Castro is a 19-year old female, who is the second youngest child in a family of four children. Castro lives with her mum and the rest of the family as she is still pursuing her education and is a sophomore in college. When growing up, Castro was raised by both parents and in the presence of all siblings. In general, they live a happy life with no history of any kind of physical, emotional neglect or abuse. Her main complains involves having a lot of panic attacks, which she attributes to sadness after her father was taken to jail. Castro reports that she has been experiencing a lot of panic attacks and feelings of sadness since the moment that his father was taken to jail. In her entire life, Castro has always been close to her dad and they were close friends. She reports that she had never lived far from him as he was his closest family member who made her feel safe.
Patient’s History
Castro who is generally a happy, outgoing, and alert person has had previous episodes of panic disorders. The first panic attack that she ever experienced was when she was 8-9yrs. The duration of the attack was approximately two hours, meaning that it was not a severe case. In that case, Castro did not get any medical treatment or further assessment considering that the panic attack did not reoccur frequently and that it lasted a few hours. Cuijpers et al. (2016) mention that the reoccurrence of panic attacks may help to define the severity of the condition thus the need to seek specialized care. Since the first occurrence of the panic attack, Castro has experienced a few episodes of panic attacks that reoccurred later in her life. The severity of the panic attacks experienced by Castro is estimated to be medium considering that they do not cause many effects on her general wellbeing.
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The second key aspect noted as part of her medical history is the fact that she experiences a general anxiety disorder. Castro mentions that she often finds herself worrying too much about events and activities. She reports that the source of her anxiety and worry differs and that she finds it difficult to control the levels of worry thus increasing anxiety. The first episode of anxiety occurred when she was 9 years. During the time, the anxiety was moderate and did not cause any alarm, thus did not seek any medical help. Castro has experienced other episodes of anxiety whereby the signs and symptoms vary based on the situation. Some of the key symptoms that she has experienced over the years include difficulties in trying to relax, feelings of restlessness, difficulties in falling asleep, and having excessive worries Although the signs and symptoms have reoccurred over time, it is important to note that she had never sought medical treatment relating to the given symptoms.
Another important fact to note is that Castro has had a history of Von Willebrand disease, which is a genetic disorder that is characterized by a missing or defective clotting protein in the human body. However, she has no record of any surgical process and no known drug allergies. The evaluation of the family history of the patient indicates that close members of the family have had a history of different mental health disorders. Castro reports that an aunt was treated for schizophrenia, while the father was treated for anxiety disorder. Additionally, she reports that one of her sisters was treated for anxiety and depression and another one was treated for anxiety disorder. From the information given, it is necessary to note that the conditions of the mentioned family members were relatively less severe considering that they were all treated in outpatient. Cui et al. (2016) discuss that evaluating family history is an important aspect that helps to assess and diagnose a patient based on the history provided. Although the condition of a patient may not be a reflection of the family history, the history guides the diagnosis process.
Although Castro cannot identify the actual factors that cause panic attacks and anxiety, she mentions that jailing of her father is one of the most traumatizing experiences she has ever had. Being separated from a person who has always been a father and a close friend since birth is an experience that brought fear and too much worry in her life. Despite having a happy childhood life, the occurrence of such situations and the presence of other unknown stressors have played a major role in changing her behavior from being a jovial person to being a thoughtful and a dull person. However, Castro denies having engaged in alcohol consumption at any time of her life and also does not engage in drug and substance abuse. She mentions that despite having anxiety and worrying too much, her relationship with close family has not changed and that they have good interactions at all times.
Assessment
Assessing a patient is the most important step that helps to evaluate and discover a wide range of factors that concern the general wellbeing of the patient. The first significant measure undertaken when handling the patient involves administering the DSM-5, which plays a significant role in assessing the patient focusing on a wide range of factors. In the DSM-5 assessment scale, a health professional engages the patient in a structured interview that seeks to assess the signs and symptoms presented ( APA, 2013) . Ensuring that a patient meets the criteria defined in the assessment is an important aspect that helps towards achieving high levels of success in the process. During the assessment, Castro was required to provide crucial information regarding the current signs and symptoms experienced and the persistence and the reoccurrence of such symptoms. Additionally, the assessment focuses on the analysis of the physical and behavioral attributes of the patients that may have a significant role in defining the underlying conditions that Castrol may have.
