Anxiety Disorders Case Analysis Paper
Questions and Suggested Answers
1. What behaviors does this client have that match the criteria for a diagnosis of Generalized Anxiety Disorder?
In order to meet the criteria for a diagnosis of Generalized Anxiety Disorder (GAD), a person must have
“excessive anxiety and worry” and “apprehensive expectation” occurring on more days than it does not occur for at least six months and involving a variety of worries about various events or activities. The person has to find it difficult to control the anxiety and worry. In addition, the person must have at least three other symptoms from a list including restlessness, fatiguing easily, concentration difficulties, irritability, muscle tension, and sleep problems, which include difficulty …show more content…
getting asleep, difficulty staying asleep, or feeling as if the sleep has not satisfied their needs (APA, 2000). Betty has had excessive worry most days for over six months.
The nurse observed this client’s restless behavior and heard her complaints of fatigue. The client’s husband described her failure to sleep at night. In addition to the criteria already mentioned, the person diagnosed as having GAD must experience significant distress or impairment in some area of functioning, such as social or occupational, as a result of the anxiety, worry, or physical symptoms. Betty has experienced impairment in both social and occupational areas of her life as a result of her anxiety and worry.
2. How common is the diagnosis of Generalized Anxiety Disorder? Is it common for clients with GAD to have comorbidity, and should this client be assessed for any particular condition? According to Mason and
Jacobson (1999), Generalized Anxiety will affect one in twenty adults sometime during their lives and most of those affected will be women. This is congruent with the DSM IV-TR statement that the lifetime prevalence rate of GAD was 5 percent based on a community sample. A large percentage of people with GAD are believed to have a comorbid diagnosis. Wells (1999) describes one national comorbid survey that found more than 90 percent of those with a diagnosis of GAD had a comorbid diagnosis, with 22 percent experiencing dysthymis and 39–69 percent experiencing depression. This client needs to be screened for symptoms of mood disorders.
3. What explanation do you have for the number of family members coming to the community mental health center with this client? If you were the nurse, how would you deal with Betty’s request for her whole family to accompany her to see you? Hispanic and Hispanic Americans are often part of a large extended family
system.
It is not unusual for extended family members to accompany a Hispanic or Hispanic American person to the office of health care providers or to a health care facility. You need to build some rapport with the family, and this involves respecting the family and their culture, acknowledging each family member, and accepting any input given voluntarily from family members. When the client has medical problems, the nurse can perform most if not all procedures with family members present. When the client has mental health problems, it is important to observe interactions with others, but it is also exceedingly important to talk with the client alone so the client’s issues can be explored in a therapeutic environment with a professional and without the distraction of family members.
4. Before the nurse, or any other staff at the community mental health center, can talk with Betty’s family health care provider, what do they need to do? Before talking with the family health care provider about Betty’s case, the nurse needs to get a release of information form signed by Betty.
5. What does the nurse need to know about buspirone? What teaching needs to be done with the client in …show more content…
regard to buspirone? What medications other than buspirone are being used in the treatment of GAD, and how effective are they? The nurse needs to know the following information about buspirone:
• It binds to serotonin and dopamine receptors increases norepinephrine metabolism in the brain.
• It is contraindicated in hypersensitivity and severe hepatic or renal impairment.
• Usual dose is 20–30 mg/day and is not to exceed 60mg/day.
• Concurrent use with itraconazole or erythromycin increases blood levels and dosage reduction may need to occur if using these drugs.
CASE STUDY 2 BETTY 29
TDE-RICHIM-06-0602-002.indd 29 7/26/06 8:23:33 PM
Answers to all 40 Case Studies Included in the Instructor’s Manual!
Instructor’s Manual Available Only to Adoptiong CustomersCase Studies Product Sampler Answers to Sample Case Study
30 Part 2 THE CLIENT EXPERIENCING ANXIETY
• Patients changing from other antianxiety drugs to BuSpar should be gradually tapered off their other antianxiety meds before being placed on BuSpar.
