NURS 6670 Week 6 Discussion: General Anxiety Disorder

NURS 6670 Week 6 Discussion: General Anxiety Disorder

NURS 6670 Week 6 Discussion: General Anxiety Disorder

Generalized Anxiety Disorder, GAD Sample Paper

Difference between an adjustment disorder and anxiety disorder.

While little research has gone into advancing the understanding of adjustment disorder, it is one of the most diagnosed disorders. The disorder presents with such symptoms as anxiety, depression, or conduct disturbance that are generally responses to certain life stressors (Bachem & Casey, 2018). Often, the symptoms emerge within three months of the individual encountering the triggering stressor and extensively interfere with the patient’s daily functioning.

According to Killikelly et al. (2019), the common stressors often seen in individuals experiencing prolonged grief disorder are similar to those of adjustment disorder, and include financial challenges, medical issues and relationship problems. Anxiety disorder, on the other hand, presents with such symptoms as excessive anxiety or worry that interfere with an individual’s daily functioning. Further, unlike adjustment disorder that follows a negative life occurrence, the causes of anxiety disorder vary, and the symptoms often appear before a specific traumatic life event.         

Diagnostic criteria for generalized anxiety disorder.

Today, the diagnosis of generalized anxiety disorder follows DSM-5 and ICD-10 and ICD-11 criteria. According to Crocq (2017), the DSM-5 criteria for diagnosing GAD identifies such presentations as the existence of extensive worry and anxiety observed frequently for at least six months and the inability to control worry. The worry and anxiety are defined by restlessness, easy fatigue, difficulty concentrating, muscle tension, irritability and sleep disturbance (Crocq, 2017). Under the ICD codes, the diagnosis of GAD requires the daily observance of prominent tension, worry and apprehension for at least six months or the presence of at least four symptoms of the 22 outlined under ICD-10, with at least one of these four symptoms being an autonomic arousal item. Under ICD-11, GAD diagnosis aligns with anxiety and fear-related disorders, but which differs from OCD based on the additional observation that the patient is worried about multiple aspects of everyday life activities and occurrences (Crocq, 2017 NURS 6670 Week 6 Discussion: General Anxiety Disorder).

Evidenced-based psychotherapy and psychopharmacologic treatment for GAD.

Treatment and management of GAD tend to leverage psychotherapy and psychopharmacologic interventions. Among the different psychotherapy interventions often used in managing GAD, mindfulness-based interventions tend to have the greatest efficacy. A study by Hoge et al. (2018) showed that GAD patients subjected to mindfulness-based stress reduction (MBSR) procedures had greater reduction in their levels of adrenocorticotropic hormone compared to those who received no intervention. Further, the study showed that MBSR intervention greatly reduced the concentration of inflammatory cytokines in the body. Thus, MBSR is an effective tool in reducing stress markers in patients suffering from GAD.  

In addition to psychotherapy intervention, patients suffering from GAD can also benefit from different psychopharmacologic treatment interventions. Chiefly, the preferred psychopharmacologic interventions include “selective serotonin and selective norepinephrine reuptake inhibitors (SSRIs and SNRIs, respectively),” (Shawn et al., 2018). Among the commonly used, broad spectrum SSRIs in the treatment of GAD are fluoxetine, sertraline, citalopram, and paroxetine. Among the SNRIs used include venlafaxine and duloxetine. Other treatment mechanisms for GAD include the use of atypical antidepressants, multimodal antidepressants, benzodiazepines and non-benzodiazepine hypnotics, among others (Shawn et al., 2018).

NURS 6670 Week 6 Discussion: General Anxiety Disorder References

• Bachem, R. & Casey, P. (2018). Adjustment Disorders: A diagnosis whose time has come. Journal of Affective Disorders, 227(), 243-253. doi:10.1016/j.jad.2017.10.034. NURS 6670 Week 6 Discussion: General Anxiety Disorder
• Crocq M. A. (2017). The history of generalized anxiety disorder as a diagnostic category. Dialogues In Clinical Neuroscience, 19(2), 107–116. https://doi.org/10.31887/DCNS.2017.19.2/macrocq
• Hoge, E. A., Bui, E., Palitz, S. A., Schwarz, N. R., Owens, M. E., Johnston, J. M., Pollack, M. H. & Simon, N. M. (2017). The effect of mindfulness meditation training on biological acute stress responses in generalized anxiety disorder. Psychiatry Research, 262(), 328-332. doi:10.1016/j.psychres.2017.01.006
• Killikelly, C., Lorenz, L., Bauer, S., Mahat-Shamir, M., Ben-Ezra, M., & Maercker, A. (2019). Prolonged Grief Disorder: Its co-occurrence with Adjustment Disorder and Post Traumatic Stress Disorder in a bereaved Israeli general-population sample. Journal of Affective Disorders, 249(), 307-314. doi:10.1016/j.jad.2019.02.014. NURS 6670 Week 6 Discussion: General Anxiety Disorder
• Strawn, J. R., Geracioti, L., Rajdev, N., Clemenza, K., & Levine, A. (2018). Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert Opinion on Pharmacotherapy, 19(10), 1057–1070. doi:10.1080/14656566.2018.1491966

Instructions – NURS 6670 Week 6 Discussion: General Anxiety Disorder

NURS 6670 Week 7 Case Study: A young woman with Depression

NURS 6670 Week 7 Case Study: A young woman with Depression

NOTE: Please includes introduction and conclusions

Examine Case 2: You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical, as well as mental factors that might impact the client’s diagnosis and treatment.