In the assessment process, it is necessary to focus on engaging a patient on a mental status examination to determine some of the mental health issues that a patient may be experiencing. For Castro, the key aspects examined involved the mood, behavior, and the general perception that she had towards life in general. The assessment checked on the speech of the patient and found out that she had a normal rate, volume, and prosody, which is an indication that she did not have any abnormalities affecting her speech. The second important aspect assessed is the mood and the effect of the mood. The assessment indicated that Castro can be described as an anxious person who worried too much even with things that were beyond her control. The effects discovered concerning the anxiety involved crying. Other significant aspects noted involved the ability to make a proper judgment, a linear, organized, and goal-oriented thought process. From the assessment, the patient is diagnosed with Panic Disorder, Generalized Anxiety Disorder, and Other Unspecified Depressive Disorder.
Treatment
Initial Phase
In the initial phase of treatment, the main objective is to explore the details of the interpersonal functioning of the patient. In this stage, it is important to review the life of Castro based on the past and present aspects to connect with the development of the current signs and symptoms presented. The most significant aspect to consider in this stage is the medical and personal history of the patient and connect with the present experiences. The involvement of a therapist is important in this state considering that a patient presents signs and symptoms that require the intervention of mental health professionals. In this case, the therapist capitalizes on the implementation of an interpersonal psychotherapy approach to the patient. According to Yonkers et al. (2017) , and interpersonal psychotherapy is a limited, evidence-based, and focused approach that focuses on treating a wide range of mood disorders.
The main objective of the approach is to identify the interpersonal issue that contributes to the development of mood disorders and identify techniques to improve the interpersonal relationships in an individual's life. The approach is important in the case of Castro considering that she is considered to have different types of mood disorders that impact on her ability to engage in day to day activities effectively. Castro acknowledges having interpersonal challenges in her current life, which is an aspect that impacts on her level of concentration. She further mentions that since the time her father was put in jail, she experienced a worsened case of anxiety and too much worry that she cannot control. The therapist reviews the current symptoms of the patient and detects that Castro had other symptoms that she had not disclosed. The therapist noted that she preferred staying alone and that she had few friends that before, where she would spend most of her time crying out of too much worry and concern about her father who is in jail.
Although Castro had a good childhood life, the experience of her dad being jail cause trauma considering that the father was one of the most important persons in her life. The therapist helped Castro to identify and deal with the issues relating to anxiety and too much worry in life. As part of the interpersonal psychotherapy, the therapist recommended different sessions that may help the patient to deal with the stressors and factors that contribute to the development of panic disorders. The most important aspect to consider in this case is the fact that the therapist focused on enabling the patient to overcome the issue of her father through acceptance. The therapist used a wide range of techniques such as assurance to the patient to ensure that she deals with anxiety and too much worry that came from thinking about the dad. The implementation of the approach played a significant role in ensuring that the patient in a position to deal with ger worries and insecurities as an initial step towards healing.
Middle Phase
Considering that Castro agrees to focus on her role transition through the acceptance of the situation and concentrating on building her life, the therapist ushers her into the middle stage of the interpersonal psychotherapy. The most important thing, in this case, is the fact that Castro understands her clinical symptoms, which are related to her experience having his dad jailed. Firstly, the therapist ensured that she understood that overthinking would not change anything but result in more harm considering her vulnerability to panic attacks and anxiety disorder. Secondly, the therapist helped Castro to understand the anxiety and panic disorders were terrible mental illnesses that may impact on her ability to engage in normal day to day life effectively. In that case, Castro learned to gradually detect and monitor different signs and symptoms that relate to anxiety and panic disorder. According to Ivanova et al. (2016) , the ability to detect and monitor different kinds of symptoms that result in mental disorders is an important aspect of therapy that aids the healing process.