• While some improvement may occur in seven to ten days, optimal improvement takes three to four weeks. Teaching about buspirone needs to include the following information:
• Buspirone is given for the management of anxiety.
• It must be taken exactly as directed.
• Although food slows absorption, this drug may be taken with food to decrease gastric irritation. It needs to be taken either consistently with or consistently without food.
• Alcohol and other CNS depressants are not to be concurrently used.
• Client should consult health care provider before taken any over-the-counter drugs.
• Client should notify health care provider if any abnormal movements noticed while on this drug.
• Side effects can include dizziness and drowsiness so client shouldn’t drive until he or she knows the medication is not going to cause these side effects.
• Client should keep follow-up appointments to evaluate effectiveness of medication (Spratto and Woods,
2006).
In addition to buspirone, venlafaxine extended release therapy (Effexor XR) has been found to be effective in treating the symptoms of Generalized Anxiety Disorder (Rose, 1998). Imipramine, opirpramol, paroxetine, and trazodone have also been found to improve symptoms over four to eight weeks (Newman,
Consoli, and Andres, 1999).
6. What are some of the interventions, in addition to antianxiety drugs, that are being used with clients who have GAD? Cognitive Behavioral Therapy is one of a number of treatment modalities used today with patients who have a diagnosis of GAD. Wells (1999) describes a model in which generalized anxiety is an abnormal state of worrying involving worry about worrying. In the therapy, worry is used as a strategy to control worry and put it to work. Newman and Consoli (1999) report a palmtop computer program that can be used to increase the efficiency of Cognitive Behavioral Therapy in working with clients with GAD. The program, as they describe it, assists in ongoing unobtrusive gathering of data about treatment adherence and the impact of the therapy
techniques.
The computer draws the treatment out beyond the hour with the therapists and motivates clients to do homework assignments by “prompting practice of cognitive behavioral strategies.”
7. At one point the daughter says that she thinks Betty is not showing progress. What progress, if any, do you think has been made? What can you tell the daughter? The client has made some progress in the area of “trust” and developing trusting relationships. Betty confided her feelings and thoughts about the husband loaning money to the daughter. You can tell the daughter that the medication Betty is taking has a slow onset of action: it tends to require at least two weeks to show benefits and longer for maximum benefit. Frisch and Frisch (2006) point out that the effect of buspirone is delayed, often as much as seven weeks, but it can be as effective as benzodiazepines in controlling anxiety/worry without the abuse potential of benzodiazepines.
8. What do you think about Betty’s sister using herbal remedies and rituals for driving out evil spirits in trying to cure Betty? Do herbal remedies work? Many herbal remedies do produce some beneficial effects,
and herbals are used in the development of new medicines; however, the nurse in this case must caution Betty about the possibility of her herbal medication interacting negatively with her prescribed medications, as well as a lack of control on the quality of herbal medicines. The nurse needs to advise her to check with her prescribing health acre provider before taking herbals. Kava has been found to have an effect on vagal cardiac control in Generalized Anxiety Disorder (Watkins et al. 2001). According to Akhondzadeh et al.
(2001), Passaflora (passionflower) is an old folk remedy for anxiety. Treatment effectiveness of passaflora was compared to that of oxazepam (Serax) in a double-blind randomized trial. While oxazepam results were
TDE-RICHIM-06-0602-002.indd 30 7/26/06 8:23:34 PMCase Studies Product Sampler Answers to Sample Case Study seen quicker, this drug produced impairment of job performance whereas passaflora was found to be effective with a much lower incidence of job performance impairment. Rituals to drive out evil spirits may help decrease anxiety for some people. If a person believes strongly enough that a ritual will drive out evil spirits, it could possibly stop the worry or reduce the time spent in worrying. 9. What nursing diagnoses would you write for Betty related to her Generalized Anxiety Disorder? Possible nursing diagnoses based on the assessment of Betty’s generalized anxiety include:
