Assignment Task: Respond to the following:
I. Daniela
Anxiety Case
Summarize the clinical case
Ms. JN is a 24y old student of law with the complaints of the generalized anxiety disorder. She presents herself with continuous concern in various areas of her life such as academics, money and the health of her husband. According to her, she experiences fatigue, difficulty in concentration, headache as well as the spasms of the neck muscles which affect her normal functioning every day. Her husband confirms her over worrying about many things and talking about her as a worrier and that she is a worrying wife. Though in the past anxiety motivated her, in the last year her symptoms have been reaching the level of debilitation.
Formulate
Following the description of clinical manifestation, Ms. JN can be diagnosed with generalized anxiety disorder (GAD) with the features of excessive worrying, physical tension, and the inability to regulate anxiety during more than six months (DeGeorge et al., 2022). The diagnosis is supported by her school-related anxiety, sleeplessness, and physical pain. The formulation has taken into consideration both the psychosocial component, including the law school stress, and the biological susceptibility, since she has been anxious since her early age.
The progression and the persistence of her anxiousness give rise to the possibility that change programs in both pharmaceutical and nonpharmaceutical ways are required. The aim is to minimize anxiety, maximize focus and sleep and optimize her overall functioning.
List of the problems of the patient and prioritize them:
The issue raised is an extreme generalized anxiety with much distress and impaired performance. Secondary complications are contraindicated with insomnia that causes the aggravation of fatigue and concentration deficit, and somatic symptoms, such as headaches and muscle spasms (DeGeorge et al., 2022). The issue of academic stress is also contextual, which is worsening her anxiety and making her whole life more burdened. Relationship strain can also be the case because she worries too much as she reports to the husband. The priorities should be to address her anxiety first followed by a better sleep and additional somatic symptoms with support interventions on the academic and relationship stress.
Pharmacologic Treatment and Rationale:
SSRIs, including sertraline, would also be the preferred firstline pharmacological agent to manage GAD because of their proven effect and tolerable profile. SSRI lowers the excessive worry and bodily sign of nervousness through control of serotonin within the brain (Kidd et al., 2022). They are widely tolerated and said to be safer than the benzodiazepine that leads to dependence. Since she is old with a history of anxiety area of need, SSRIs are long-term solution. Treatment would begin with a low dose, and the dose would be progressively stepped up to ensure that the side effects remained at minimal levels in order to treat the patient effectively.
Non-pharmacological treatment and rationale
Cognitive-behavioral therapy (CBT) is the best nonpharmacological therapy in the case of GAD. CBT is used to assist patients in pinpointing and reformulating maladaptive cognitions, decreasing unnecessary worry, and working out a skillful coping plan (Kidd et al., 2022). It also offers the use of relaxation training and mindfulness that would deal with the insomnia and somatic symptoms experienced by Ms. JN. Through this plan, she will have the strengths to deal with stressors, like pressure at school, in a healthier manner.
Integration of CBT and pharmacotherapy has proven to be the best in long-term results.
Appropriateness, cost, effectiveness, safety and patient adherence potential of treatment SSRI can be considered appropriate and evidenced-based in the case of GAD, and it presents effectiveness at a relatively low cost when generic options are taken. They can be used long-term, although patients need to be watched to evaluate side effects including gastrointestinal upset or sexual dysfunction (DeGeorge et al., 2022). CBT is most effective yet can be more expensive based on insurance coverage and the availability of therapeutic trained professionals. Nonetheless, it has a great safety profile, and its acquisition allows the development of longterm skills preventing the risk of relapse. With the combination of medication and therapy, patient adherence is likely to be high due to the increase in symptoms that induce the continuation to remain in the treatment. Need Assignment Help?
II. Darya
Module Discussion: Anxiety Case
Summary of the clinical case
Ms. JN, a 24-year-old law student, presents with symptoms of excessive worry, stress, fatigue, difficulty concentrating, frequent headaches with associated neck muscle spasms, and difficulty falling asleep. Her symptoms have become debilitating over the past year. Her husband describes her as a chronic worrier who experiences anxiety about various aspects of life. Ms. JN states that she has always had some anxiety but previously found it motivating, whereas now it is beyond her control.
