Week 8 Discussion 1: Anxiety Case Study

2

ANXIETY CASE STUDY

2

ANXIETY CASE STUDY

Post#2 Anxiety Case Study by Ivan

What information, if any, would you like to know that was not included in the case?

I would like to know that what was not presented in the case study in the history of mental disorders in the patient's family, the patient's psychiatric history, and any medication that she has ever taken in the past. The provider explores all the factors, including the patient's symptoms and when they started. However, she does not explore the family history, patient psychiatric history, and medications she has received in the past. Understanding such additional information would be essential in helping the patient manage the condition.

Which psychiatric symptoms are a treatment priority for this case?

Various psychiatric symptoms that I would prioritize in the case study are the feeling of nervousness, increased heart rate, having a sense of impending danger, concentration difficulties, and the urge to avoid the things that trigger anxiety. In our case study, the patient is always nervous when her heart beats faster. She feels that she might be having a heart problem like her deceased father. Besides, the patient has been having concentration difficulties; she always thinks nothing other than the present worries. The patient has also been avoiding things that trigger her anxiety, including exercises and going to the pub. Prioritizing such things is essential because it can help the provider understand the severity of the disorder.

What are the non-pharmacologic issues in this case (problems/complaints that cannot be addressed by medication)?

Some non-pharmacological issues in the case study that medications cannot address are the phobia of doing exercises and accompanying the husband to the pub. The patient is worried about doing exercises because she thinks her heart would beat faster, putting her on the verge of heart disease. Besides, she fears going to the club since it triggers her anxiety symptoms. The medications cannot effectively address such factors; only psychotherapeutic interventions such as CBT can best manage them.

Medication Choice 1

List one medication that would be appropriate for this case. Include the name and starting dose.

The medication that would best address the symptoms in the case study is Xanax (Alprazolam). When administering this medication, the patient should start with an initial dose of 0.25 to 0.5 milligram (mg) 3 times a day. This can be increased as needed; but, it should not exceed 4 mg per day.

Describe your clinical decision-making. What is your rationale for choosing this medication? Also, include the mechanism of action for this medication choice and the neurotransmitters and areas of the brain on which the drug is proposed to act.

Xanax is preferable in managing the symptoms exhibited in the case study because it is from the benzodiazepines class of drugs. As depressants, these medications lower brain activity; thus, driving various conditions such as anxiety. In its mechanism of action, Xanax binds to gamma-aminobutyric acid (GABA) receptors in the brain to enhance GABA-mediated synaptic inhibition (Stahl, 2017). As a result, an individual can manage the negative symptoms such as worries and panic with anxiety disorder. Xanax would, therefore, be the best medication to treat the anxiety symptoms in the case study.

What laboratory testing/monitoring is needed for safely prescribing this medication?

Before prescribing this medication, various laboratory tests are needed. One of the tests is the complete blood count; this test is carried out to ensure that the patient's blood is in good condition to sustain the medication actions. Other tests are the Urine tests and saliva swaps; these tests are carried out to determine any substance the patient might have taken that can interfere with the patient's functionating (Chowdhury, 2019). And the last test required before administering the medication is the liver function test; these tests help diagnose and monitor liver diseases or damages and whether Xanax can cause any complication.

Are there any contraindications or safety issues associated with this medication?

Various contraindications or safety issues associated with Xanax are as follows. First, the medication should not be taken by individuals with decreased kidney function because it can result in renal failure. Another safety issue is that individuals with liver problems should not take the medication. When individuals with liver problems take Xanax, they might experience elevated liver enzymes that further cause liver tissue damage or more complications. Finally, this medication should not be taken by individuals with a history of alcohol intoxication. Mixing Xanax with alcohol might increase the activity of the inhibitory neurotransmitters gamma-aminobutyric acid (GABA) and glycine and decrease the activity of excitatory neurotransmitters such as NMDA (N-methyl-D-aspirate) (Stahl, 2013). This, as a result, can increase the severity of the symptoms.

Non pharmacologic Interventions

What non-pharmacologic interventions do you recommend? Do you recommend including but not limited to psychotherapy, complementary and holistic therapies?

Various non-pharmacologic interventions that I would be recommendable to this patient are Cognitive Behavioral Therapy (CBT) and progressive muscle relaxation. CBT helps examine how the negative thoughts or cognitions contribute to anxiety and how individuals behave and react in situations that trigger anxiety (Springer et al., 2018). In our case study, CBT can help the patient understand how her thoughts contribute to her symptoms, such as withdrawal from various events and how her thoughts contribute to her behaviors. By understanding such things, the patient can change the negative cognitions to positive ones; thus, managing her anxiety symptoms. Another intervention that can help address anxiety is progressive muscle relaxation. In this intervention, the patient tenses a group of muscles as she breathes in and relaxes them as she breathes out. As a result, she acquires muscle relaxation that helps her manage the anxiety symptoms.

Safety Risk Assessment

What are the safety concerns, if any, associated with this case? How will you address safety?

Various safety concerns associated with the case study are avoidance of situations and bodily sensations and assurance seeking. Due to her condition, the patient is likely to avoid various problems or phenomena that trigger her anxiety. This is a safety concern because it might create loneliness. To address such concerns, the patient can be linked to friends and family members to manage the severity of her symptoms.

When would you follow up with this patient?

The first follow-up can be after seven days, then two weeks as per the patient's progress.

References

Chowdhury, L. (2019). Handbook of Pharmacology for the Anesthesiologist. Jaypee Brothers Medical Publishers.

Springer, K. S., Levy, H. C., & Tolin, D. F. (2018). Remission in CBT for adult anxiety disorders: a meta-analysis. Clinical psychology review, 61, 1-8.

Stahl, S. M. (2013). Stahl's essential psychopharmacology: neuroscientific basis and practical applications. Cambridge university press.

Stahl, S. (2017). Stahl's essential psychopharmacology prescribers guide (6th ed.). Cambridge University Press.