Panic and Generalized Anxiety Disorders

Description of Problem 

Ms. Castro is a 19-year-old woman, who is currently a sophomore in college. She is the second youngest child in a family of four children and currently lives with her mother. Ms. Castro is experiencing a lot of panic attacks attributed to the fact that her father was taken to jail the previous Wednesday. She indicates that she has a rather close relationship with her father, which gives her a sense of safety when her father is around. After her father was taken to jail, she notes that she has been experiencing feelings of sadness and insecurity considering that it becomes hard for her to cope with the fact that her father is in jail. Ms. Castro has a history of panic attacks but raises concern due to the increasing number of attacks that she has been having over the past month, which is affect her behavior in a significant way.

Ms. Castro has never received any form of treatment for Panic Disorder regardless of her experiencing her first panic attack between the age of 8 and 9 years. Additionally, she exhibits signs suggesting that suffers from generalized anxiety disorder considering that she is experiencing excessive worrying and often has difficulty sleeping and relaxing. Similar to the case of panic attacks, Ms. Castro experienced her first episode of anxiety between the age of 8 and 9 years but has never received any treatment for the same. She does not show any underlying signs to suggest that she may suffer from any other mental disorder, such as eating disorder and manic. Although she has never gone for psychiatric evaluation, Ms. Castro is currently taking Xanax from PCP as a way of managing her anxiety and panic disorders. She denies taking any illegal drugs, alcohol, or tobacco, which may serve as indicators for her symptoms.

The Client’s Vulnerabilities 

Ms. Castro has a history of Panic and Generalized Anxiety Disorders having experiencing panic and anxiety episodes from a young age. She equally has a family history of mental illnesses with her maternal aunt being diagnosed schizophrenia. On the other hand, her father is currently receiving treatment for anxiety, which is similar to one of her sisters. Her other sister is also receiving treatment for anxiety and depression. Lester, Marsit, Conradt, Bromer, & Padbury (2012) note that children brought up in family settings with mental health issues are predisposed to suffer from one or more forms of mental illnesses. The fact that some members of Ms. Castro’s family have been receiving treatment for mental illnesses highlights the possibility that she too is likely to be diagnosed with a mental disorder. That is an important vulnerability to consider while evaluating Ms. Castro considering that it will help in determining some of the underlying risks that she faces.

Ms. Castro is exhibiting general signs associated with anxiety, which are equally important to consider when evaluating her vulnerabilities. She indicated that experiences excessive worrying, especially on matters or issues that are beyond her control. The challenge is that these issues create an environment where it becomes hard for her to control her worry; hence, the possibility of panic attacks. She also noted that she had been having difficulty in sleeping, which is a sign of excessive worrying and difficulty in relaxing. For example, she has been worrying about her father, who is currently in jail, which affects her ability to engage in her everyday duties. Additionally, she indicated that she is experiencing feelings of an impending doom, which contributes to her restlessness. Panic and anxiety disorders often create feelings of doom where patients believe that they are likely to encounter some form of danger (Melton & Kirkwood, 2017). That is currently the case for Ms. Castro, who is experiencing such feelings.

The Client’s Triggers 

Ms. Castro has several triggers that contribute to some of the key signs indicated. The first trigger is her father’s current state where he has been taken to jail, which becomes a source of worry for her. Melton & Kirkwood (2017) note that watching a close family member is some form of distress often creates a sense of worry considering that it becomes hard for individuals to get over the fear that something bad is likely to happen. She noted that the number of panic attacks have increased significantly since the day her father was taken to jail, which suggests that this is a possible trigger for her symptoms. The second trigger that is likely to cause the symptoms is school. Ms. Castro identifies school as one of the main stressors, which can also be quantified as a trigger for her mental state. While considering that she is likely to encounter serious challenges in school, it becomes much harder for her to cope with other areas of her life; thus, exposing her to possible anxiety attacks.

Core Beliefs 

Ms. Castro shows extreme worry about her father, who she has been close to for a long time, and believes that it is within herself to help him. The increasing number of panic attacks is become a key source of concern not only for Ms. Castro but also for those around her considering that they are interfering with her functionality. The challenge for her is that it is becoming extremely difficult to let go of the fact that she cannot help her father. Her family has a history of anxiety disorders and depression, which predisposes her to a higher risk of these mental health issues. The combination of her risk factors and the current events taking place in her life puts Ms. Castro at a high risk of being diagnosed with Panic and Generalized Anxiety Disorders.

The Most Central Thought the Client is Avoiding 

The central though that Ms. Castro is trying to avoid is the fact that she needs professional psychiatric assistance to help her cope with the stresses that she is facing in her everyday life. Currently, she lacks the expected coping mechanisms that would allow her to handle any notable issues or challenges. The fact that Mr. Castro is willing to take Xanax from PCP while having never gone for psychiatric evaluation suggests that she is avoiding the possibility that she needs such help. It is becoming harder for her to comprehend the fact that receiving help would be of far greater benefits in ensuring that she improves her mental health to help deal with the panic attacks and anxiety episodes.

Differential Diagnosis 

Separation Anxiety Disorder 

Separation anxiety disorder is a condition that is characterized by excessive worry as a result of separation from people who matter in an individual’s life. The most significant aspect that helps to explain the development of the condition is the strong emotional attachment broken during separation. The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) maintains that there are different diagnostic criteria for the condition. The diagnostic criteria help to analyze a patient and focus on various aspects relating to the condition, with the aim of making proper diagnosis. In the case of Ms. Castro, the development of separation anxiety disorder associates with separation from her father when he was taken to jail. Considering that Ms. Castro has a close relationship with his father is a vital aspect that created strong attachments. The anxiety experienced resulted from increased feelings of sadness and insecurity considering that she considered her dad as a person who protected her and made her feel safe in her entire life.

