Psychiatry: Case Analysis

Psychiatry: Case Analysis
Your Name
Subject and Section
Professor’s Name
Date
1 Summarize the clinical case
This is a case of J.N., a 24-year-old female, married, and a law student, who complains of increased anxiety, incapacitating the patient secondary to the lack of control over the condition. Specifically, this is manifested by constant worrying about academic workload and performance, possible accidents, unemployment, and financial issues. This is associated with increased stress, headache, fatigue, poor concentration, insomnia, and cervical muscle spasms. Previously, the condition motivated the patient, but currently, the gravity of the anxiety is disproportionate to the situation.
2 Generate a primary and two differential diagnoses. Use the DSM-5 to support your assessment. Include the DSM-5 and ICD-10 codes.
Primary Diagnosis
1 Generalized Anxiety Disorder. DSM-5 Code 300.02, ICD-10 Code F41.1 (ICD10data.com, 2022).
According to the Diagnostic and Statistical Manual of Mental Disorders-5, generalized anxiety disorder is characterized by disproportional and unwarranted worrying about many aspects of daily life, and the patient lacks control of her response. Specifically, the patient must fulfill at least three of the six symptoms, including easy fatigability, restlessness, poor concentration or mind block, irritability, sleep dysfunction, and muscle tension. Additionally, the patient must have difficulty in controlling the symptoms. These must be present for most days in the past six months, and the condition should not be the result of another psychiatric condition (Crocq, 2017).
In this case, the patient fulfilled five out of the six criteria, and the symptoms persisted for most of the days in a year and admitted that there is a difficulty in controlling the anxiety. There is also evidence of the significant negative impact of the disorder in her routine activities. Moreover, the condition does not seem to be related to another mental health condition.
Differential Diagnoses:
1 Social Anxiety Disorder. DMS-5 Code 300.23, ICD-10 Code F40.10 (ICD10Data.com, 2022)
This is exemplified by a fear that is out of proportion with the actual threat in social situations or in circumstances where the individual is prone to scrutiny (i.e., rejection, humiliation, etc.). Social phobia elicits fear and/or anxiety, resulting in avoidance in such situations. The condition must be present for at least six months, and another mental or medical condition should be ruled out (Substance Abuse and Mental Health Services Administration, 2016).
2 Adjustment Disorder Mixed with Anxiety. DSM-5 Code 309.24, ICD-10 Code F43.22 (ICD10Data.com, 2022)
This condition is observed within three months after a stressor has been introduced to the individual, resulting in a varied behavioral or emotional response. Additionally, the level of distress is out of proportion to the exciting event, and the symptoms are debilitating to the individual’s routine activities. Adjustment disorder with predominant anxiety symptoms illustrates excessive nervousness, jitteriness, worry, or separation anxiety (Substance Abuse and Mental Health Services Administration, 2016).
3 Create a list of the patient’s problems and prioritize them.
The following problems are listed according to priority:
Problem list:
1 Increased anxiety
Heightened anxiety is a significant risk factor in patients who develop a major depressive disorder. Anxiety is quite common, especially in the undergraduate and postgraduate degrees, secondary to the high academic demand, worrying about failure, and the inability to control the situation, resulting in a negative impact on the patient’s life (England et al., 2019).
This is the most crucial problem of the patient because she is currently a law student and a wife, and demands of the school concurrent to the demands of married life already exceed her capacity, and without adequate intervention, the patient will be lost to anxiety beyond salvation. This is manifested by her complaints of increased anxiety when given a high workload at school and during examinations. This is probably the root cause of all the other problems in this list, but the rest are separated since another intervention can solve these.
2 Insomnia, poor concentration, and fatigue.
Insomnia is a chronic sleep disorder that may range from the following symptoms: difficulty in maintaining sleep, poor sleep quality, difficulty falling asleep, and a short duration of sleep. This is highly associated with cognitive dysfunction resulting in poor information processing, deprived learning, poor concentration, memory and recall, and inferior rationality (Haile et al., 2017). This can also result in daytime fatigue secondary to the lack of stress (Pathak, 2020). Hence, these three belong to a single problem.
3 Muscle tension and headache
Although muscle tension and headache are part of the criteria for diagnosing anxiety, which means that these two can be secondary to the latter symptom, both can be categorized under a single problem since headache is also a result of muscle tension, resulting in a tension-type of headache. Tension on the pericranial muscles results in muscle stiffness that presses on the head and neck. The tenderness around these areas is also directly proportional to the frequency and severity of headaches (Do et al., 2018). These two belong to a single problem since alleviating muscle stiffness can result in decreased severity and frequency of headaches.
4 Which pharmacological treatment would you prescribe? Include the rationale for this treatment.
* Selective Serotonin Reuptake Inhibitors (SSRIs) or Selective Norepinephrine Reuptake Inhibitors (SNRIs)
These drugs are antidepressants that can be used as a first-line treatment for generalized anxiety disorder. An example of SSRI is escitalopram. The prescribed dose can be at 10 milligrams (mg), one tablet once a day. Both SSRIs and SNRIs should be taken for at least four weeks since the effects have a latency period between 2 to 6 weeks. These drugs may also be used for long-term use. However, some...