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Generalized Anxiety Disorder

Generalized Anxiety Disorder

Generalized Anxiety Disorder

QUESTION
L. P., age 23, is a Hispanic woman who graduated from college last year. She reports to the CNP in her local community mental health center. She began working as an accountant 1 month after graduating. Approximately 2 months ago, she moved into a two-bedroom apartment with another woman who works at the same accounting firm. She states that her roommate recommended that she see a doctor to find out if she has anemia or “some sort of fatigue syndrome.” She states that she has felt “restless” and “on edge” for most of the past 9 months. She becomes easily fatigued and irritable and has difficulty concentrating and falling asleep. She states that sometimes her mind “just goes blank,” and she is worried that her work performance is no longer excellent. She reports that all her life she had good grades in school and was very successful in everything she attempted. Although she has been “a worrier from the day I was born,” now she worries more than she ever has and feels nervous “all the time.” L. P. reports that she has a good relationship with her boyfriend but they do not get to see each other very often because he is attending graduate school 100 miles away. She reports having a satisfying sexual relationship with him. She denies having any problems with relationships with her parents, roommate, or peers. She denies having any financial worries unless she is fired from her job for poor work performance. She reports that she has always been healthy and has taken good care of herself. The only medication she takes is birth control pills, which she has taken for the past 4 years without any adverse effects.
In a paper not to exceed six pages, excluding title and reference pages, submit your answers to the following in an MS Word document:
1. What is L. P.’s likely diagnosis?
2. List specific pharmacotherapeutic treatment goals for L. P.
3. Should the CNP order any labs for L. P. at this time? Why?
4. What drug therapy would the CNP likely prescribe? Why?
5. What are the parameters for monitoring the success of the therapy?
6. Describe specific patient monitoring based on the prescribed therapy.
7. List one or two adverse reactions for the selected agent that would cause the CNP to change therapy.
8. L. P. returns to see the CNP after six weeks, complaining of still feeling anxious and had heard of a medication called Klonopin that she would like to try; how should the CNP respond to her request?
9. What health promotion activities should be recommended for this patient?
10. What is L. P.’s long-term prognosis?
Please use the Case Study Analysis rubric provided to guide you in completing this assignment. It will be used to evaluate your submitted work.
Competency 40 36
Case Study questions completely and thoroughly answered with accurate evidence-based supported rationales Accurate and well defined discussion of all 10 questions for the case study using current evidence-based resources. Accurate discussion of nine case study questions presented with use of current evidence-based resources.

40 36 33
Evidence of
• critical thinking
• therapeutic decision-making in drug selection and evaluation of patient care
• pathophysiology and current pharmacological research
• assessment of the effectiveness of drug therapy
• formulation of clinical care and teaching plans for persons from diverse populations Well-defined evidence of
• critical thinking
• therapeutic decision-making in drug selection and evaluation of patient care
• pathophysiology and current pharmacological research
• assessment of the effectiveness of drug therapy
• formulation of clinical care and teaching plans for persons from diverse populations Evidence of critical thinking in prescriptive therapy, monitoring and adverse events. May have lacked a teaching plan or pathophysiologic discussion. /40
Competency 10 9 Points Earned
Grammar, spelling, and punctuation There are no errors in grammar, spelling, and punctuation There are a few minor errors in grammar, spelling, and punctuation that do not detract from the meaning (1-3 errors) /10
Competency 10 9 8 0
APA Compliance The paper meets APA formatting guidelines There are a few minor errors (1-3 errors) /10
Total Points
Generalized Anxiety Disorder