• Anxiety
• Impaired social interaction
• Social isolation
• Altered role performance
1. What behaviors does this client have that match the criteria for a diagnosis of Generalized Anxiety Disorder?
In order to meet the criteria for a diagnosis of Generalized Anxiety Disorder (GAD), a person must have
“excessive anxiety and worry” and “apprehensive expectation” occurring on more days than it does not occur for at least six months and involving a variety of worries about various events or activities. The person has to find it difficult to control the anxiety and worry. In addition, the person must have at least three other symptoms from a list including restlessness, fatiguing easily, concentration difficulties, irritability, muscle tension, and sleep problems, which include difficulty …show more content…
getting asleep, difficulty staying asleep, or feeling as if the sleep has not satisfied their needs (APA, 2000). Betty has had excessive worry most days for over six months.
The nurse observed this client’s restless behavior and heard her complaints of fatigue. The client’s husband described her failure to sleep at night. In addition to the criteria already mentioned, the person diagnosed as having GAD must experience significant distress or impairment in some area of functioning, such as social or occupational, as a result of the anxiety, worry, or physical symptoms. Betty has experienced impairment in both social and occupational areas of her life as a result of her anxiety and worry.
2. How common is the diagnosis of Generalized Anxiety Disorder? Is it common for clients with GAD to have comorbidity, and should this client be assessed for any particular condition? According to Mason and
Jacobson (1999), Generalized Anxiety will affect one in twenty adults sometime during their lives and most of those affected will be women. This is congruent with the DSM IV-TR statement that the lifetime prevalence rate of GAD was 5 percent based on a community sample. A large percentage of people with GAD are believed to have a comorbid diagnosis. Wells (1999) describes one national comorbid survey that found more than 90 percent of those with a diagnosis of GAD had a comorbid diagnosis, with 22 percent experiencing dysthymis and 39–69 percent experiencing depression. This client needs to be screened for symptoms of mood disorders.
3. What explanation do you have for the number of family members coming to the community mental health center with this client? If you were the nurse, how would you deal with Betty’s request for her whole family to accompany her to see you? Hispanic and Hispanic Americans are often part of a large extended family
system.
It is not unusual for extended family members to accompany a Hispanic or Hispanic American person to the office of health care providers or to a health care facility. You need to build some rapport with the family, and this involves respecting the family and their culture, acknowledging each family member, and accepting any input given voluntarily from family members. When the client has medical problems, the nurse can perform most if not all procedures with family members present. When the client has mental health problems, it is important to observe interactions with others, but it is also exceedingly important to talk with the client alone so the client’s issues can be explored in a therapeutic environment with a professional and without the distraction of family members.
4. Before the nurse, or any other staff at the community mental health center, can talk with Betty’s family health care provider, what do they need to do? Before talking with the family health care provider about Betty’s case, the nurse needs to get a release of information form signed by Betty.
5. What does the nurse need to know about buspirone? What teaching needs to be done with the client in …show more content…
regard to buspirone? What medications other than buspirone are being used in the treatment of GAD, and how effective are they? The nurse needs to know the following information about buspirone:
• It binds to serotonin and dopamine receptors increases norepinephrine metabolism in the brain.
• It is contraindicated in hypersensitivity and severe hepatic or renal impairment.
• Usual dose is 20–30 mg/day and is not to exceed 60mg/day.
• Concurrent use with itraconazole or erythromycin increases blood levels and dosage reduction may need to occur if using these drugs.
CASE STUDY 2 BETTY 29
TDE-RICHIM-06-0602-002.indd 29 7/26/06 8:23:33 PM
Answers to all 40 Case Studies Included in the Instructor’s Manual!
Instructor’s Manual Available Only to Adoptiong CustomersCase Studies Product Sampler Answers to Sample Case Study
30 Part 2 THE CLIENT EXPERIENCING ANXIETY
• Patients changing from other antianxiety drugs to BuSpar should be gradually tapered off their other antianxiety meds before being placed on BuSpar.
