Diagnosis and Management of Generalized Anxiety Disorder.

Assignment 3 L. P., age 23, is a Hispanic woman who graduated from college last year. She reports to the CNP in her local community mental health center. She began working as an accountant 1 month after graduating.

Diagnosis and Management of Generalized Anxiety Disorder.

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Approximately 2 months ago, she moved into a two-bedroom apartment with another woman who works at the same accounting firm. She states that her roommate recommended that she see a doctor to find out if she has anemia or “some sort of fatigue syndrome.” She states that she has felt “restless” and “on edge” for most of the past 9 months. She becomes easily fatigued and irritable and has difficulty concentrating and falling asleep. She states that sometimes her mind “just goes blank,” and she is worried that her work performance is no longer excellent. She reports that all her life she had good grades in school and was very successful in everything she attempted.

Diagnosis and Management of Generalized Anxiety Disorder.

Although she has been “a worrier from the day I was born,” now she worries more than she ever has and feels nervous “all the time.” L. P. reports that she has a good relationship with her boyfriend but they do not get to see each other very often because he is attending graduate school 100 miles away. She reports having a satisfying sexual relationship with him. She denies having any problems with relationships with her parents, roommate, or peers. She denies having any financial worries unless she is fired from her job for poor work performance. She reports that she has always been healthy and has taken good care of herself.

Diagnosis and Management of Generalized Anxiety Disorder.

The only medication she takes is birth control pills, which she has taken for the past 4 years without any adverse effects. In a paper not to exceed six pages, excluding title and reference pages, submit your answers to the following in an MS Word document: What is L. P.’s likely diagnosis? List specific pharmacotherapeutic treatment goals for L. P. Should the CNP order any labs for L. P. at this time? Why? What drug therapy would the CNP likely prescribe? Why? What are the parameters for monitoring the success of the therapy?

Diagnosis and Management of Generalized Anxiety Disorder.

Describe specific patient monitoring based on the prescribed therapy. List one or two adverse reactions for the selected agent that would cause the CNP to change therapy. L. P. returns to see the CNP after six weeks, complaining of still feeling anxious and had heard of a medication called Klonopin that she would like to try; how should the CNP respond to her request? What health promotion activities should be recommended for this patient? What is L. P.’s long-term prognosis? Please use the Case Study Analysis rubric provided to guide you in completing this assignment. It will be used to evaluate your submitted work. Competency 40 36 33 0 Points Earned Case Study questions completely and thoroughly answered with accurate evidence-based supported rationales Accurate and well defined discussion of all 10 questions for the case study using current evidence-based resources.

Diagnosis and Management of Generalized Anxiety Disorder.

Accurate discussion of nine case study questions presented with use of current evidence-based resources. Accurate discussion of 8 questions using current evidence-based resources Missing response to questions or inappropriate answers to questions. No use of evidence-based resources. /40 40 36 33 0 Evidence of critical thinking therapeutic decision-making in drug selection and evaluation of patient care pathophysiology and current pharmacological research assessment of the effectiveness of drug therapy formulation of clinical care and teaching plans for persons from diverse populations Well-defined evidence of critical thinking therapeutic decision-making in drug selection and evaluation of patient care pathophysiology and current pharmacological research assessment of the effectiveness of drug therapy formulation of clinical care and teaching plans for persons from diverse populations Evidence of critical thinking in prescriptive therapy, monitoring and adverse events.

Diagnosis and Management of Generalized Anxiety Disorder.

May have lacked a teaching plan or pathophysiologic discussion. Evidence of critical thinking but incompletely described therapeutic decision making and omitted teaching plan and pathophysiology. Multiple bulleted points are absent or poorly defined in the assignment. There is no demonstration of critical thinking. /40 Competency 10 9 8 0 Points Earned Grammar, spelling, and punctuation There are no errors in grammar, spelling, and punctuation There are a few minor errors in grammar, spelling, and punctuation that do not detract from the meaning (1-3 errors) There are major errors in grammar, spelling, and punctuation .(4-5 errors) No content or more than 5 errors /10 Competency 10 9 8 0 APA Compliance The paper meets APA formatting guidelines There are a few minor errors (1-3 errors) There are significant errors in the format of the paper (4-5 errors) No content or more than 5 errors /10

Diagnosis and Management of Generalized Anxiety Disorder.

