Examine Case Study: A Middle-Aged Caucasian Man With Anxiety

Posted: August 27th, 2024

The Assignment

Examine Case Study: A Middle-Aged Caucasian Man With Anxiety. This case study provides a comprehensive look into the complexities of anxiety disorders in adults. You will be asked to make three decisions concerning the medication to prescribe to this client. These decisions will require careful consideration of the client’s unique circumstances and medical history. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes. Understanding these factors is crucial for effective and safe medication management.

BACKGROUND INFORMATION

The client is a 46-year-old white male who works as a welder at a local steel fabrication factory. His occupation may contribute to his stress levels due to its demanding nature. 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. This incident highlights the severity of his anxiety symptoms. He stated that he felt chest tightness, shortness of breath, and feeling of impending doom. These symptoms are often associated with panic attacks. He does have some mild hypertension (which is treated with low sodium diet) and is about 15 lbs. overweight. These health factors could influence his anxiety and overall well-being. He had his tonsils removed when he was 8 years old, but his medical history since that time has been unremarkable. This suggests that his current health issues are relatively recent developments. Myocardial infarction was ruled out in the ER and his EKG was normal. This finding provides some reassurance regarding his cardiac health. Remainder of physical exam was WNL. This indicates that there are no other immediate physical health concerns.

He admits that he still has problems with tightness in the chest and episodes of shortness of breath- he now terms these “anxiety attacks.” His self-diagnosis reflects a growing awareness of his mental health condition. He will also report occasional feelings of impending doom, and the need to “run” or “escape” from wherever he is at. These feelings can significantly impact his daily functioning and quality of life.

In your office, he confesses to occasional use of ETOH to combat worries about work. This coping mechanism may exacerbate his anxiety symptoms. He admits to consuming about 3-4 beers/night. This level of alcohol consumption could have implications for his treatment plan. Although he is single, he is attempting to care for aging parents in his home. This responsibility likely adds to his stress and anxiety. He reports that the management at his place of employment is harsh, and he fears for his job. Job insecurity can be a significant source of anxiety for many individuals. You administer the HAM-A, which yields a score of 26. This score indicates a moderate level of anxiety.

Client has never been on any type of psychotropic medication. This suggests that pharmacological intervention could be a new and potentially beneficial approach for him.

MENTAL STATUS EXAM

The client is alert, oriented to person, place, time, and event. This indicates that he is currently functioning well cognitively. He is appropriately dressed. His appearance suggests that he maintains a level of self-care. Speech is clear, coherent, and goal-directed. This reflects his ability to communicate effectively despite his anxiety. Client’s self-reported mood is “bleh” and he does endorse feeling “nervous”. These mood descriptors align with his anxiety diagnosis. Affect is somewhat blunted, but does brighten several times throughout the clinical interview. This variability in affect may indicate underlying emotional resilience. Affect broad. This suggests that he is capable of experiencing a range of emotions. Client denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. This absence of psychotic symptoms is important for differential diagnosis. Judgment is grossly intact, as is insight. These cognitive strengths are positive indicators for treatment adherence. He denies suicidal or homicidal ideation. This is a crucial aspect of his mental health assessment.

The PMHNP administers the Hamilton Anxiety Rating Scale (HAM-A) which yields a score of 26. This assessment tool helps quantify the severity of his anxiety symptoms.

Diagnosis: Generalized anxiety disorder. This diagnosis will guide the treatment plan and therapeutic interventions.

RESOURCES

§ Hamilton, M. (1959). Hamilton Anxiety Rating Scale. Psyctests, doi:10.1037/t02824-0. This resource provides a validated measure for assessing anxiety levels.