Another significant aspect during the middle phase of treatment is the development of tactics and techniques to guide through emotional responses to different stressors and factors that cause panic attacks in the patient. The therapist introduces different sessions that help the patient to develop interpersonal communication. In this case, it important for Castro to focus on creating a positive relationship with the mother and her other siblings. The interpersonal relations may help in creating a sense of security for the patient and deal with different kinds of fears relating to the fact that his father was in jail. The main objective of the sessions is to ensure that she accept the situation and that she finds solace in other people who may encourage how to let go of the things that she cannot control. Considering that Castro had a problem of taking things too seriously, the therapist helped her to focus only on the things that would be beneficial and not those that would cause trauma and mental health issues. At the end of the middle phase, the patient is hopeful that she will be calmer and that she will experience the ability to concentrate and rest.
Termination Phase
The termination phase includes the final sessions of the treatment plan. The main objective of this phase is to examine the progress made by the patient and take note of any improvements made. The therapist focuses on ensuring that the patient understands the need to adhere to the recommendations given in a bid to obtain positive results. In this case, the therapist ensures that Castro has indeed made some notable progress, which is an aspect that is determined by the occurrence of panic episodes. The therapist prepares the patient to live without the therapy sessions and to focus on maintaining a good mental status. The most important aspect that was noted is the fact that Castro has improved on communication and that she has experienced an improvement in handling things that are beyond control. The therapist is very keen on ensuring that the patient develops and maintains a good relationship with the family considering that they may help in providing support during the recovery process.
During this phase, the patient receives major recommendations that may help to lead a healthy life that is free from mental health issues ( Newman, Shin, & Zuellig, 2016 ). The patient is advised on the need of maintaining a healthy lifestyle by focusing on healthy habits that are beneficial to the body. The patient is encouraged to maintain a healthy diet and exercise regularly. Additionally, the patient receives medication that helps to reduce the anxiety levels and enable her to rest and overcome feelings of restlessness. The therapist encourages Castro to finish the dosage considering the implications that may be experienced in a situation where she does not take the prescribed medication. To maintain a good and healthy mental state, it is important that the patient avoids stressors and focus on the things that make her happy and content. Lastly, she is advised to return after four weeks for checkup and assessment.
Conclusion
Dealing with patients with a mental health issue requires proper implementation strategies and approaches that help towards identifying the underlying factors that contribute to the given condition. In the case of Castro, the most important aspect was to understand the underlying symptoms and assess the medical and family history of the patient. The assessment plays a significant role in making a proper diagnosis and determines factors that contribute to the development of the condition. During the assessment, the patient needs to provide accurate information regarding the signs and symptoms presented. After making a proper diagnosis, it is necessary to focus on the implementation of a treatment plan that helps to guide the patient in the recovery process. The treatment plan includes the initial, middle, and termination phases. In mental health issues, a therapist has a significant role in ensuring that a patient undergoes the treatment plan effectively.
References
APA. (2013). Desk Reference to the Diagnostic Criteria from DSM-5™. Washington DC: American Psychiatric Association.
Cui, H., Zhang, J., Liu, Y., Li, Q., Li, H., Zhang, L. ... & Li, W. (2016). Differential alterations of resting‐state functional connectivity in generalized anxiety disorder and panic disorder. Human brain mapping , 37 (4), 1459-1473.
Cuijpers, P., Gentili, C., Banos, R. M., Garcia-Campayo, J., Botella, C., & Cristea, I. A. (2016). Relative effects of cognitive and behavioral therapies on generalized anxiety disorder, social anxiety disorder, and panic disorder: A meta-analysis. Journal of Anxiety Disorders , 43 , 79-89.
Ivanova, E., Lindner, P., Ly, K. H., Dahlin, M., Vernmark, K., Andersson, G., & Carlbring, P. (2016). Guided and unguided Acceptance and Commitment Therapy for social anxiety disorder and/or panic disorder provided via the Internet and a smartphone application: A randomized controlled trial. Journal of anxiety disorders , 44 , 27-35.
Newman, M. G., Shin, K. E., & Zuellig, A. R. (2016). Developmental risk factors in generalized anxiety disorder and panic disorder. Journal of affective disorders , 206 , 94-102.
Yonkers, K. A., Gilstad-Hayden, K., Forray, A., & Lipkind, H. S. (2017). Association of panic disorder, generalized anxiety disorder, and benzodiazepine treatment during pregnancy with the risk of adverse birth outcomes. JAMA Psychiatry , 74 (11), 1145-1152.
