Diagnosis and Treatment of Social Anxiety in a 23-Year-Old Male, Exams of Nursing

Download Diagnosis and Treatment of Social Anxiety in a 23-Year-Old Male and more Exams Nursing in PDF only on Docsity! 2 NR - 603 ADVANCED CLINICAL DIAGNOSIS AND PRACTICE ACROSS THE LIFESPAN 2024 UPDATE RATED A+ Setting: Primary care office Patient Information: G.G., 23, male, Caucasian S: Chief Complaint: “I have been experiencing high levels of fear, and nervousness every day at work. I feel anxious around a large group of people, and feel like my heart is racing, and I begin to excessively sweat anytime I have to initiate conversation with others. This has started since the start of my job, which was 6 months ago. I can’t seem to shake this feeling.” HPI: Mr. G., 23-year-old Caucasian male presents to the clinic with complaints of anxiety-like symptoms at work. Large groups of people cause him to feel nervous and fearful, with an increase in heart rate. This started since the beginning of his new job, which was 6 months ago. Prior to this job he was a full-time college student, who took online classes to complete his bachelor’s degree. He only feels these symptoms while at work, and once home he feels like himself again. Current Medications: No current medications Allergies: NKA PMHx: No chronic illness. Chicken pox as a child. No hospitalizations. All vaccines up to date PSHX: NA Health screening: Routine yearly physical, last physical 8/6/18. Soc Hx: Single, college graduate, lives alone, non-smoker, has 1-2 drinks per week on the weekends only, no illicit drugs. Does not workout. Enjoys playing video games in the comfort of his home. Fam Hx: Maternal: Depression, and arthritis. Paternal: HTN, high cholesterol, diabetes type 2, general anxiety. 3 Siblings: 2 sisters, no significant medical history ROS: General: denies headache, vision changes, weight loss, fever, or fatigue CV: No chest pain, no palpitations on a regular basis, occasional chest discomfort when he feels severe anxiety HEENT: No vision loss or blurred vision, no hearing loss, congestion, runny nose, sore throat, dry mouth and throat Respiratory: No difficulty with breathing, negative for cough Skin: Excessive sweating during episodes of anxiety, no rash, dry and intact Gastrointestinal: Negative for vomiting or nausea, occasional upset stomach Genitourinary: negative for dysuria, frequency, urgency. Musculoskeletal: No muscle pain, joint pain Neuro: Trembling and muscle twitching during work around coworkers Endocrinologic: Negative for cold or heat intolerance, polyuria, polydipsia Psych: No history of depression, has always been an introvert and shy around people. Feels most comfortable alone at home, or with close family. O: Physical Exam: BP: 130/85; HR 87; RR 20; T: 98.8; Height: 5'9"; Weight: 175 lbs; BMI: 25 General: Well-nourished male. Alert and oriented, answers questions appropriately. Avoids making eye contact. Flushed looking in the face. Seems concerned about his condition, and wants to be able to do his best at work. Trembling hands. HEENT: Head normocephalic without evidence of masses or trauma. PERRLA, EOMs intact, non-injected. Ear canal without redness irritation, TMs clear, pearly, bony landmarks visible, no discharge, no pain noted. Neck negative for masses, no thyromegaly, no JVD distention. Skin: intact. No bruising noted. Sweating. CV: S1/S2, RRR, no murmurs, no rubs Lungs: CTA bilaterally. Abdomen: Soft, non-tender, non-distended, BS present x 4 Musculoskeletal: Normal ROM in all extremities, normal gait 6 patients. The CSF in studies in humans shows elevated levels of orexin, also known as hypocretin, which is thought to play an important role in the pathogenesis of panic in rat models (Schub & March, 2018). Treatment of social phobia includes medication and psychological therapy. Long-term treatment with antidepressants (usually selective serotonin reuptake inhibitors [SSRIs]), effectively decreases anxiety and resolves the fear of anxiety-provokingstimuli; Paroxetine (Paxil) is considered the most effective SSRI for social phobia (Schub & March, 2018). Cognitive behavioral therapy (CBT), including gradual social exposure, cognitive restructuring, and relaxation techniques, has been shown to be effective in the treatment of social phobia. With treatment, prognosis for individuals with social phobia is good; most patients experience symptom resolution after receiving combination treatment of psychotherapy and medication (Schub & March, 2018). Additional Analysis According to the National Institute for Health and Care Excellence (NICE) clinical guideline, if social phobia or social anxiety are suspected, then the provider should ask the identification questions for anxiety disorders in line with recommendation 1.3.1.2 in Common mental health disorders (NICE clinical guideline 123), and if social anxiety disorder is suspected: • use the 3-item Mini-Social Phobia Inventory (Mini-SPIN) or • consider asking the following 2 questions: o Do you find yourself avoiding social situations or activities? o Are you fearful or embarrassed in social situations? If the person scores 6 or more on the Mini-SPIN, or answers yes to either of the 2 questions above, refer for or conduct comprehensive assessment for social anxiety disorder. If the 7 identification questions indicate possible social anxiety disorder, a practitioner who is competent to perform a mental health assessment should review the person's mental state and associated functional, interpersonal and social difficulties (NICE, 2014). A validated measure for social anxiety, for example, the Social Phobia Inventory (SPIN) or the Liebowitz Social Anxiety Scale (LSAS) can be used to indicate whether or not the patient does have social anxiety (NICE, 2014). Follow-up The patient returns to the clinic after one month for a follow-up appointment. He appears to be doing better, and is able to make eye-contact now. When asked how things are going, he states that he feels less anxious at work now. He believes that his CPT in conjunction with her medication is working, and does not have any complaints at this point. He said he would like to remain on the treatment plan and hopefully come off of medication in the near future. He was given 3 refills on his medication, and will be seen back in the office in 3 months. Quality A few things I have learned from this case study is how to approach mental health issues, and where to begin when it comes to the assessment process. According to the NICE guidelines it is important to be alert to possible depression and consider asking people who may have depression two questions, specifically • During the last month, have you often been bothered by feeling down, depressed or hopeless? • During the last month, have you often been bothered by having little interest or pleasure in doing things? When assessing a person with a suspected common mental health disorder, consider using: 8 • a diagnostic or problem identification tool or algorithm, for example, the Improving Access to Psychological Therapies (IAPT) screening prompts tool. • a validated measure relevant to the disorder or problem being assessed, for example, the 9-item Patient Health Questionnaire (PHQ-9), the Hospital Anxiety and Depression Scale (HADS) or the 7-item Generalized Anxiety Disorder scale (GAD-7) to inform the assessment and support the evaluation of any intervention. When it comes to mental health, this is a very sensitive subject, which is beginning to receive more awareness now. As practitioners it is important to know how to go about assessing, and diagnosing these very complicated mental health disorders. Using guidelines gives us the framework to begin our investigative and treatment process in order to provide the patient with the best care possible. Coding and Billing ICD Codes: Social phobia, unspecified (F40.10) CPT Code: 99213