Anxiety Disorders

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Anxiety disorders are a commonly occurring mental disorder.  It is important to use proper screening to evaluate the client and aid them in their treatment.  This paper will discuss screening techniques, pharmacological approaches, differential diagnosis, and whether or not hospitalization is required in this case.

The screening tool that would likely be most effective for Ms. Li is that of Motivational Interviewing.  As Weiser et al. (2014) explained, motivational interviewing (MI) helps to aid the client in realizing that they have not only the responsibility but the capability for change.  This moves the locus of change from the therapy session to the clients’ internal resources.  As the authors point out, the evidence strongly supports the fact that MI effects do not diminish over time.  In the MI process, the goal is to build an empathetic relationship with the patient, then set clear boundaries and responsibilities for changes in the client’s condition.  While working at a pace that is comfortable for the client, the clinician guides them in understanding their strengths and how their strengths can be utilized to overcome the anxiety they are experiencing.

There are several pharmacological and CBD approaches that can be utilized, however selective serotonin reuptake inhibitors (SSRIs) tend to be the most effective.  As Datillo and Goddard (2017) outline, medications within this class include citalopram (Celexa), escitalopram (Lexapro), fluvoxamine (Luvox), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft).  These medications are generally the best tolerated of the pharmacologic options to treat this disorder.  When treating the patient with these medications, their condition should be monitored for 3 to 4 weeks.  The general best practice for SSRI administration is to start with a low dose and titrate up to an amount that successfully provides the needed relief.  This prevents exacerbation of anxiety symptoms when the initial dosing starts.  While benzodiazepines are effective as a short-term anxiety treatment, SSRIs are favored due to their non-addictive nature.

In addition to the MI and pharmacological approaches just discussed, another approach that can be utilized is exposure therapy.  As Papadakis, Rabow, and McPhee (2018) outline, exposure therapy is a behavioral approach that aids the patient in altering the contingencies in nature and culture that are triggering the anxiety attacks.  Through exposure therapy, the client can be exposed to graded levels of the anxiety-provoking situation to desensitize them gradually to the situation.  The added value of this approach is that it is one that the patient can engage in on their own outside of the therapy setting.

The Diagnostic and Statistical Manual of Mental Disorders (5th Ed., DSM-5; American Psychiatric Association, 2013) diagnosis that applies here is Generalized Anxiety Disorder.  A physiological disorder, such as an endocrine disorder could be a differential diagnosis in this case.  As Datillo and Goddard (2017) elucidate, several organic causes such as endocrine disorders, hypoxia, intoxication or withdrawal, metabolic anomalies, and neurological disorders could be influencing the anxiety disorder.  In order to eliminate these potential causes, a full workup, including a complete blood count and metabolic panel, electrocardiogram, thyroid-stimulating hormone, and urine toxicology should be run.  It should also be noted that antihypertensives, such as the Lisinopril the patient is taking could be involved.

The final question is whether or not hospitalization is called for in Ms. Li’s case.  As Woo and Keatinge (2016) outline, when a client’s case becomes severe, then hospitalization or partial hospitalization might be called for.  The definition of severe includes a situation where the individual is a potential harm to themselves or others.  There is no indication in Ms. Li’s case file that would indicate this is so, so hospitalization is not indicated in this situation.  Of course, careful monitoring of the client’s situation is important.  Should their condition worsen, it would be appropriate to discuss possible hospitalization with their family members.

As the introduction indicated, anxiety disorders are commonly encountered mental disorders.  The motivational interview can help determine the level and extent of the client's disorder.  Proper use of pharmacological aids, such as SSRIs may aid in the treatment, alongside psychotherapy.  As was mentioned, it is also important to make certain that a differential diagnosis of an endocrine disorder or another physiological disorder may be in play here.  By conducting the proper tests, Ms. Li can receive the care needed.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, D.C.: American Psychiatric Association.

Datillo, N. C., & Goddard, A. W. (2017). Anxiety disorders. In E. T. Bope & R. D. Kellerman (Eds.), Conn’s Current Therapy 2017 (pp. 721–724). Philadelphia, PA: Elsevier.

Papadakis, M. A., Rabow, M., & McPhee, S. J. (2018). Current medical diagnosis & treatment (57th ed.). New York: McGraw-Hill Medical.

Weiser, P., Kilian, R., McDaid, D., Berti, L., Burti, L., Hjorth, P., … Becker, T. (2014). Rationale, component description and pilot evaluation of a physical health promotion measure for people with mental disorders across Europe. Journal of Community Medicine & Health Education, 4(4), 1–10. https://doi.org/10.4172/2161-0711.1000298

Woo, S. M., & Keatinge, C. (2016). Diagnosis and treatment of mental disorders across the lifespan (2nd ed.). Hoboken, NJ: Wiley.