anxiety of different types
This case study presents a 31-year-old male who presents with a chief complaint of “anxiety of different types.” He has had a history of feeling anxious throughout college and reports having symptoms of feeling tense, restless, irritable, and worried, which has made him argumentative and temperamental. He is employed, married, denies substance use, and denies having any medical history. He has had psychotherapy in the past, which reveals that he encountered issues with his abusive, alcoholic father. In the past, he has taken hydroxyzine for his allergic skin reaction and noticed anxiety with that medication and has taken paroxetine augmented with tiagabine, in which he has had a reasonable response. Three different providers prescribe all three medications that he is on. This client has a chronic generalized anxiety disorder and reported to be adherent to his medication and reports minor sexual side effects and fatigue from the medications.
Three Questions to Ask
It was reported that the client likes to stay busy all of the time and that he has no time for all of the things. I would ask this client if he has any hyperactivity or impulsivity symptoms, such as fidgeting, often on the go, talks excessively, difficulty waiting his turn, or interrupting or intruding on others. These symptoms are aligned in the criteria within the Diagnostic and statistical manual of mental disorders 5th edition (DSM-5) that is characterized by the hyperactivity portion of attention deficit hyperactivity disorder (ADHD) diagnosis (American Psychiatric Association, 2013). I would also ask about the inattention symptoms of ADHD, such as failing to give close attention to detail, not listening when spoken to, difficulty organizing tasks, forgetful in daily activities, or easily distracted by extraneous stimuli (American Psychiatric Association, 2013). I would ask about his history with his father and inquire about the type of abuse he had with him and then assess if the patient has experienced any dreams, flashbacks, avoidance of certain places or people, and having any reactivity associated with the traumatic event, such as irritable behavior, hypervigilance, startled response, or sleep disturbances; in which these symptoms align with the criteria of having posttraumatic stress disorder (PTSD) (American Psychiatric Association, 2013). The client did mention that he noticed to be more argumentative and temperamental, so it would be ideal to rule out PTSD.
Source of Information from Family Members
This case study reveals that the client is married. Asking the spouse about any symptoms that he or she has witnessed can gain insight about the client’s condition. It would be wise to obtain another perspective of the client to gain more evidence that the symptoms interfere with the quality of his interpersonal relationships or occupational functioning, especially if the patient has poor insight and judgment.
Physical Exam and Diagnostic Testing
Since this patient is suspected of having a chronic generalized anxiety disorder (GAD), this patient will require a careful history and physical exam and an evaluation of generalized anxiety disorder. Any medical disorder which may induce anxiety or depressive symptoms should be ruled out. Patients with late-set anxiety, weight loss, or cognitive disability are known to be at higher risk of having a physical-related cause of anxiety in which laboratory tests may include a complete blood count, chemistry panel, urinalysis, thyroid-stimulating hormone, rapid plasma reagin, and urinal toxicology screen (Wilde, Kim, Schulz, & Yudofsky, 2014). For any life-stressors that have caused anxiety or depression, the assessment will include any drug abuse history, medical history, family psychological history, and social history.
Three Differential Diagnoses
This patient has a differential diagnosis of generalized anxiety disorder. The DSM-5 determines that the diagnosis of a general anxiety disorder requires the development of chronic anxiety and worry for more than six months, issues of worry management, and the presence of three or more anxiety symptoms. (American Psychiatric Association, 2013). Such signs can include restlessness, exhaustion, difficulty concentrating, irritability, muscle tension, and sleep disturbances. Such symptoms must have distress or impairment in the daily life of the patient, and no other cause or reason is explained in a better way. Another differential diagnosis that this patient may have is a posttraumatic stress disorder. As mentioned earlier, this diagnosis requires having six or more symptoms of inattention and or six or more symptoms of hyperactivity and impulsivity (American Psychiatric Association, 2013). Such symptoms must have occurred before age 12, symptoms are present in two or more environmental contexts, symptoms interfere with social, academic, or occupational functioning, and these symptoms are not explained adequately by another condition. The third differential diagnosis would be mania, since ADHD shares some characteristics with manic symptoms of distractibility, impulsivity, and increased talkativeness (American Psychiatric Association, 2013). Mania, however, is more distinguishable by other symptoms of grandiosity, increased sexual drive, elevated mood, and rapid cycling.