LP’s Case Study

1. P.’s likely diagnosis

The major probable diagnosis of the patient is a generalized anxiety disorder. She displays anxiety unlike previously, and she is concerned that her job success is not exceptional. It leads her to fear being unemployed. L.P. says she’s exhausted, irritable, has trouble focusing and getting sleep (Patriquin & Mathew, 2017). She as well says that her thought sometimes “goes blank.” This symptoms show that, the patient’s condition falls in the DSM-5 Diagnostic Criteria for Generalized Anxiety Disorders. The criteria controls medical care for generalized anxiety disorders (GAD)

Diagnosis and Management of Generalized Anxiety Disorder.

Pathophysiology of Generalized Anxiety Disorder

According to P-atriquin & Mathew (2017), the generalized anxiety disorder pathophysiology comprises of a disturbance in the regulation of the brain function. The prefrontal cortex and amygdala has a diminished interaction. Emotional control happens in the prefrontal cortex. Patients with GAD appear to have reduced heart rate variations, an increase in heart rate, and greater rates of skin permeability. Patriquin & Mathew claims that individuals with GAD have a unique psychophysiological feature as a hypervigilant physiological reaction at the base, as well as a prodigious reaction to the hazard.

Diagnosis and Management of Generalized Anxiety Disorder.

Goals of Treatment

Treatment for L.P. is important and if treatment is successful, it will keep it from causing major depressive disorder (MDP), which is one of the pharmacotherapy goals. Another long-term aim of treatment is to improve its quality of life and get it back to its core functioning by fully addressing its anxiety symptoms. By pharmacotherapy, the nurse professional aims to reach a full recovery of the disorder. Archangelo & Peterson (2017) claims that, once complete recovery is achieved, there is a low risk for the patient to relapse

Diagnosis and Management of Generalized Anxiety Disorder.

Initial Examination

Before the start of treatment, the patient ought to undergo a detailed physical assessment to determine all such clinical issues. Comprehensive family history can be used, concentrating mainly on psychiatric health issues. The B12 level must be derived to determine its deficiency (Seo & Park, 2015). The CNP shall as well request for a pregnancy test before beginning the patient on some drugs because she falls under the age of childbearing. There are a variety of complications involved with pregnancy. There would be a possibility that her fear would not be handled if she was pregnant. There are also several dangers involved with antidepressant use in embryonic fetuses, comprising of teratogenicity, malformation, and premature birth.

Diagnosis and Management of Generalized Anxiety Disorder.

The patient complains of getting tired quickly, which may be an indication of several other medical problems. Anemia, diabetes, sleep apnea, an underactive thyroid, restless leg syndrome, and celiac disease are a few of the disorders that should be checked before the start of pharmacotherapy (Seo & Park, 2015). The CNP should perform a blood test together with a detailed metabolic review, CBC, Iron analysis, and thyroid examinations. It is necessary to manage any basic disorders that can suppress the symptoms of GAD.

Pharmacotherapy Treatment

The initial pharmacotherapy care should begin with a one prescription, which is commonly an antidepressant. Serotonin-norepinephrine reuptake inhibitors (SNRIs) and Selective serotonin reuptake inhibitors (SSRI’s) are the priority GAD therapies. Paroxetine, which is an SSRI, is most likely recommended by the CNP. At 32 weeks, there were high remission rates of 74%, with a 10 percent relapse (Archangelo & Peterson 2017). Side effects are one of the downsides of this prescription. Relative to other medications, this treatment has a higher rate of patients developing sexual repression and weight gain. This will have to be evaluated in the patient’s follow-up visit to the facility. The CNP should be very certain to begin the patient on 10 to 20 mg of paroxetine.

Diagnosis and Management of Generalized Anxiety Disorder.

The patient should go for a follow-up to the facility in 5-10 weeks to determine the response and efficacy of the therapy. If the patient tolerates the medication well and has not encountered sexual inhibition or weight gain and has had a better clinical reaction while still having any of its effects, once the optimal clinical outcome has been reached, the CNP will perfuse the medication upwards.

