Question

Patient: A 35-year-old male who is married and has two school-aged children (8 and 10 years old). Job History: Patient joined the military upon graduating from high school. He was unsure of a profession/career to pursue. Patient was in the United States Marines for 8 years. He reports two tours of duty overseas; one of those tours being spent in Iraq. While in the military, patient earned his bachelor’s degree in business. Patient currently works as a manager in a bank. He reports moderate levels of stress in his job, which sometimes results in him staying home from work to avoid the stress. The patient reports that while he does not dislike his job, it is not a career he can see remaining in until retirement. Medical Background: Patient reports that he was healthy for the majority of his life. He is active and physically fit. He eats well and does not abuse drugs or alcohol. In his early 20s, he smoked but he “cleaned up his act” when he learned he and his wife were expecting their first child. Recently, he has been experiencing a variety of unexplained physical symptoms including back pain, headaches, and chest pain. He has sought medical help for these problems several times. He reports that he often goes to the ER due to experiencing chest pain, but after numerous tests are run, he is discharged upon finding nothing wrong. Complaint: In addition to the physical symptoms listed above, the patient also states he feels scared and anxious. He has difficulty sleeping. He reports difficulty in controlling his anger and that outbursts are often directed at loved ones (wife and children). Based on the above information, complete the following: (Make sure to use scholarly sources to back up your responses) 1. Record important factors to consider in making a diagnosis from the case study. 2. What additional information is needed? 3. Based upon the factors listed, what is your diagnosis? 4. What would you recommend to this patient based upon the factors you have to consider? 5. Ensure you have cited tools that you used in your assessment and diagnosis, including the current version of the DSM.

Answer 1

The above person may be suffering from an anxiety disorder like generalzied anxiety disorder or panic disorder.

Ans 1 points in favour :

difficulty in sleeping,

panicattacks - episodes of chest pain leading to ER visit but nothing significant showing up on the tests,

general anxiety,

irritability - anger outbursts towards family

Physical symptoms of anxiety - headache, back pain, chest pain

Ans 2 additional information needed is the duration of symptoms. For making a diagnosis of an anxiety disorder at least 6 months duration of symptoms is required as per DSM5

Ans 3 could be Generalized anxiety disorder.

Ans 4 Relaxation exercises like JPMR/ breathing exercises. CBT for anxiety provoking situations, low dose of benzodiazpeines for short term, antidepressants from SSRI class for atleast 6-12 months.

Ans 5 We can use Hamilton anxiety rating scale for an objective assessment of his anxiety.