Severe Anxiety And Panic Symptoms Case Study Read through this case study and thoughtfully answer the questions.
Case
Armella, a 77-year-old African American, was widowed almost 10 months ago. She presents with severe anxiety and panic symptoms that have persisted since the death of her husband. She also reports having some short-term memory loss, and sometimes wakes up at night feeling confused. Armella was married for 58 years. She is currently living alone in the four-bedroom house where she lived with her husband and raised their five children. All of her children live far away from her. She has a sister who lives 20 minutes away whom she sees a few times per month. She has been attending a grief support group held at her church for a month. Her primary care provider referred her for the evaluation for medication management.
Severe Anxiety And Panic Symptoms Case Study Social History
Retired as a school teacher 10 years ago; taught 3rd grade for 40 years. Five adult children who all live in California. She lives in Missouri and has limited contact with her children.
Education
Master’s degree in education
Medical history
History of back pain uses Motrin IB 400 mg every 8 hours.
History of diabetes type II takes Metformin 1000 mg daily with meals, last A1C from a month ago was 7.6.
History of coronary artery disease, two stents placed 5 years ago.
History of hypertension for 10 years, managed with Lisinopril 30 mg daily po.
History of rheumatoid arthritis for 20 years, received Rituxan infusions every 4–6 months.
Severe Anxiety And Panic Symptoms Case Study Surgical History
Tonsillectomy at age 5
TAH at 55 years
Cervical fusion 15 years ago
Cardiac stents placed 5 years ago for coronary artery disease
Allergies
Penicillin (hives)
Current Medications
Fluoxetine 20 mg at night, has been taking for two months, prescribed by her primary care provider
Lisinopril 30 mg daily po for HTN
Motrin IB 400 mg every 8 hours for back pain
Metformin 1000 mg daily with meals
Rituxan infusions every 4–6 months for RA
Metoprolol 12.5 mg at night
Alprazolam 0.25 mg twice daily for anxiety (used for 2 months, prescribed by primary care provider)
OTC multivitamins
Alcohol Intake: Occasional glass of wine with dinner. No other alcohol use.
Nicotine intake: Denies tobacco use.
Drug use: Denies drug use.
Sexual activity: None for many years since her husband had been ill with cancer for 3 years prior to his death.
Questions
Based on this case presentation, answer the following questions.
Write a summary statement about the case presentation.
Identify the potential DSM-5 diagnosis or diagnoses for Armella based on information noted in the case presentation.
Discuss what medication changes you would recommend (including doses and administration times). Provide documented rationale for the changes you would make.
Discuss other clinical issues that you consider to be significant (including references), based on the case presentation.
List references and citations for all of your rationale.
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