Diagnosis and Management of Generalized Anxiety Disorder.

Psychotherapy Treatment

Besides pharmacotherapy, Psychotherapy should as well be provided to enable her to develop methods for coping and dealing with the stressors of her life, and ways to help alleviate the physical problems she has. Cognitive therapy (CT), Cognitive-behavioral therapy (CBT), and applied stimulation may be used (Stein & Sareen, 2015). CBT is combined with psychoeducation, anxiety exposure, applied calming, relaxation, problem-solving, internal re-structuring, and behavioral psychotherapy (Stein & Sareen, 2015). Typically, this type of therapy comprises 12-25 sessions. CT is going to teach L.P. how to critically and generally analyze her anxious feelings and it comprises of 15-20 sessions. Relaxation will teach L.P. the coping strategies that can allow her to calm easily and more efficiently mitigate and ultimately stop her anxiety responses.

Diagnosis and Management of Generalized Anxiety Disorder.

Parameters for Monitoring Success of the Therapy

Monitoring the effectiveness of treatment with L.P. is for her to record her symptoms on her own. There are 7 questions in the PROMIS Emotional Distress-Anxiety-Short Form that she can fill out before she meets with the CNP. This evaluation method was created by the American Psychiatric Association to chart success in recovery. The CNP can also check for the adverse effects and adherence to the drug. If the patient experiences adverse effects, it may make her not comply with the medication. The CNP introduced the L.P. on paroxetine.

Diagnosis and Management of Generalized Anxiety Disorder.

Paroxetine’s side effects include insomnia, weight gain, anxiety, symptoms of GI, and sexual impairment (Roberge, et al., 2017). Paroxetine is more prone than the other drug options to have sexual dysfunction and weight gain. The patient is 23 years of age and her sexual function and weight and may be of great concern to her. That could eventually cause deterioration of her GAD or failure to comply with her prescription to accumulate an unhealthy weight amount, or being unable to reach an orgasm. If she was to undergo sexual dysfunction or weight gain, this might lead CNP to alter L.P. treatment.

If L.P. is currently complaining that she feels nervous, the CNP can recommend Klonopin to cope with her anxious thoughts. Klonopin may help accelerate the restoration of these effects, but they are correlated with resistance and can only be used for a short amount of time if she thinks she is in distress (Roberge, et al., 2017).

Diagnosis and Management of Generalized Anxiety Disorder.

The CNP is expected to teach L.P. that Klonopin would not relieve her anxiety in the long term and is mainly for use in the short term. She has to realize that counseling aims to fully alleviate her anxious symptoms. This can be done by standardizing the paroxetine and re-assessing her symptoms relief in 48 weeks. The medical practitioner should recommend L.P to restrict the Klonopin use when she thinks that she is stressed.

Diagnosis and Management of Generalized Anxiety Disorder.

Lifestyle Changes

It is essential for the CNP to maintain a therapeutic interaction with the patient. She deserves to feel secure and gain confidence in the practitioner for it to be effective in her recovery plan. Providing her with education is highly essential to her recovery. Lifestyle adjustments can help alleviate anxiety associated symptoms (Roberge, et al., 2017). She should be made conscious of issues that could cause her symptoms and eliminate them. Some of the causes may comprise nutritional triggers, caffeine, nicotine, stimulants, and tension. She should as well consume balanced-diet, improve her sleeping habit, and partake in fitness exercise, which shall reduce her symptoms.

Diagnosis and Management of Generalized Anxiety Disorder.

Long – Term Prognosis

The aim of the patient’s treatment strategy, comprising of dietary adjustments, pharmacotherapy, and psychotherapy is to induce complete reduction of anxiety associated symptoms. If the patient is adherent to her medication schedule and frequently checking up with the nurse practitioner to make some changes to her treatment schedule, she possesses an extremely positive prognosis of reaching full recovery (Locke et al., 2017). Persisting pharmacotherapy 6-12 months after the patient’s symptoms have been addressed will improve her prognosis to maintain her remission as well as reducing the risk of relapse.

Diagnosis and Management of Generalized Anxiety Disorder.