Formulation - causes, and precipitants of the client's presenting problems
Ms. JN is experiencing stress and anxiety related to her academic responsibilities. The pressure to perform well and the fear of failure may contribute to her symptoms. There is also the problem of chronic worrying. Ms. JN's husband describes her as a chronic worrier, which suggests that she may be predisposed to excessive worry and anxiety.
This chronic worrying pattern has intensified over time, leading to debilitating symptoms. Also, Ms. JN mentions that her symptoms have become more severe over the last year. Exploring any potential life events, trauma, or changes in her environment that may have triggered or exacerbated her symptoms is essential.
List of patient's problems and prioritization:
- Excessive worry and stress
- Fatigue and difficulty concentrating
- Headaches and neck muscle spasms
- Difficulty falling asleep
Pharmacological treatment:
Considering the severity and debilitating nature of Ms. JN's symptoms, pharmacological intervention may be necessary. Selective serotonin reuptake inhibitors (SSRIs), such as escitalopram or sertraline, are commonly used as first-line pharmacotherapy for generalized anxiety disorder (GAD) and can be effective in reducing excessive worry, anxiety, and associated symptoms (Ansara, 2020). SSRIs have demonstrated efficacy, safety, and tolerability in treating GAD. They increase serotonin levels in the brain, which helps regulate mood and anxiety.
SSRIs have shown efficacy in reducing excessive worry and anxiety symptoms in patients with GAD, which aligns with Ms. JN's clinical presentation. Also, they are generally safe and well-tolerated when used as prescribed. Adverse effects may include initial activation, gastrointestinal symptoms, or sexual side effects, but they are typically mild and transient. Once-daily dosing and ease of administration enhance patient adherence to pharmacological treatment (Ansara, 2020). Besides, SSRIs can be used for an extended period, allowing Ms. JN to effectively manage her chronic anxiety symptoms.
Non-pharmacological treatment
In addition to pharmacological treatment, non-pharmacological interventions should complement and enhance the overall treatment plan. Cognitive-behavioral therapy (CBT) is a well-established psychotherapeutic approach for anxiety disorders, including GAD. CBT effectively reduces anxiety symptoms, excessive worry, and maladaptive thinking patterns associated with GAD (Newman, Zainal, & Hoyer, 2020). It focuses on identifying and modifying unhelpful thoughts and behaviors, teaching relaxation techniques, and improving coping strategies. Also, it is a non-invasive and safe treatment option with no significant adverse effects. CBT equips patients with skills and techniques they can utilize beyond the duration of therapy, promoting long-term symptom management and relapse prevention (Newman et al., 2020). CBT involves active participation from the patient, allowing them to develop a sense of control over their anxiety and its impact on their life.
Assessment of treatment appropriateness, cost, effectiveness, safety, and potential for patient adherence Pharmacological treatment with an SSRI and non-pharmacological treatment with CBT is appropriate and evidence-based interventions for generalized anxiety disorder. The combination of pharmacotherapy and psychotherapy is more effective than either treatment alone. Regarding cost, the availability and pricing of medications and therapy sessions may vary depending on insurance coverage and healthcare systems.
However, many SSRIs are available in generic forms, which can help reduce costs. The average cost of generic antidepressants without insurance is $62.50 for 30 tablets (Ansara, 2020). CBT may require multiple sessions, which should be considered regarding the patient's financial resources and access to mental health services.
Both pharmacological and non-pharmacological treatments have effectively reduced anxiety symptoms and improved overall well-being.
However, it is essential to regularly assess treatment progress and modify the treatment plan if needed. In terms of safety, both treatments are generally considered safe when used appropriately. However, close monitoring for any potential side effects or adverse reactions is essential, especially during the initial stages of treatment (Newman et al., 2020).
Patient adherence is a crucial factor for successful treatment outcomes.
The simplicity of once-daily dosing for SSRIs may promote patient adherence. CBT requires active participation from the patient, and their motivation and commitment to therapy play a significant role in its effectiveness. Regular therapy sessions and homework assignments may enhance patient engagement and adherence to treatment goals.
Combining pharmacological treatment with an SSRI and nonpharmacological treatment with CBT provides a comprehensive and evidence-based approach to address Ms. JN's excessive worry, anxiety, and associated symptoms. The appropriateness, cost, effectiveness, safety, and potential for patient adherence should be continuously assessed and addressed throughout treatment to optimize outcomes.