At each Decision Point stop to complete the following:

Decision #1: Differential Diagnosis

Which Decision did you select?

Why did you select this Decision? Support your response with evidence and references to the Learning Resources. NURS 6670 Week 6 Discussion: General Anxiety Disorder

What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #1 and the results of the
Decision. Why were they different?

Decision #2: Treatment Plan for Psychotherapy

Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this

Decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #2 and the results of the
Decision. Why were they different? NURS 6670 Week 6 Discussion: General Anxiety Disorder

Decision #3: Treatment Plan for Psychopharmacology

Why did you select this Decision? Support your response with evidence and references to the Learning Resources. NURS 6670 Week 6 Discussion: General Anxiety Disorder

What were you hoping to achieve by making this
Decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Also include how ethical considerations might impact your treatment plan and communication with clients and their family.

A young woman with Depression

SUBJECTIVE

Stefanie is a 32-year-old female from Puerto Rico who presents to your office today with complaints of difficulty sleeping. You learn that Stefanie can go for a few days with minimal sleep (about 3 hours/night), but does not seem to be fatigued the next day. Stefanie explains that after 3 days with minimal sleep, she “crashes” and has a good night’s sleep. She states that sleep will be “alright” for a few days, even a few weeks, and then she will have a similar issue with sleep. NURS 6670 Week 6 Discussion: General Anxiety Disorder

You learn throughout the assessment process that Stefanie has had this problem for years. She noticed that it began in college and thought it was just because of the workload and academic demands. However, she found that it persisted after college. She also notices that she has periods where she will engage in increased amounts of goal-directed activity. She states that things will just “pile up” at work and she gets this burst of energy to “make everything right.” She states that these bursts will last most of the day. She states that these periods show up probably every 2 to 3 weeks.

Stefanie also confesses to problems with being “down in the dumps.” She states that when she has her episodes in which she endeavors to “make everything right,” she feels fantastic and on top of the world. However, when these periods of energy end, she reports that she feels “depressed”—but then states: “well, maybe not depressed, but I definitely feel sad and empty.” She also endorses feelings of fatigue and a decreased ability to concentrate when she is feeling sad. She finally tells you: “I have lived with this for so long, I have to admit that it is finally a relief to tell someone how I feel!” NURS 6670 Week 6 Discussion: General Anxiety Disorder

OBJECTIVE

Stefanie is dressed appropriately to the weather. She has no gait abnormalities. Physical assessment is unremarkable. Gross neurological assessment is within normal limits.

MENTAL STATUS EXAM

Stefanie is alert and oriented × 4 spheres. Her speech is clear, coherent, goal directed, and spontaneous. Self-reported mood is “sad.” Affect does appear consistent with dysphoria. Eye contact is normal. Speech is clear, coherent, and goal directed. She denies visual or auditory hallucinations. No overt evidence of paranoid or delusional thought processes noted. She denies suicidal or homicidal ideation and is future oriented.

At this point, please discuss any additional diagnostic tests you would perform on Stefanie.

Decision Point One
BASED ON THE INFORMATION PROVIDED IN THE SCENARIO ABOVE, WHICH OF THE FOLLOWING DIAGNOSES WOULD THE PSYCHIATRIC/MENTAL HEALTH NURSE PRACTITIONER (PMHNP) GIVE TO STEFANIE?
In your write-up of this case, be certain to link specific symptoms presented in the case to DSM–5 criteria to support your diagnosis. NURS 6670 Week 6 Discussion: General Anxiety Disorder

Bipolar I, current phase, depressed
Bipolar II, current phase, hypomanic
Cyclothymic disorder

NURS 6670 Week 8 Assignment

Explain the diagnostic criteria for delirium.
Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned neurocognitive disorder thus deliriums\’.
Identify the risks of different types of therapy and explain how the benefits of the therapy that might be achieved might outweigh the risks.
Support your rationale with references to the Learning Resources or other academic resource

NURS 6670 Week 9 Assignment

A 63 year-old male Caucasian, homeless ,with no jobs , retired from the military, has been diagnosed with Schizophrenia and PTSD.

