CASE STUDY:
The Patient is a 46-year-old- white male who works as a welder at a local steel fabrication factory. He presents today after being referred by his primary care physician after a trip to the emergency in which he felt he was having a heart attack. He stated he felt chest tightness, shortness of breath, and a feeling of impending doom. He does have some mild hypertension which is treated with low sodium intake and he is about 15lbs overweight. He had his tonsil removed when he was 8 years old, but his medical history since that time has been unremarkable. Myocardial infarction was ruled out in the ER, and his EKG was normal. The remainder of his physical exam was normal. He admits that he still has problems with tightness in his chest and episodes of shortness of breath he now terms these ” anxiety” He will also report feelings of pending doom, and the need to “run” or “escape” from wherever he is at.
In your office, he confesses to the occasional use of alcohol ( ETOH) to combat worries about work. He admits to consuming 3-4 beers/night. Although he is single, he is attempting to care for his aging parents in his home. He reports that the management at his place of work is harsh, and he fears for his job. You administer the HAM-A, which yields a score of 26. The client has never been on any type of psychotropic medication. The client is alert and oriented to person, place, time, and events. He is appropriately dressed. Speech is clear, coherent, and goal-directed. The client’s self-reported mood is ” bleh” and he does endorse a feeling of ” nervousness”. Affect is somewhat blunted, but does brighten several times throughout the clinical interview process. Affect broad, client denies visual or auditory hallucination, no overt delusional paranoid thought process readily apparent. You administer the Hamilton anxiety rating scale(HAM-A) which yields a score of 26.
(a) Reflect on the medication to be used to treat generalized anxiety disorder.
(b) Reflect on the psychopharmacology treatment you might recommend for the assessment and treatment of patients requiring anxiolytic therapy.