Case Study: A Middle-Aged Caucasian Man With Anxiety
Anxiolytic Therapy & PTSD Treatment
Anxiety disorders are the most common type of psychiatric disorders that include features of excessive fear and anxiety and related behavioral disturbances. These disorders appear to be caused by an interaction of biopsychosocial factors, including genetic vulnerability, which interact with situations, stress, or trauma to produce clinically significant syndromes. Anxiety is more often associated with muscle tension and vigilance in preparation for future danger and cautious or avoidant behaviors. Many patients with anxiety disorders experience physical symptoms related to anxiety (Bhatt, 2018).
Anxiety disorders are also strongly related to somatic symptoms. The emotional distress of anxiety is often accompanied by sweating, dizziness, and shortness of breath or more generalized somatic complaints, such as insomnia, restlessness, and muscle aches. In addition, many medical conditions are associated with anxiety, particularly among older patients, which include neurologic conditions, thyroid dysfunction, and cardiovascular disease. Furthermore, drug abuse and alcohol intoxication has been linked to significant anxiety (Bekhuis, Boschloo, Rosmalen, & Schoevers, 2015).
Patient Summary
BACKGROUND INFORMATION
The client is a 46-year-old white male who works as a welder at a local steel fabrication factory.
He presents today after being referred by his PCP after a trip to the emergency room in which he felt he was having a heart attack. He stated that he felt chest tightness, shortness of breath, and feeling of impending doom. He does have some mild hypertension (which is treated with low
sodium diet) and is about 15 lbs. overweight. He had his tonsils removed when he was 8 years old, but his medical history since that time has been unremarkable. Myocardial infarction was ruled out in the ER and his EKG was normal. Remainder of physical exam was WNL. He admits that he still has problems with tightness in the chest and episodes of shortness of breath- he now terms these “anxiety attacks.” He will also report occasional feelings of impending doom, and the need to “run” or “escape” from wherever he is at. In your office, he confesses to occasional use of ETOH to combat worries about work. He admits
to consuming about 3-4 beers/night. Although he is single, he is attempting to care for aging parents in his home. He reports that the management at his place of employment is harsh, and he fears for his job. You administer the HAM-A, which yields a score of 26. Client has never been on any type of psychotropic medication. MENTAL STATUS EXAM
The client is alert, oriented to person, place, time, and event. He is appropriately dressed. Speech is clear, coherent, and goal-directed. Client’s self-reported mood is “bleh” and he does endorse feeling “nervous”. Affect is somewhat blunted, but does brighten several times throughout the clinical interview. Affect broad. Client denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, as is insight. He denies suicidal or homicidal ideation.
The PMHNP administers the Hamilton Anxiety Rating Scale (HAM-A) which yields a score of 26.
Diagnosis: Generalized anxiety disorder
Decision 1
Based on the patient summary above the PMHNP has 3 choices: 1.Begin Zoloft (Sertraline) 50 mg po daily 2.Begin Imipramine 25 mg po BID
3.Begin Buspirone 10 mg po BID
Which decision did you select?
I chose to start Buspirone 10 mg po BID
Why did you select this decision? I chose this decision because buspirone is used mainly for the
treatment of anxiety disorders. I understand that Buspirone is not normally a first line treatment for anxiety, but Buspirone also has a well-established efficacy in the treatment of GAD and anxiety symptoms in depression. It is well tolerated, and the main side-effects may be minimized by slow dose titration. It does not cause sexual dysfunction or psychomotor
Anxiolytic Therapy & PTSD Treatment
Anxiety disorders are the most common type of psychiatric disorders that include features of excessive fear and anxiety and related behavioral disturbances. These disorders appear to be caused by an interaction of biopsychosocial factors, including genetic vulnerability, which interact with situations, stress, or trauma to produce clinically significant syndromes. Anxiety is more often associated with muscle tension and vigilance in preparation for future danger and cautious or avoidant behaviors. Many patients with anxiety disorders experience physical symptoms related to anxiety (Bhatt, 2018).
Anxiety disorders are also strongly related to somatic symptoms. The emotional distress of anxiety is often accompanied by sweating, dizziness, and shortness of breath or more generalized somatic complaints, such as insomnia, restlessness, and muscle aches. In addition, many medical conditions are associated with anxiety, particularly among older patients, which include neurologic conditions, thyroid dysfunction, and cardiovascular disease. Furthermore, drug abuse and alcohol intoxication has been linked to significant anxiety (Bekhuis, Boschloo, Rosmalen, & Schoevers, 2015).
Patient Summary
BACKGROUND INFORMATION
The client is a 46-year-old white male who works as a welder at a local steel fabrication factory.
He presents today after being referred by his PCP after a trip to the emergency room in which he felt he was having a heart attack. He stated that he felt chest tightness, shortness of breath, and feeling of impending doom. He does have some mild hypertension (which is treated with low
sodium diet) and is about 15 lbs. overweight. He had his tonsils removed when he was 8 years old, but his medical history since that time has been unremarkable. Myocardial infarction was ruled out in the ER and his EKG was normal. Remainder of physical exam was WNL. He admits that he still has problems with tightness in the chest and episodes of shortness of breath- he now terms these “anxiety attacks.” He will also report occasional feelings of impending doom, and the need to “run” or “escape” from wherever he is at. In your office, he confesses to occasional use of ETOH to combat worries about work. He admits
to consuming about 3-4 beers/night. Although he is single, he is attempting to care for aging parents in his home. He reports that the management at his place of employment is harsh, and he fears for his job. You administer the HAM-A, which yields a score of 26. Client has never been on any type of psychotropic medication. MENTAL STATUS EXAM
The client is alert, oriented to person, place, time, and event. He is appropriately dressed. Speech is clear, coherent, and goal-directed. Client’s self-reported mood is “bleh” and he does endorse feeling “nervous”. Affect is somewhat blunted, but does brighten several times throughout the clinical interview. Affect broad. Client denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, as is insight. He denies suicidal or homicidal ideation.
The PMHNP administers the Hamilton Anxiety Rating Scale (HAM-A) which yields a score of 26.
Diagnosis: Generalized anxiety disorder
Decision 1
Based on the patient summary above the PMHNP has 3 choices: 1.Begin Zoloft (Sertraline) 50 mg po daily 2.Begin Imipramine 25 mg po BID
3.Begin Buspirone 10 mg po BID
Which decision did you select?
I chose to start Buspirone 10 mg po BID
Why did you select this decision? I chose this decision because buspirone is used mainly for the
treatment of anxiety disorders. I understand that Buspirone is not normally a first line treatment for anxiety, but Buspirone also has a well-established efficacy in the treatment of GAD and anxiety symptoms in depression. It is well tolerated, and the main side-effects may be minimized by slow dose titration. It does not cause sexual dysfunction or psychomotor
