disorder

 Instructions:

Anxiety Disorders

Ivy, age 23, is a white woman who graduated from college last year. She began working as an accountant one month after graduating. Approximately two months ago, she moved into a two -bedroom apartment with another woman who works at the same accounting firm.

She states that her roommate recommended that she sees a doctor to find out if she has anemia or “some sort of fatigue syndrome.” She states that she has felt “restless” and “on edge” for most of the past nine months.

Case Study Questions – Anxiety Disorder

She becomes easily fatigued and irritable and has difficulty concentrating and falling asleep. She states that sometimes her mind “just goes blank,” and she is worried that her work performance is no longer excellent.

Although she has been “a worrier from the day I was born,” now she worries more than she ever has and feels nervous “all the time.” Ivy reports that she has a good relationship with her boyfriend, but they do not get to see each other very often because he is attending graduate school 100 miles away.

She reports having a satisfying sexual relationship with him. She denies having any problems with relationships with her parents, roommate, or peers. She denies having any financial worries unless she is fired from her job for poor work performance.

Case Study Questions – Anxiety Disorder

She reports that she has always been healthy and has taken good care of herself. The only medication she takes is birth control pills, which she has taken for the past four years without any adverse effects.

I started some already but I need help. Read the case study on generalized anxiety disorder (GAD) and answer the8 questions related to reading and other outside sources. I would like to try to keep what I have and my sources and just build from there. Do you think that will be OK?

Generalized Anxiety Disorder (GAD) is one of the mental health disorders set apart by a feeling of worry, fear, restlessness, or feeling of impending doom. According to the World Health Organization (WHO), 1 in 13 persons suffers from anxiety.

Case Study Questions – Anxiety Disorder

The WHO reports that anxiety disorders are the most common mental disorders worldwide with specific phobia, major depressive disorder, and social phobia being the most common anxiety disorders (WHO, 2021 ? find here >> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2174588/ ).

Anxiety can usually be self- diagnosable as with Ivy in this case study. Women, unlike men, are twice as likely to be affected with GAD (Woo & Robinson, 2020).

Just making it through a simple day causes anxiety and like with Ivy, the 6.8 million adults with GAD do not know how to stop the worry cycle and feel out of control or even things are beyond their control.

GAD can interfere with a person’s daily events and actives as with Ivy. For nine months Ivy has had trouble concentrating at work and now worries about her job security and performance (ADAA, 2021).

SSRIs can be used as the first-line medication for Ivy’s anxiety disorder. SSRIs cause more serotonin- 5-HT- in your brain to be available therefore improving anxiety as well as mood (Woo & Robinson, 2020).

Question 1. List specific treatment goals for Ivy. Treatment goals for Ivy include staying compliant with her new medication regime of SSRI- Lexapro 10 mg PO once daily, keeping follow-up appointments to assess and evaluate new medication responses and therapeutic outcomes, better sleep, increase quality in work performance.

Participate in psychotherapy (cognitive-behavioral/solution-focused) **For #1 need to include National guidelines for treatment plans and options- please look at US Preventive Services Task Force https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics

American Psychiatric Association Practice Guidelines

https://psychiatryonline.org › guidelines

American Psychiatric Association (APA) practice guidelines provide evidence-based recommendations for the assessment and treatment of psychiatric disorders.

Case Study Questions – Anxiety Disorder

Question 2. What drug therapy would you prescribe? Why? As mentioned before, SSRIs are used as the first-line medication with a new diagnosis of GAD with a safer and lower side-effect profile (Woo & Robinson, 2020).

I would start Ivy on Escitalopram (Lexapro) 10mg PO once daily, this dose may be increased after response, and tolerability is assessed to a maximum of 20mg once daily (Lexicomp, 2021).

Lexapro chemical action blocks the transport mechanism that helps return 5-HT that is unbound from returning into the presynaptic neuron therefore more 5-HT is increased and available for the brain to blind to the postsynaptic serotonin receptor.

This in turn can decrease symptoms of anxiety (Woo & Robinson, 2020). The effectiveness of the different SSRIs over each other measures the same with similar outcomes (Woo & Robinson, 2020) (Riley et al., 2009).

Question 3. What are the parameters for monitoring the success of the therapy?

Question 4. Describe specific patient monitoring based on the prescribed therapy.

Question 5. List one or two adverse reactions for the selected agent that would cause you to change therapy. Look and read UpToDate and Lexicomp under Escitalopram (Lexapro)

Question 6. What would be the choice for second-line therapy? According to Lexicomp Zoloft would be the second-line medication for Ivy.

Question 7. What dietary and lifestyle changes should be recommended for this patient? According to Woo & Robinson (2020) exercise (no matter the person’s intensity) can be a constrictive part in reducing the symptoms of anxiety.

Exercises such as brisk walks, yoga, and meditation can be helpful for Ivy’s treatment. Cognitive-behavioral therapy (CBT) can also be beneficial to the person with GAD as well as Ivy’s boyfriend or even her roommate.

Case Study Questions – Anxiety Disorder

CBT uses psych-social interventions aimed to improve anxiety by drawing focuses on changing cognitive distortion such as thoughts, beliefs, and attitudes as well as managing coping strategies that target personal problem solving and enhancing overall wellbeing (Menzies, et al., 2016).

Alcohol consumption should be avoided for Ivy. Alcohol can enhance the side effects causing increased psychomotor impairment[UptoDate,2021].

Question 8. Describe one or two drug-drug or drug-food interactions for the selected agent.

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