CC: He states, “During the night, I hear voices in my head, constantly yelling and telling me to do things like jumping my window. I see shadows dancing across the wall and .
Lately whenever somebody comes near me, I fear for my life and my heart rate starts to increase and I start getting paranoid.” NURS 6670 Week 6 Discussion: General Anxiety Disorder

The patient is experiencing the symptoms of hallucinations and voices from his Schizophrenia which is also causing his anxiety to occur and become paranoid around people.

Medication: Buspirone 10mg PO Daily for anxiety.
Olanzapine 10mg PO Daily for his Schizophrenia

Informed consent explained and signed by patient
Pt is alert and oriented x4,
Denies any street drug taken
Denies any alcohol use
Denies any allergy to medications or food
No side effects of any taken medications presently

Sleeps Pattern :Not sleeping well during the night or day, paces around in her room sometimes reading.
Food she stated she cannot eat well now Has gain 1 lb. after her last visit with her psychiatrist Is not pregnant Very compliance with taken medications taken
No suicidal ideations Hearing of voices or seeing any images Sees her regular therapist weekly Goes for individual therapy Family therapy SI/HI/AVH. NURS 6670 Week 6 Discussion: General Anxiety Disorder
Clinical Impression: Based on the diagnostic criteria in APA (2013) Diagnosed: Schizoaffective disorder (ICD-10: F25.9),
Psychopharmacology of the patient’s symptoms cause a significant impairment in function or agitation, irritable treatment is based on patients’ signs and symptoms presented, client cannot sleep always on the edge ,easily irritated ,dissociate herself from friends and family and has decrease in her appetite.

Medication Management :Increase buspirone 15mg PO Daily continue to for month.
Olanzapine 15mg po for a month .
Decreases all active activities before bedtime ,getting her family involve especially.

Sees her regular therapist weekly Goes for individual therapy Family therapy monthly Family and client educated about her illness to watch for any suicidal ideations .
Advise given to husband not arguing with client. Read or dim lights or noise around her sleeping room Patient to see her PCP for regular checkup and labs Return for evaluation in a month time. NURS 6670 Week 6 Discussion: General Anxiety Disorder

Questions

In 3–4 pages, write a treatment plan for your client in which you do the following:
• Describe the HPI and clinical impression for the client.
•
• Recommend psychopharmacologic treatments and describe specific and therapeutic endpoints for your psychopharmacologic agent. (This should relate to HPI and clinical impression.)
•
• Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.
•
• Identify medical management needs, including primary care needs, specific to this client.
•
• Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client. NURS 6670 Week 6 Discussion: General Anxiety Disorder
•
•
• Recommend a plan for follow-up intensity and frequency and collaboration with other providers.

NURS 6670 Week 10 Schizophrenia Case

CASE

Charlie A 49 years-old male AA, is a homeless man had never been in a relationship, works at a local grocery store as a stocker, has been diagnosed with schizophrenia, complains of hearing voices even while at work which distracts her from what she needs to do, she also states that she feels hopeless in some situations which cause her to be anti-social.

Medication:
Olanzapine-15mg PO Daily
Seroquel-200mg at night

At each Decision Point, stop to complete the following:

Decision #1: Differential Diagnosis

Which Decision did you select? NURS 6670 Week 6 Discussion: General Anxiety Disorder
Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?

Decision #2: Treatment Plan for Psychotherapy

Why did you select this Decision? Support your response with evidence and references to the Learning Resources.
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?

Decision #3: Treatment Plan for Psychopharmacology

Why did you select this Decision? Support your response with evidence and references to the Learning Resources. NURS 6670 Week 6 Discussion: General Anxiety Disorder
What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.
Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
Also include how ethical considerations might impact your treatment plan and communication with clients and their family. NURS 6670 Week 6 Discussion: General Anxiety Disorder

Week 10 Discussion – Sleep/Wake Disorders

topic :Insomnia

• Explain the diagnostic criteria for your assigned sleep/wake disorder.
  • Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned sleep/wake disorder. NURS 6670 Week 6 Discussion: General Anxiety Disorder
  • Describe at what point you would refer the client to their primary care physician for an additional referral to a neurologist, pulmonologist, or physician specializing in sleep disorders and explain why.
  • Support your rationale with references to the Learning Resources or other academic resources.

NURS 6670 6670 Week 11

To prepare for this Discussion:

TOPIC IS GENDER DYSPHORIA

Select a gender dysphoria, that interests you.
Review the Learning Resources.
By Day 3
Post:

Explain the diagnostic criteria for the gender dysphoria, paraphilic disorder, or sexual dysfunction you selected.

Explain the evidenced-based psychotherapy and psychopharmacologic treatment for the gender dysphoria, paraphilic disorder, or sexual dysfunction you selected.

Support your rationale with references to the Learning Resources or other academic resource. NURS 6670 Week 6 Discussion: General Anxiety Disorder