Summary of Case
Adam is a 21-year-old male college student who presents with chief complains of inability to attend class and to leave his dorm room. He reports that these problems started when he was a freshman and was on his way from class. His heart started racing, his chest tightened and experienced difficulty breathing. He reports that when he got to his dorm room, the symptoms went away. He has had several similar episodes in different places except in his room. He also explains that he is unable to predict the occurrence of symptoms but is constantly worries that he might die or have an embarrassing incident such as loss of bodily functions. This fear has caused him to rarely leave his room or to attend classes. He only manages to leave his room while intoxicated, as that helps calm his nerves.
Differential diagnosis
Generalized anxiety disorder
Social phobia
Situational anxiety disorder
Cardiac disease
Pulmonary conditions such as COPD
Laboratory and Diagnostic tests
Anxiety disorders are diagnosed through a history and mental state exam which meets the criteria for diagnosis of anxiety disorders as per DSM-5 (Giaccobe & Flint, 2018). However, tests can be carried out to rule out physical causes of the symptoms. These tests include: - thyroid function tests, complete blood count, urine drug screen, urinalysis and echocardiogram.
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Treatment plan
Pharmacological treatment
Pharmacological management of anxiety disorders is mainly selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). The use of SSRIs in management of anxiety disorders is based on the effect of the medication on serotonin, a neurotransmitter that is associated with mood regulation and is considered imbalanced in patients with anxiety disorders (Giaccobe & Flint, 2018). SSRIs therefore decrease the reabsorption of serotonin in nerve cells, stabilizing the levels. Stabilization of serotonin decreases anxiety and regulates an individual’s mood. TCAs also inhibit the reuptake of serotonin and norepinephrine, hence stabilizing their levels in the brain. The result is a balance in the neurotransmitters, reducing symptoms of anxiety and stabilizing a person’s mood.
Non-pharmacologic management of anxiety?
Anxiety can also be managed using cognitive and behavioral therapy. Cognitive therapy involves helping the patient understand how false and automatic thoughts cause anxiety and in turn the behaviors manifested (Springer et al., 2018). A therapist helps the patient develop new ways of thinking and behaving to avoid anxiety disorders. Behavioral therapy involves sequentially exposing the patient to stimuli that provokes anxiety, causing the patients to be desensitized to the stimuli (Bandelow et al., 2017). In addition, the patient can practice techniques to help them relax when faced with anxiety-provoking situations.
References
Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in clinical neuroscience , 19 (2), 93.
Giacobbe, P., & Flint, A. (2018). Diagnosis and Management of Anxiety Disorders. CONTINUUM: Lifelong Learning in Neurology , 24 (3), 893-919.
Springer, K. S., Levy, H. C., & Tolin, D. F. (2018). Remission in CBT for adult anxiety disorders: A meta-analysis. Clinical psychology review , 61 , 1-8.
