Running head: SEPARATION ANXIETY DISORDER
Journal 2: Separation anxiety disorder
Author's Name
Institutional Affiliation
SEPARATION ANXIETY DISORDER
Optionfour
Write about a continuation of a situation that you faced earlier in your clinical. How has the
situation evolved? What have you done to guide the relationship? What interventions and so on
have you tried? What is the current outcome? What are your goals with this patient? Provide
justification and reasoning for your actions. This commentary should include a reference to
relevant course content or research.
SEPARATION ANXIETY DISORDER
Separation anxiety disorder
A 7-year-old boy comes to the office occupied by his mother which reports that her child
cannot go to sleep without having a parent in his room. While
falling asleep, he frequently awakens to check that a parent is still there. One
parent usually stays until the boy falls asleep. If he wakes up alone during the
night, he starts to panic and gets up to find his parents. He also reports frequent
nightmares in which he or his parents are harmed. He occasionally calls out
that he saw a strange figure peering into his darkroom. The parents usually
wake in the morning to find the boy asleep on the floor of their room. They
once tried to leave him with a relative so they could go on a vacation; however,
he became so distressed in anticipation of this that they canceled their plans.
References support : DSM 5 2013.
Explanation: The essential feature of separation anxiety disorder is excessive
anxiety about being separated from home or attachment figures, beyond what
would be expected for the person’s developmental stage. By definition, it firsts
presents before age 18; however, it may continue into adulthood. Typical presentations
include reluctance to leave home or even stay in a room without a
parent. In the latter case, children frequently have difficulty at bedtime and
may insist that a parent stay with them. They frequently express fear of harm
or untoward events that may prevent them from being with a loved one, and
they may have nightmares regarding these fears as well as unusual perceptual
SEPARATION ANXIETY DISORDER
experiences, particularly at night or in the dark. The child’s focus on a fear of being left
alone makes separation anxiety disorder the most likely diagnosis
SEPARATION ANXIETY DISORDER
A few weeks ago, a 7-year-old boy came to the facility exhibiting symptoms of a Separation
anxiety disorder (SAD). Essentially, the patient's symptoms major symptoms include excessive
anxiety regarding the separation from his parents, recurrent and excessive distress and panic,
frequent nightmares, and constant worries that have severely interfered with his normal life
activities. According to Mayo Clinic (2019) "sometimes, a separation anxiety disorder can be
triggered by life stress that results in separation from a loved one. Genetics may also play a role
in developing the disorder." Some of the major risk factors of SAD as revealed in this particular
case study include life distresses, certain temperaments, family history, as well as the
environment (Connolly et al. 2011).
The initial diagnosis involves establishing whether the child was undergoing a normal stage in
life or the problem was actually a mental disorder. Upon ruling out all the other medical
conditions, psychotherapy treatment was begun immediately. The Cognitive behavioral therapy
(CBT) sessions have proved useful because the parents have now reported that the patient's
anxiety levels have significantly reduced, and now has a normal sleep (Child Mind.org, 2019).
During CBT sessions, the child has been taught ways to face and manage his anxieties and fears
about uncertainty. In addition, the patient's parents have proved effective in providing him with
much-needed emotional support. While the patient's condition has significantly improved, his
inability to clearly identify his thoughts, we have recommended and taken him through play
therapy. Over the last week, we have combined the use of toys, games and puppets to help the
patient better express his feelings. On the other hand, I have managed to validate his feelings
and assist him better understand some of the key reasons behind them (Connolly et al. 2011). I
have also collaborated with the patient's mother to provide alternative ways of coping with
emotions, feelings and things the young patient can easily relate to.
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The other vital intervention has been a combination of CBT with medications. The combination
of psychotherapy and medications was particularly important during the initial stages when the
patient's symptoms were severe. In some instances, SAD symptoms may be caused or made
worse by family issues such as the style of parenting, personalities, divorce, financial difficulties,
among others. For this reason, it has become increasingly necessary to adopt family therapy.
The rationale for family therapy is to address family issues that may be directly or indirectly
contributing to the child's fears and anxieties. The participation of his parents and siblings to
address how he affects the rest of the family. As such, family therapy will help to create a sense
of teamwork while also reducing the notion "it's the child's problem, not mine."
The primary goal of the treatment has always been to eradicate the child's anxieties and improve
the quality of his life by enabling him to live a normal life. Severe SAD symptoms can
adversely affect the patient's school life and academic performance and his relationships with
friends and family (Wehry et al. 2014). In a nutshell, the treatment methods being implemented
have proved effective, but close monitoring and assessment are necessary to ensure a successful
recovery.
SEPARATION ANXIETY DISORDER
References
Child Mind.org (2019). Separation Anxiety: Treatment. Retrieved from
https://childmind.org/guide/separation-anxiety-disorder/sad-treatment/
Connolly, S. D., Suarez, L., & Sylvester, C. (2011). Assessment and treatment of anxiety
disorders in children and adolescents. Current psychiatry reports, 13(2), 99-110.
