Questions I would ask the patient
Regarding this patient, I would want to know the exact factors that trigger or exacerbate his anxiety symptoms. This is important because anxiety disorders have specific triggers and identifying the various factors that worsen his anxiety would be a very important step in the management of the patient (Mayo Clinic, 2018). Once the exact cause has been identified, cognitive behavior therapy could be applied to help the patient cope with these ‘scary’ situations. Once a patient is able to manage his fears/anxiety when presented with the situations that worsen his anxiety, this would be a very important step towards his recovery.
Another question that I would want to ask the patient is the type of social support that he has. Social support is a very important aspect of treatment of mental illnesses because a lot of stigma is associated with mental illnesses and it is only by having a good social support system that the patient can cope with his symptoms (Dour, et al., 2013). Having people who understand his condition and who even encourage him through the treatment journey is key if at any success is to be achieved. In the likely event that the patient has a poor social support system, it would be helpful to link the patient up with other patients with similar symptoms so that they can support each other over the course of treatment. Group therapy would also come in very handy in such a situation as it helps to link up patients with similar symptoms and support each other over the course of the treatment.
Delegate your assignment to our experts and they will do the rest.
Another question that I would ask the patient is if he has a health insurance cover. Since the treatments could be too costly for the patient as it is expected that he would require almost lifelong treatment, health insurance cover would come in handy. The financial burden of treating his condition is likely to be an additional stressor and this would hinder his recovery and a health insurance cover would help relieve that stress.
People in the patient’s life
The first person I would want to talk to regarding the patient’s condition is his wife since she is the closest. I would ask her if she understands the patient’s condition and if she supports him. Since that the wife is the closest person to the patient, it would be very important for her to understand what the patient is going through and whether she supports the patient. By understanding what the patient is going through, the wife would help in ensuring that the patient takes his medications as advised by the doctor and that he attends his clinics as scheduled. Also, by understanding what the patient is going through, this would reduce the stigma that comes with the condition particularly the sexual dysfunction secondary to the medications the patient is using.
Another person I would want to talk to is the closest friend the patient has. I would ask him/her any confidential concerns/ issues that the patient would have raised regarding his condition. People mostly open up to their closest friends about what they are going through and this input would be very helpful in the approach I would take while treating the patient.
I would also want to talk to the mother and the question I would want to ask her is how the condition started, any triggers that she thinks could have resulted in the condition. This would helpful in formulation of a diagnosis of the patient. The patient could not be giving accurate information and a third party would come in handy in shedding more light to the patient’s condition.
Physical examination and Diagnosing testing
In order to fully understand the patient’s condition, it would be very important to carry out a comprehensive physical examination. Physical examination would be helpful in diagnosing other comorbidities that could be contributing to the patient’s condition ( Bienvenu et al, 2009) . For example, liver diseases such as hepatic encephalopathy are known to cause CNS symptoms. Also, some STIs for example syphilis are also known to have a CNS component and could also be contributing to the patient’s symptoms. Therefore, I would do a thorough head to toe exam for the patient whereby I would do the general exam, examine his CVS, CNS, Abdomen, musculoskeletal system, respiratory system, head and neck, eyes, nose and throat take his vital signs because they are also likely to give a clue as to what the patient could be having.
With regards to the diagnostic testing I would perform, I would order a CT scan to rule out any lesion in the brain, I would do a full hemogram in order to see the blood picture, I would also do a urinalysis to rule out any drugs of abuse in his system, I would also do his kidney function test, liver function test, do serology testing, genetic testing to determine if he has a gene for mental illnesses.
Differential Diagnosis
Panic attacks
Post-traumatic stress disorder
Generalized Anxiety Disorder
In my view, the patient could be suffering from GAD given that his anxiety is triggered by a wide variety of factors and the fact that he is anxious most of the time even in the absence of triggers.
Treatment of choice
I would put the patient on either Guanfacine-ER or Tiagabine and then review the patient after every 4 weeks. Guanfacine-ER would be my most appropriate choice because the fact that it dampens the sympathetic tone brings about an anxiolytic effect thus reduces anxiety.
Lessons Learnt
In this lesson I have learnt the need of coming up with the correct diagnosis before starting treatment of any mental illness. Diagnosis could be aided by use of DSM manual and also using various scales to measure the severity of symptoms.
I have learnt that in the management of GAD, monotherapy is the most effective mode of treatment and should be attempted as the first option before trying polytherapy
I have also learnt the approach of managing psychiatric patients especially those suffering from Depression and anxiety disorders and are hypertensive. This understanding is important because most of the drugs used can interact hence worsening or improving the condition.
If I meet a patient with similar symptoms in my practice, I am now in a position to initiate treatment and follow the patient up. I am also in a position to determine when to withdraw or add a drug to their treatment regimen depending on clinical progress.
References
Anxiety disorders. (2018, May 4). Retrieved from https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961
Bienvenu, O. J., Wuyek, L. A., & Stein, M. B. (2009). Anxiety Disorders Diagnosis: Some History and Controversies. Behavioral Neurobiology of Anxiety and Its Treatment Current Topics in Behavioral Neurosciences , 3–19. doi: 10.1007/7854_2009_4
Dour, H. J., Wiley, J. F., Roy-Byrne, P., Stein, M. B., Sullivan, G., Sherbourne, C. D., … Craske, M. G. (2013). Perceived Social Support Mediates Anxiety And Depressive Symptom Changes Following Primary Care Intervention. Depression and Anxiety , 31 (5), 436–442. doi: 10.1002/da.22216
