NURS 7330 Module 3 Case Study Paper

NURS 7330 Module 3 Case Study Paper

This week’s case study is about a 26-year-old female who complains of distress when interacting with people including coworkers. She also reports feelings of depressed mood and anxiety. These symptoms only occur when she is with people. As a result, she has avoided her workplace. Her sleep quality is subjectively poor. During the mental state examination, she was tearful, anxious, and had a depressed mood. She also avoided eye contact but had good speech and an anxious tone. Lab works revealed no abnormalities in thyroid function tests. NURS 7330 Module 3 Case Study Paper

NURS 7330 Module 3 Case Study Paper

Differential Diagnoses

Normal results in thyroid function tests and other lab work highly suggest an absence of organic origin of her illness. The subjective and objective data provided is not fully sufficient to point out the definitive diagnosis but can be used to identify some possible diagnoses. Therefore, her condition is most likely psychiatric in etiology. Differential diagnoses include social anxiety disorder, atypical depression, agoraphobia/ panic disorder. NURS 7330 Module 3 Case Study Paper

NURS 7330 Module 3 Case Study Paper

Social anxiety disorder is associated with fear in social situations. These include interacting with people – either familiar people or strangers. The fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) criteria for diagnosis of a social anxiety disorder requires that the social situations should always provoke fear or anxiety (American Nurses Association, 2014) and anxiety produced be out of proportion to the threat in the social situation (American Psychiatric Association, 2013). The patient had persistent anxiety and distress while interacting with people including his coworkers and this had significant impairment in social function and sleep. She cannot go to work and maintain a healthy sleep. The absence of substance use rules out substances as the cause of her anxiety and depression.

Atypical depression is also likely in this patient. Atypical depression is a subtype of major depressive disorder. DSM-5 criteria for diagnosis of atypical depression requires that the patient meet at least two specified features besides exclusion of other subtypes. The patient had depression and social functioning impairment as seen from the mental state examination and history of avoidance of work respectively. There are sleep disturbances that can be generalized from her subjective data. However, there are no appetite problems or suicidal ideation. This differential diagnosis is made less likely by the fact that other subtypes of major depression cannot be ruled out using the provided information. Besides, depression is not the major presentation in this patient. NURS 7330 Module 3 Case Study Paper

Agoraphobia is characterized by fear of places where escape may be restricted. The patient in this case study avoided her workplace and had to abandon her work. She usually confines herself to her house most of the time. In the clinician’s office, the patient appears anxious and maintained poor eye contact. The workplace and the clinician’s office are some of the places where easy escape can be assumed to be difficult. These might be the triggers for her anxiety. It can be assumed that the patient anticipates limitation in escape from these places and develops panic attacks (Balaram & Marwaha, 2021 NURS 7330 Module 3 Case Study Paper ).  This anticipation could be the reason for the avoidance of her workplace and coworkers. Therefore, an element of behavioral modification toward anticipated anxiety is seen in this patient. The patient categorizing her fear as triggered by interacting with people only makes the diagnosis of agoraphobia less likely. My final diagnosis is social anxiety disorder – sometimes called social phobia.

 Possible Final Diagnoses

The patient most likely has a social anxiety disorder. However, other likely diagnoses include agoraphobia and atypical depression. She has both anxiety and depression, but anxiety symptoms dominate. She develops panic attacks when she interacts with people. Her management would include pharmacotherapy and psychotherapy. CBT would be used alongside the administration of sertraline followed by patient education. NURS 7330 Module 3 Case Study Paper

Management Plan

My management plan for this patient would include pharmacotherapy and psychotherapy. Available psychological therapies for this patient would include cognitive therapy, social skills training, in vivo exposure, and cognitive behavior therapy. For this patient, cognitive behavior therapy will be the best therapy because it combines both cognitive and exposure therapies (Boyd & Luebbert, 2019 NURS 7330 Module 3 Case Study Paper). This therapy would take unspecified time and would be used alongside pharmacotherapy.

The cognitive behavior therapy for this patient would begin with weekly one-hour sessions that start with exposure therapy. In the exposure therapy, the patient would be registered together in group therapy with other patients with anxiety issues. During this exposure, the patient would be taught activities such as public speaking to train her social skills. The exposure therapy would be moderated by a skilled therapist who would manage anxiety symptoms during these sessions. Repeated exposure sessions would aim at making her used to social places and meeting people. It is expected to be the lengthiest part of her psychotherapy. These exposure stimulation therapies, and social skills training would be followed by a home-based assignment where the patient would be assigned tasks to complete at home these stats would include addressing her family members under the watch of her spouse or parent. NURS 7330 Module 3 Case Study Paper

The pharmacotherapy would include the use of antidepressants and anxiolytics. Fortunately, some drugs can treat both anxiety and depression (Boyd & Luebbert, 2019). The patient would be prescribed Zoloft 25 mg QID for a start dose that would be increased by 25 mg weekly up to less than 200mg per day as indicated by the quality of control of the patient’s symptoms after 4 weeks of initial dose. Zoloft is a brand name for sertraline – an antidepressant used for the management of depression and related anxiety disorders (Dold et al., 2017 NURS 7330 Module 3 Case Study Paper). This drug would take effect in managing her depression after about four weeks. In the meantime, adequate patient education on the possible occurrence of suicidal tendencies and weight gain will be provided to the patient

Social Anxiety Disorder

Zoloft 25 mg

Sig: Take one tablet by mouth QID

Disp # 30 tablets

Refills: 0

Mechanism of Action: A serotonin-norepinephrine reuptake inhibitor which produces a strong block of NE and 5-HT reuptake and a weak block of dopamine reuptake. The increase of serotonin, norepinephrine, and dopamine helps reduce symptoms associated with anxiety disorders and management of depression as well.  (Dold et al., 2017 NURS 7330 Module 3 Case Study Paper). This drug would take effect in managing her depression and anxiety after about four weeks.

NURS 7330 Module 3 Case Study Paper References

  • American Nurses Association. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). American Nurses Publishing. NURS 7330 Module 3 Case Study Paper
  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5 (R)) (5th ed.). American Psychiatric Association Publishing.
  • Balaram, K., & Marwaha, R. (2021). Agoraphobia. In StatPearls. StatPearls Publishing.
  • Boyd, M. A., & Luebbert, R. A. (2019). Essentials of psychiatric nursing (2nd ed.). Wolters Kluwer Health. NURS 7330 Module 3 Case Study Paper
  • Dold, M., Bartova, L., Souery, D., Mendlewicz, J., Serretti, A., Porcelli, S., Zohar, J., Montgomery, S., & Kasper, S. (2017). Clinical characteristics and treatment outcomes of patients with major depressive disorder and comorbid anxiety disorders – results from a European multicenter study. Journal of Psychiatric Research, 91, 1–13.
  • Halverson, J. L., & Bienenfeld, D. (2019). What are the DSM-5 criteria for the diagnosis of atypical depression? Medscape.