Mayo Clinic (2019). Separation anxiety disorder. Retrieved from
https://www.mayoclinic.org/diseases-conditions/separation-anxiety-disorder/diagnosis-
treatment/drc-20377457
Milrod, B., Markowitz, J. C., Gerber, A. J., Cyranowski, J., Altemus, M., Shapiro, T., .& Glatt,
C. (2014). Childhood separation anxiety and the pathogenesis and treatment of adult
anxiety. American Journal of Psychiatry, 171(1), 34-43.
Wehry, A. M., Beesdo-Baum, K., Hennelly, M. M., Connolly, S. D., & Strawn, J. R. (2015).
Assessment and treatment of anxiety disorders in children and adolescents. Current
psychiatry reports, 17(7), 52.
SEPARATION ANXIETY DISORDER
Journal 2:
Optionfour
Write about a continuation of a situation that you faced earlier in your clinical. How
has the situation evolved? What have you done to guide the relationship? What
interventions and so on have you tried? What is the current outcome? What are
your goals with this patient? Provide justification and reasoning for your actions.
This commentary should include reference to relevant course content or research.
SEPARATION ANXIETY DISORDER
Schizoaffectivedisorder,Bipolartype
E 36EyoEHispanicEmaleEpresentsEforEmedicationEmanagementEforESADEbipolarEtypeEcurrentlyEwellEmanagedEwithEmedication.EPatient
reportsEfeelingEwell,EbutEtiredEmostEofEtheEtime.EReportsEheEhadEaEfollowEupEwithEhisEPCPEandEreportsEhisEcholesterol,EtriglyceridesEand
sugarEbloodElevelsEareEhigh,EA1cE8,EhemoglobinE16,EEKGEandEbloodEpressureEwithinEnormalElevels.ENewEmedicationsEaddedEbyEPCP:
Metformin,EAtorvastatin,EpatientEreportsEheEhasEnotEstartedEtoEtakeEthemEyet.EPatientEwasEeducatedEaboutEtheEimportanceEofEtaking
medicationsEasEprescribed.EReportsEactiveETCM.EPSREwasErecommendedEbut the patientErefuses.EDeniesEs/hEideationsEorEpsychoticEfeatures.
E CurrentEMedications:
ZiprasidoneE80EmgEPOEQBID
ClonazepamE1EmgEPOEbid
EscitalopramE20EmgEPOEQAM
ProlixinE25EmgEIMEQmonthEE
SEPARATION ANXIETY DISORDER
A 36-year-old Hispanic male was brought to the facility for medication management for SAD
bipolar. The patient reported feelings well but fatigued most of the time. He also reports that he
had a follow up with his PCP and also reports his cholesterol, triglycerides, and sugar blood
levels are high. However, A1c 8, hemoglobin 16, EKG, and blood pressure within normal levels.
New medications added by PCP: Metformin, Atorvastatin, patient reports he has not started to
take them yet. The patient was educated about the importance of taking medications as
prescribed. The patient reports active TCM. PSR was recommended, but the patient refuses. He
denies ideations or psychotic features.
Current Medications
Ziprasidone 80 mg PO QBID
Clonazepam 1 mg PO bid
Escitalopram 20 mg PO QAM
Prolixin 25 mg IM Qmont
Therapeutic relationship is a very vital prerequisite to effective engagement and communication
between patients and care providers. Successful treatment and quality care largely depend on the
client honestly and openly sharing their experience, feelings, and emotions. In order to
strengthen the therapeutic alliance between by asking questions and providing feedback to help
the patient feel more welcome. Moreover, I made efforts to build the much-needed rapport and
trust with the patient. To achieve this, I expressed empathy and genuine for the patient's health
problem. In the words of Alinson & Chaar (2016), "patients are more likely to open up and
SEPARATION ANXIETY DISORDER
disclose the information if they trust their pharmacist or healthcare professional, and a better
quality of interaction may result in greater patient autonomy and shared decision-making."
Tests and screenings were done to rule out other conditions with similar symptoms. MRI and CT
scans were carried out to rule out some of the other conditions that may potentially be confused
with the patient's condition.
The primary goal of this treatment is to eradicate the various symptoms of schizoaffective
disorder through the necessary medical interventions. The second important goals are to restore
his well-being. It is important to note that individuals with schizoaffective disorder respond best
to a combination of medications and psychotherapy. For this reason, I prescribed individual
therapy to help improve the patient's outcomes. Psychotherapy may help to normalize thought
patterns and reduce symptoms. Building a trusting relationship in therapy helps to improve the
patient's understanding of their condition and ways to manage symptoms better (DeRosse et al
2009). The patient will undergo 20 sessions of individual therapy that will focus on his real-life
challenges, relationships, and coping strategies.
