CASE STUDY-Seasonal Affective Disorder

Case Study:

Patient Information:

D.A. 32-year-old Caucasian male

CC: fearful of being around loud noises, terrible anxiety, memories of an explosion and nightmares.

HPI: D.A. is a 32-year-old, single, Caucasian male who came to the clinic seeking medication that will help with panic attacks, feeling fearful of being around loud noises, terrible anxiety, memories of an explosion and nightmares. He stated that his symptoms were harsh and that they started about one year after being around an explosion that took the lives of five men and women while he was in Baghdad two years prior. He reported serving two tours in the military. He reported that he started feeling this way a year now when he went out in public and heard bang noises from an old car muffler. He reported that any banging would trigger his feelings, and the symptoms would ease if he meditates and or take slow deep breaths. He reported the episode would last for twenty-four hours, and he reports becoming more withdrawn than usual. He denied seeking help because he was afraid of being labeled.

A:

Diagnosis: Post traumatic stress disorder, also called, PTSD. (F43.1)

One must understand that PTSD is a type of anxiety disorder that arises after exposure to a distressing incident such as threat of death, serious physical injury to and threat to physical well-being (Domino, Baldor, Golding, & Stephens, 2019).

Individuals affected must have a comprehensive management plan which are based on clinical practice guidelines, clinical judgment, patient preferences and the patient’s response to psychotherapy or psychopharmacology are completely vital factors in selecting the course of action or treatment for PTSD.

The clinical practice guidelines that should have been applied to D.A. are psychotherapies such as cognitive processing therapy (CPT) and eye movement desensitization and reprocessing (EMDR) (American Psychological Association, 2017) which is a newer nontraditional way of therapy along with medications such as Sertraline (Zoloft) or Paroxetine (Paxil) which are the only approved medications by the Food and Drug Administration (FDA) for PTSD (American Psychological Association, 2019).

The lessons learned from this discussion were the importance of thoroughly assessing one’s patients, being very attentive to details, listen to your patients and the need for making referrals beyond the scope of practice.

Final Treatment Plan/Analysis:

ANALYSIS

The research has shown that the pathophysiology of PTSD is unsure, however the evidence is suggestive of underlying methods include activation of the part of the brain that’s immersed in fear, volume loss of the hippocampus that’s involved in formation of memory (Lisieski, Eagle, Conti, Liberzon, & Perrine, 2018) therefore creating a need for medications such as SSRIs. These are known to play an active part in regulating mood and anxiety disorders.

The action of this neurotransmitter in both the peripheral and central nervous systems can be controlled by SSRIs (APA, 2019).

Medication prescribed:

Paroxetine (Paxil) 20 mg daily

Take one tablet by mouth once daily

Disp: #30

No Refill

Educate the patient on the possibility of side effects from the medication. It will take some weeks before the medication starts to work, and therefore taking the medication as prescribed is important.

Follow-up:

Psychiatrist and Psychologist and PCP in 2 to 4 weeks to reassess medication effect

Coding and Billing:

ICD-10 code is F43.1- Post-traumatic stress disorder (PTSD)

References

American Psychological Association. (2017). Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults. Guideline development panel for the treatment of PTSD in adults. Retrieved from https://www.apa.org/ptsd-guideline/ptsd.pdf

American Psychological Association. (2019). Clinical practice guideline for the treatment of post traumatic stress disorder: medications for PTSD. Retrieved from https://www.apa.org/ptsd-guideline/treatments/medications

Domino, F.J., Baldor, R.A., Golding, J., & Stephens, M.B. (2019). The 5-minute clinical consult 2019 (27th ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Lisieski, M. J., Eagle, A. L., Conti, A. C., Liberzon, I., & Perrine, S. A. (2018). Single-prolonged stress: A review of two decades of progress in a rodent model of post-traumatic stress disorder. Frontier in Psychiatry. Doi.org/10.3389/fpsyt.2018.00196