Treatment for a Patient with a Common Condition

Answer

Treating a Patient with a Common Condition

Question to Ask the Patient in Case She Was in the Office

1. During the periods when you are experiencing anxiety, do you feel as if you have the control over your situation?

 It is important to ask the client this question to establish and acknowledge the real situation that the client experiences. It is normal for the client to experience things they lack control over and the only way to do so is to appreciate the situation.

2. What do you think is the major cause of the symptoms of anxiety? Do you think the situation is caused by certain situation?

Posing this question to the client will help establish the client’s view and sense of belief regarding the cause of anxiety she experiences. Moreover, it is critical to get the client’s perspective to establish why symptoms are being experienced. Posing this question will enable me to establish whether the client is anxious around certain stimulants, or whether the anxiety emanate from the fears connected to depression, death or others.

3. While comparing with your overall quality of life, particularly in regards to feeling anxious, do you belief you have a quality life? Does the anxiety make you feel that you have missed out critical elements of life?

This question is prudent in understanding the overall life quality of the client as she views it to be. Personally, I would be interested in knowing whether the client feels as if she spends much of her life and time worrying and being anxious about the death of her husband. Knowing this will assist me establish whether she has some regrets in life or situations that could have been handled differently to prevent the death of her husband.

Individuals in Client’s Life to Speak to or Get Response to Further Assess Client’s Situations

To get responses to further examine the client, I would speak to her close relative, especially her father and mother in law (if present) to get some history regarding the client’s moods following the death of her husband, any past triggers, her routine wake or sleep cycle, as well as any information on how she was before the death of her husband. From the information presented, it is evident that the client shows critical signs of anxiety. Some of the questions I would ask the family members include: when your daughter in law experiences anxious episode, how long have you witnessed the episodes lasting? Is there a given instance you can remember where it appeared her condition was getting worse? Is there a specific time you can remember when she was receiving proper treatment? Does she take the prescribed medication promptly? Has she complained of trouble sleeping at night?

It is appropriate to ask the client’s close relatives these questions to establish when the episodes started and how long they noticed them lasting. These questions will also enable me establish whether the client takes any approach to assist calm herself while experiencing these situations. Moreover, these questions will help understand specific techniques the relatives are using to support their daughter in law among others.

Appropriate Diagnostic Tests and Physical Examinations for the Patient

            Diagnosis of Attention deficit hyperactivity disorder (ADHD) is often based on clinical examination. As such, there are no laboratory oriented medical tests that can be used to ascertain the diagnosis. Nonetheless, fundamental laboratory studies that can be used to confirm diagnosis and assist in the treatment encompass thyroid function tests, serum CBC count with differential, electrolyte levels, as well as, liver function tests prior to starting stimulant therapy (Starck, Grünwald, & Schlarb, 2016). Additional sources for examination or diagnostics encompass ADHD symptom checklists, as well as, a standardized behavior rating scales. Verma, Kaur and David (2012) posited that ADHD hardly occur alone and studies have revealed that more than 75% of individuals suffering from ADHD have at least one co-existing conditions that entail depression, anxiety disorders, substance use disorders and learning disabilities. As such, a detailed assessment entail screening for co-existing conditions.

Differential Diagnosis for the Patient

             Generalized Anxiety Disorder is one of the differential diagnosis for the patient under the study. Cuomo, Giordano, Goracci and Fagiolini (2017) maintained that generalized anxiety disorder entails excessive and persistent worry that disrupts the daily activities accompanied by physical signs including easily fatigued, restlessness, muscle tension, difficulty concentrating and sleeping problems. Moreover, the patient has been anxious for many days following the death of her husband. Other differential diagnosis for the patient include major depressive disorder, attention deficit hyperactivity disorder and hypersomnolence disorder.

            Generalized anxiety disorder is the most likely differential diagnosis for the patient. As indicated in the case scenario, the patient experiences severe and persistent depression, sleeping difficulties and all these symptoms related to generalized anxiety disorder that I would consider as the most possible diagnosis. More importantly, the client has been grappling with issues related to anxiety and depression since her husband died, all these are clear indication of generalized anxiety disorder

Appropriate Pharmacologic Agents for the Patient

             As shown in the case scenario, the client experiences difficulties in sleeping and increased anxiety. Based on this information, I would select Atomoxetine 40mg daily and Buspar 15 mg BID. Essentially, Atomoxetine improves neurotransmitter norepinephrine, enhances dopamine in the front cortex, increases noradrenergic neurotransmission and enhances the transmission of dopamine in the front part of the brain (Asherson et al., 2014). Therapeutic effects can be witnessed as early as the first day of taking the drug and may continue until the 12^th week. Similarly, Buspar 15mg BID helps manage depression and anxiety disorders. Stahl (2013) contended that buspirone has no potential for withdrawal symptoms, dependence, or rebound anxiety once the patient has withdrawn from the anxiety.

Checkpoints

             The case scenario discussed herein offered different factors and consideration for the client being studied. From the information obtained from the case scenario, it is not evident that there is a diagnosis of bipolar disorder. Nonetheless, the prescription made was for mood stabilizers. Nonetheless, to effectively arrive at the true conclusion of factors that cause sleeping difficulties to the patient, the client should be advised to stop using the medications already prescribed to her in a bid to establish whether she still depicts these symptoms.

            In conclusion, this case scenario has revealed the challenges that patients undergo when they are bereaved. A major lesson that can be learned from this case is that there is need for healthcare provider to understand the medication, the usage and establish whether there is need to reduce the prescribed drugs to the client. Moreover, healthcare providers should establish the findings that the medication is supposed to depict and the real findings being displayed. Moreover, rather than using polypharmacy techniques with scarce evidence base, it is appropriate to take into account solid approved monotherapies. In addition, rather than considering adult ADHD as diagnosis of exclusion, there is need to assess this symptom earlier enough using different rating scales. More importantly, there is need for a comprehensive research on typical comorbidities and presentations for adults suffering from ADHD together with diagnostic rating tools and scales that can help in diagnosing patients suffering from ADHD.