Part of the necessary strategies to help the patient overcome isolation and improve his quality of
life, he will be taken through regular sessions of life skills training. The training will emphasize
social skills training to improve communication as well as social interactions. For instance, the
patient will be trained on the necessary skills and behaviors specific to his specific settings, such
as the workplace. According to Cascade et al (2009), if the patient does not exhibit quick
recovery and is unable to resume his healthy life, he will be undertaken through vocational
rehabilitation to help him find and retain a job and relate well with everyone around.
SEPARATION ANXIETY DISORDER
References
Chaar, B. (2017). How to build and maintain trust with patients. Management, 12, 17.
Mayo Clinic (2019). Schizoaffective disorder. Retrieved from
https://www.mayoclinic.org/diseases-conditions/schizoaffective-disorder/diagnosis-treatment/
drc-20354509
DeRosse, P., Burdick, K. E., Lencz, T., Siris, S. G., & Malhotra, A. K. (2013). Empirical support
for DSM-IV schizoaffective disorder: clinical and cognitive validators from a large patient
sample.EPloS one,E8(5), e63734.
Cascade, E., Kalali, A. H., & Buckley, P. (2009). Treatment of schizoaffective
disorder.EPsychiatry (Edgmont),E6(3), 15.
SEPARATION ANXIETY DISORDER
SEPARATION ANXIETY DISORDER
Journal 3
Optionone
Write about situation that you felt you handled well. What did you do? Provide justification and
reasoning for your actions. This commentary should include reference to relevant course
content or research.
Major depressive disorder, recurrent, severe with psychotic symptoms
SEPARATION ANXIETY DISORDER
During the week, I encountered a 41-year-old woman, had a 10-year history of severe MDD
(DSM-IV). The patient's first episode began when she was 30 years old. Her depressive has
become more pronounced over the years, characterized by irritability, mood swings, lack of
interest in normal activities, severe weight loss, insomnia and poor concentration. In the las six
months, her symptoms have resulted in impaired work as well a social functioning. The patient
also reports that her father has a history of chronic depressive mood disorder. Additionally, she
has also exhibited psychotic symptoms in recent months.
This is a situation I believed I handled quite well. The combination of medications and
psychotherapy proved to be an effective strategy for treating the patient's symptoms. In the
words of Sijbrandij et al. (2014) "combined treatment with psychotherapy and antidepressant
medication is more effective than treatment with antidepressant medication alone."
Antidepressants are some of the most effective medications for treating the chronic depressive
mood disorder. For this reason, prescribed Sertraline, sold under the trade name Zoloft.
According to WebMd (2019) "Zoloft improves mood, sleep, appetite, and energy level and may
help restore your interest in daily living. It may decrease fear, anxiety, unwanted thoughts, and
the number of panic attacks." Also, this medication may also reduce the patient's urge to perform
repeated tasks that could adversely affect daily living. It is also important to note that Zoloft is a
selective reuptake inhibitor (SSRI) that works by helping the restoration of a balance of serotine
in the brain. Also, the patient revealed that her elderly father, who also suffers major depressive
disorder, had responded well to Zoloft. This was another important consideration in prescribing
this particular medication for the patient. According to Mayo Clinic (2019), if a family member
SEPARATION ANXIETY DISORDER
responds well to a given antidepressant, the same antidepressant may be one that could work for
another family member who suffers the same disorder. Essentially, inherited traits play an
integral role in how an antidepressant affects a patient.
From this course and my own research, I have learned that a combination of medications and
psychotherapy is a very effective method of treating mental disorders. Various types of
psychotherapy can be used in treating depression. These include CBT, interpersonal therapy etc.
The patient was enrolled in a 20-session CBT to help modify her thought patterns. CBT is an
effective treatment option for the major depressive disorder because it changes behaviors and
moods hence putting the patient on a path to recovery. During the CBT sessions, a therapist talks
with the patient about her actions affect her feelings and thoughts. The other vital issue to
address during CBT sessions is how the patient perceives herself, other people, as well as the
world in general (Health Quality Ontario, 2017). More importantly, the therapist uses CBT to
help the patient identify negative thought patterns that contribute to her depressive symptoms. In
a nutshell, a combination of antidepressants and psychotherapy have proved effective for this
particular patient because her psychotic symptoms have significantly reduced.
SEPARATION ANXIETY DISORDER
References
Cuijpers, P., Sijbrandij, M., Koole, S. L., Andersson, G., Beekman, A. T., & Reynolds III, C. F.
(2014). Adding psychotherapy to antidepressant medication in depression and anxiety
disorders: a meta-analysis. Focus, 12(3), 347-358.
Health Quality Ontario. (2017). Psychotherapy for major depressive disorder and generalized
anxiety disorder: a health technology assessment. Ontario health technology assessment
series, 17(15), 1.
Mayo Clinic (2019). Depression (major depressive disorder. Retrieved from
https://www.mayoclinic.org/diseases-conditions/depression/diagnosis-treatment/drc-
20356013
WebMd (2019). Drugs &Medications: Zoloft. Retrieved from
https://www.webmd.com/drugs/2/drug-35/zoloft-oral/details