• While some improvement may occur in seven to ten days, optimal improvement takes three to four weeks. Teaching about buspirone needs to include the following information:
• Buspirone is given for the management of anxiety.
• It must be taken exactly as directed.
• Although food slows absorption, this drug may be taken with food to decrease gastric irritation. It needs to be taken either consistently with or consistently without food.
• Alcohol and other CNS depressants are not to be concurrently used.
• Client should consult health care provider before taken any over-the-counter drugs.
• Client should notify health care provider if any abnormal movements noticed while on this drug.
• Side effects can include dizziness and drowsiness so client shouldn’t drive until he or she knows the medication is not going to cause these side effects.
• Client should keep follow-up appointments to evaluate effectiveness of medication (Spratto and Woods,
2006).
In addition to buspirone, venlafaxine extended release therapy (Effexor XR) has been found to be effective in treating the symptoms of Generalized Anxiety Disorder (Rose, 1998). Imipramine, opirpramol, paroxetine, and trazodone have also been found to improve symptoms over four to eight weeks (Newman,
Consoli, and Andres, 1999).
6. What are some of the interventions, in addition to antianxiety drugs, that are being used with clients who have GAD? Cognitive Behavioral Therapy is one of a number of treatment modalities used today with patients who have a diagnosis of GAD. Wells (1999) describes a model in which generalized anxiety is an abnormal state of worrying involving worry about worrying. In the therapy, worry is used as a strategy to control worry and put it to work. Newman and Consoli (1999) report a palmtop computer program that can be used to increase the efficiency of Cognitive Behavioral Therapy in working with clients with GAD. The program, as they describe it, assists in ongoing unobtrusive gathering of data about treatment adherence and the impact of the therapy
techniques.
The computer draws the treatment out beyond the hour with the therapists and motivates clients to do homework assignments by “prompting practice of cognitive behavioral strategies.”
7. At one point the daughter says that she thinks Betty is not showing progress. What progress, if any, do you think has been made? What can you tell the daughter? The client has made some progress in the area of “trust” and developing trusting relationships. Betty confided her feelings and thoughts about the husband loaning money to the daughter. You can tell the daughter that the medication Betty is taking has a slow onset of action: it tends to require at least two weeks to show benefits and longer for maximum benefit. Frisch and Frisch (2006) point out that the effect of buspirone is delayed, often as much as seven weeks, but it can be as effective as benzodiazepines in controlling anxiety/worry without the abuse potential of benzodiazepines.
8. What do you think about Betty’s sister using herbal remedies and rituals for driving out evil spirits in trying to cure Betty? Do herbal remedies work? Many herbal remedies do produce some beneficial effects,
and herbals are used in the development of new medicines; however, the nurse in this case must caution Betty about the possibility of her herbal medication interacting negatively with her prescribed medications, as well as a lack of control on the quality of herbal medicines. The nurse needs to advise her to check with her prescribing health acre provider before taking herbals. Kava has been found to have an effect on vagal cardiac control in Generalized Anxiety Disorder (Watkins et al. 2001). According to Akhondzadeh et al.
(2001), Passaflora (passionflower) is an old folk remedy for anxiety. Treatment effectiveness of passaflora was compared to that of oxazepam (Serax) in a double-blind randomized trial. While oxazepam results were
TDE-RICHIM-06-0602-002.indd 30 7/26/06 8:23:34 PMCase Studies Product Sampler Answers to Sample Case Study seen quicker, this drug produced impairment of job performance whereas passaflora was found to be effective with a much lower incidence of job performance impairment. Rituals to drive out evil spirits may help decrease anxiety for some people. If a person believes strongly enough that a ritual will drive out evil spirits, it could possibly stop the worry or reduce the time spent in worrying. 9. What nursing diagnoses would you write for Betty related to her Generalized Anxiety Disorder? Possible nursing diagnoses based on the assessment of Betty’s generalized anxiety include:
• Anxiety
• Impaired social interaction
• Social isolation
• Altered role performance