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 affects 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 non-
pharmaceutical 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 first-
line 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 non-
pharmacological 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 long-
term 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.
Darya
Module 3 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 are 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 non-
pharmacological 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.