ANSWER
Generalized Anxiety Disorder

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Generalized Anxiety Disorder
This report’s objective is to evaluate the case of L.P., who is a 23-year-old Hispanic woman. The information provided shows that L.P. suffers from one type of anxiety disorder, especially considering that she experiences “restless” and “on edge” for most past nine months. The case will examine the different signs and symptoms that L.P. present, which would serve as a guide when making a diagnosis. The likely diagnosis will determine the most appropriate laboratory tests to be conducted on L.P., therapy, and the patient’s long-term prognosis.
Likely Diagnosis
Based on the case study’s information, L.P. is most likely suffering from generalized anxiety disorder (GAD). GAD is among the ten different types of anxiety disorders (Mossman et al., 2017). An analysis of anxiety disorders indicates that these are disorders in which patients experience worry or fear, which often translates to anxiety. In L.P.’s case, she may be suffering from GAD, considering that she has a long history of anxiety, which extends close to 9 months. The feelings of restlessness, fatigue, and feel as being on edge are key signs that point to the highest possibility that L.P. may be suffering from GAD. These symptoms represent the four elements of GAD, as presented in the American Psychological Association’s (APA) DSM-IV.
Pharmacotherapeutic Treatment Goals
Most notable about GAD is that it is an incurable condition considering that it cannot be treated using pharmacotherapeutic approaches. When dealing with GAD, the use of medication is only intended to return to his/her pre-anxiety state, which allows him/her to undertake daily activities without any challenges (Crocq, 2017). That would serve as the main pharmacotherapeutic treatment goal for L.P., considering that she is currently facing challenges in everyday life because it is hard for her to handle her everyday life due to the disorder. Statistically, approximately half of GAD patients respond to the different treatment approaches considered where they will return to their pre-anxiety state (Crocq, 2017). The goal is to ensure that L.P. achieves this outcome after treatment.
Laboratory Testing Ordered by CNP
The CNP should not order any laboratory tests considering that GAD is a mental disorder that cannot be detected through such tests. However, the CNP should consider conducting a full blood test to determine some of the key risks that the patient is facing, which are likely to affect the treatment plan selected. The expectation is that this would enhance overall effectiveness in delivery of best possible treatment outcomes. Instead, the CNP should develop a full psychiatric history of the patient, which would help determine the predisposing factors that may have contributed to L.P. facing the risk of GAD. Additionally, it would also be necessary to monitor the patient because some of the medications used for GAD management may cause an increase in blood pressure. An increase in the patient’s blood pressure may severely impact treatment approaches’ effectiveness; hence, the need for effective monitoring.
Drug Therapy
Drug therapy for GAD involves taking a combination of medications that would help manage the patient’s symptoms (Hinz et al., 2017). Firstly, the CNP may prescribe antidepressants. The medications may fall into primary classes, which as selective serotonin reuptake inhibitor (SSRI) and serotonin and norepinephrine reuptake inhibitor (SNRI) (Hinz et al., 2017). An example of antidepressants that would be prescribed includes escitalopram (Lexapro) and duloxetine (Cymbalta). Secondly, the CNP may prescribe an anti-anxiety medication, buspirone, which would help manage the symptoms when taken for a few weeks when it becomes effective. The CNP may equally prescribe a benzodiazepine, which is most appropriate when relieving acute anxiety on a short-term basis. The CNP must take proper steps to monitor the side effects of the different medications prescribed for the patient.
Parameters for Monitoring the Success of the Therapy
The main parameter for monitoring the therapy’s success is adherence to the prescription given and attendance of counseling sessions. Significant GAD treatment results from the steady use of medications prescribed and cognitive behavioral therapy (CBT), which work in unison to deliver on similar outcomes (Jordan, Shedden-Mora, & Löwe, 2017). Another parameter that would determine the success of the therapy is the severity of the patient’s symptoms. Treatment success suggests that patients would reduce their symptoms, highlighting the effectiveness of the therapeutic approaches taken. If the symptoms have not been reduced, the CNP may opt for benzodiazepine, which is only intended to deal with the condition’s short-term effects.
Patient Monitoring
Patient monitoring is essential when dealing with mental disorders because it determines the risks patients face as they take specific medications and therapy (Mossman et al., 2017). As noted earlier, the patient may face a high risk of increased blood pressure; hence, the need for effective patient monitoring. The CNP would need to regularly monitor the patient’s vital, which will be of great value in ensuring that the patient is safe despite the medications taken. On the other hand, patient monitoring will focus on the severity of the patient’s symptoms, which are likely to extend to depression risks. In case the patient shows signs of depression, the CNP would need to take appropriate steps to deal with the disorder appropriately.
Adverse Reactions Causing the CNP to Change Therapy
Patients often experience adverse reactions when taking specific medications, which may force the clinician or physician to consider changing the therapy or treatment approaches. In this case, the CNP may need to look out for a wide array of reactions, such as dizziness, drowsiness, headaches, and nervousness. Additionally, L.P. may also show signs of difficulty sleeping because of the therapy selected hence the need for the CNP to change the same. In other words, if the CNP’s expectations vary from what the patient is showing, the most likely possibility is that the patient would experience adverse reactions. Therefore, this would highlight the need for change in the therapy selected.
L.P.’s Medication Request
The CNP should respond to L.P.’s request for Klonopin by engaging the patient in education on how the drug works and its intended purpose. The aim is to ensure the patient gets a clear understanding that Klonopin cannot be used to treat GAD. The CNP would need to highlight that existing scientific evidence suggests that the drug is not recommended for many health organizations advising against this drug. The CNP must indicate that taking this drug only exposes the patient to more significant risks than enhancing her clinical outcomes. The CNP should instead focus on increasing dosage for the medications prescribed.
Health Promotion Activities
The health promotion process is vital in providing crucial information relating to health promotion and prevention of major diseases. The health promotion strategy would involve encouraging LP to engage in a healthy lifestyle as an essential measure that supports the patients’ health. The most significant aspect considered vital to maintain a positive lifestyle involves eating a balanced diet, limiting alcohol consumption, and engaging in regular exercise. The mentioned strategies for health promotion can be used alongside pharmacological therapy to capitalize on providing a stabilized condition and helping in the gradual healing process. LP should engage in effective techniques to deal with the condition by focusing on the prevention of disease severity through the management of anxiety.