Diagnosis 

Generalized Anxiety Disorder 

Ms. Castro depicts various signs and symptoms that relates to the generalized anxiety disorder, which is a condition that characterized by excessive worrying. The fact that the patient worries too much after her father was put to jail is the primary indicator of the generalized anxiety disorder in the patient. Other than excessive worrying, the patient presents other signs that helps to make a proper diagnosis of the generalized anxiety disorder. The signs and symptoms include difficulties falling asleep and relaxing. Additionally, the patient experiences feelings of restlessness and low concentration, which are factors that impact on the day to day activities. The presentation of the signs and symptoms relation to the condition and the analysis of the medical and family history of the patient helps to ascertain the existence of the generalized anxiety disorder. The social impairment caused by the condition in the patient’s life results in the development of behaviors such as isolation.

Panic Disorder 

Panic disorder is a condition where a patient experiences panic attacks resulting from fear. The attacks of panic are often as a result of natural responses to stressful situations. Ms. Castro is diagnosed with panic disorder considering that she exhibits various signs and symptoms that helps to reflect on the condition. The most significant symptom that is presented by the patient include the occurrence of periods of intense fear when she remembers that her father was no longer with her to offer protection against any kind of harm that may befell her. Additionally, Ms. Castro experienced severe chest pains, discomforts, and increased heart rates, which are key factors that helped to make a correct diagnosis of the patient’s condition. Another significant aspect to note about the patient is the fact that she had a history of the condition having had her first panic attack at the age of 8 years.

Other Unspecified Depressive Disorder 

Ms. Castro can also be diagnosed with other unspecified depressive disorder considering that she is exhibiting signs associated with depression. Duan et al. (2019) indicate that this category of depressive symptoms is often associated with issues relating to school, work, or relationships with others. In this case, Ms. Castro’s main stressor is school, which is affecting her ability to function effectively. The key issue of concern for her is that the amount of work she is receiving in school is way beyond her considering the stressful events in her personal life. Therefore, Ms. Castro exhibits signs of this type of depression considering that the events in her life are inhibiting her ability to enjoy the things that make her happy.

Coping Strategies 

The development of effective coping strategies is an important aspect that helps towards enabling a patient to overcome a condition and improve on day to day activities effectively. In the case of MS. Castro, one of the most significant coping strategies involve having a good plan for selfcare. The plan for selfcare takes the form of a crisis aversion plan that enables the patient to develop ways of handling difficult situations in life to avoid anxiety and panic attacks. Considering that the patient denied SI/HI, the implementation of a good plan for self-care helps to gradually address the issue faced as a strategy to letting go off the anxiety. Additionally, family support and therapeutic alliance are other coping strategies that help the patient to gradually deal with the issues of anxiety and fear. Through the therapy sessions, the patient may focus on establishing positive and strong relations with other family members who may help her to overcome fear and anxiety.

Treatment Plan 

Ms. Castro presents mild to moderate signs and symptoms, which means that she will be treated as an outpatient. Currently, she does not pose any danger or harm to herself or those around her, which is the main determinant of whether to admit her on an inpatient basis. The treatment considered with focus on supportive psychotherapy and pharmacotherapy with the objective being to ensure that she improves her ability to function in everyday life. The primary treatment will involve use of psychotherapy / Cognitive Behavioral Therapy (CBT). CBT is an important treatment approach because it establishes a hand-on approach aimed at dealing with any underling problems or issues likely to impact one’s behavior (Leichsenring & Steinert, 2017). In the case of Ms. Castro, CBT will be an important treatment approach because it will give her the opportunity to talk about her feelings, especially those relating to her father, which would improve her ability to cope with his current situation.

Ms. Castro was advised on the need to maintain a healthy lifestyle, which involves eating healthy and ensuring to engage in regular exercising and avoiding foods rich in carbohydrates and fats. On the other hand, the patient has been prescribed several medications as part of pharmacotherapy to deal with her symptoms. She will take Sertraline 50 mg PO QAM for 30 days as a way of dealing with her anxiety. She is eligible for a single refill during the 30 day period. She will also take Vistaril 10mg PO TID PRN for 90 days, which will also help her deal with anxiety. Ms. Castro will stop taking Xanax from PCP for the entire duration of treatment. She is expected to come back for a review after 4 weeks or earlier if necessary.

References

Duan, Y., Wei, J., Geng, W., Jiang, J., Zhao, X., Li, T. ... & Zhang, K. (2019). The effect of short-term use of benzodiazepines on cognitive function of major depressive disorder patients being treated with antidepressants.  Journal of affective disorders ,  256 , 1-7.

Leichsenring, F., & Steinert, C. (2017). Is cognitive behavioral therapy the gold standard for psychotherapy?: The need for plurality in treatment and research.  Jama ,  318 (14), 1323-1324.

Lester, B. M., Marsit, C. J., Conradt, E., Bromer, C., & Padbury, J. F. (2012). Behavioral epigenetics and the developmental origins of child mental health disorders.  Journal of developmental origins of health and disease ,  3 (6), 395-408.

Melton, S. T., & Kirkwood, C. K. (2017). Anxiety disorders: generalized anxiety, panic, and social anxiety disorders.  DiPiro JT, Talbert RL, Yee GC, Matzke GR, et al. Pharmacotherapy: A Pathophysiologic Approach, 10th edition. New York, NY: McGraw-Hill.