Description
George is a 44 year old man presenting with chest pains several times a week at random times. He also experiences tightness in his neck and shoulders and is tired all of the time. He worries that he forgets things sometimes and has trouble concentrating at work. He said that he works about 60 hours a week and has a wife and three children. He states that he worries about bills, the kids, the house, his job, and his parents often. He said that as soon as he gets ahead something else comes up like the heating going out in the house. He talks about his concerns to his therapist hoping for reassurance for how he is handling things. He shares that he drinks a beer each night after dinner while watching tv. He has trouble falling asleep at night as his mind races with all of the things he needs to get done tomorrow. His wife worries about his heart and he secretly wonders if he is having a heart attack but it always goes away within a few minutes. He said that he has tried atarax 25mg as needed when he feels really anxious but that it makes him too tired during the day and he already has trouble concentrating at work with too much to do.For this case study please answer the following questions:
1. How would you define his disorder?
2. What signs/symptoms would one see in the patient that demonstrate the disorder?
3. What are the main DSM-5 criteria for this disorder?
4. What are the top 3 differential diagnosis for this disorder from the DSM-5? Any differential diagnoses (Include a short line indicating why each one should be considered for the case)
5. What medications would you use? Why? Black box warnings? What medications are considered first line best practice for treating anxiety? What do you need to assess before prescribing a benzodiazepine? What special considerations should be given and discussed with the patient? How long can they expect these medications to take full effect? Alternative medications to consider?
6. Do not forget labs to rule out most organic causes of anxiety.
7. What type of therapy would you recommend for this patient with anxiety and why?
8. What do you see as the possible outcomes for this patient?
9. What are the 5 components of a suicide risk assessment (From the PowerPoint/Kaltura in Week1) that the patient needs to be asked?