Long-Term Prognosis
General anxiety disorder refers to a disease that focuses on the patient’s experience. The most significant aspects regarding patient experience involve remission and exacerbation of the disorder. Some of the critical factors that should be considered to live a complete life despite the condition involve self-care, medication, and therapy. Additionally, leading a healthy lifestyle a crucial measure that enables an individual to achieve health goals and objectives despite having an experience of general anxiety disorder. Upon the initial diagnosis of the condition, it is necessary to watch out for signs and symptoms that could indicate the condition’s existence. Identifying signs and symptoms helps to seek immediate help just if there is a possibility of an exacerbation.
Conclusion
From the analysis of L.P.’s case, the most likely diagnosis for her symptoms is GAD. She will need to take several medications to manage her symptoms and engage in cognitive behavioral therapy. Although GAD is an incurable mental disorder, her medications will help her return to her pre-anxiety state. She would be in a much better position of undertaking her daily activities. The objective is to ensure that she becomes more vibrant, which would help avoid possible outcomes associated with the feelings of “restless” and “on edge” she has been experiencing for most past nine months.

References
Crocq, M. A. (2017). The history of generalized anxiety disorder as a diagnostic category. Dialogues in Clinical Neuroscience, 19(2), 107.
Hinz, A., Klein, A. M., Brähler, E., Glaesmer, H., Luck, T., Riedel-Heller, S. G., … & Hilbert, A. (2017). Psychometric evaluation of the Generalized Anxiety Disorder Screener GAD-7, based on a large German general population sample. Journal of Affective Disorders, 210, 338-344.
Jordan, P., Shedden-Mora, M. C., & Löwe, B. (2017). Psychometric analysis of the Generalized Anxiety Disorder scale (GAD-7) in primary care using modern item response theory. Plos One, 12(8), e0182162.
Mossman, S. A., Luft, M. J., Schroeder, H. K., Varney, S. T., Fleck, D. E., Barzman, D. H., … & Strawn, J. R. (2017). The Generalized Anxiety Disorder 7-item (GAD-7) scale in adolescents with generalized anxiety disorder: signal detection and validation. Annals of Clinical Psychiatry: Official Journal of the American Academy of Clinical Psychiatrists, 29(4), 227.

Generalized Anxiety Disorder

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