Diagnostic Assessment Jorge Tase Presentation No 2 Pm Hn Acr

Diagnostic Assessmentjorge Tasepresentation No 2pmhn Across The Lifes

Diagnostic Assessment Jorge Tase Presentation No. 2 PMHN Across the Lifespan. Practicum I: Individual & Family Therapy Professor Roxana Orta, DNP, PMHNP, FNP FNU Clinical case Clinical Case: Encounter No. 6 J.R., male, Hispanic, 45-year-old, unemployed since 2020. He suffers from GAD since 2012 which has impaired him to work and behave properly.

Patient shows minimal treatment response as of today. He continues to exhibit symptoms of the disorder. Symptoms continue the same in frequency and intensity, and no significant improvement is noted. Symptoms of this disorder occur more days than not. Sleep difficulty continues unchanged.

Feelings of increased muscular tension across neck and shoulders continue unchanged. He describes feeling irritable with lack of focus and inability to concentrate. Feelings of fatigue are described as continuing unchanged. Medication has been taken regularly. He has to force herself to socialize with others.

A fair night's sleep is described. Sleep was not continuous and not completely restful.

Clinical Case: Encounter No. 6 J.R. is irritable, distracted, and fully communicative, casually groomed, and appears anxious. He exhibits speech that is normal in rate, volume, and articulation and is coherent and spontaneous.

Language skills are intact. Mood is entirely normal with no signs of depression or mood elevation. The affect is congruent with mood. There are no signs of hallucinations, delusions, bizarre behaviors, or other indicators of psychotic process. Associations are intact, thinking is logical, and thought content is appropriate.

Homicidal ideas or intentions are convincingly denied. Cognitive functioning and fund of knowledge are intact and age appropriate. Short and long-term memory is intact, as is ability to abstract and do arithmetic calculations. This patient is fully oriented. Clinically, IQ appears to be in the above average range.

Insight into illness is fair. Social judgment is intact. There are signs of anxiety with his behavior in fidgety stage. Diagnostic classification: Anxiety disorders include disorders that share features of excessive fear and anxiety and related behavioral disturbances. Fear is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat (Boland, Verdiun, & Ruiz, 2021).

Clinical case: J.R. presents with anxiety and worry associated with three or more of the previous six symptoms (with at least some symptoms present for more days than not for the past 6 months). He finds it difficult to control the worry. The disturbance is not better explained by another mental disorder. The focus of the anxiety and worry is not confined to features of an Axis I disorder.

The disturbance is not attributable to the physiological effects of a substance. Result: DSM-5 diagnostic criteria met. Diagnosis: Generalized Anxiety Disorder.

Diagnostic criteria sets include persistent and excessive anxiety and worry about various domains, including work and school performance. The individual experiences physical symptoms such as restlessness or feeling keyed up or on edge; fatigue; difficulty concentrating or mind going blank; irritability; muscle tension; and sleep disturbance. These symptoms cause significant distress or impairment and are not due to substances or other medical conditions, fitting the DSM-5 criteria (APA, 2022).

The core feature of GAD is excessive and uncontrollable worry about multiple domains, lasting at least six months, accompanied by physical and cognitive symptoms that impair daily functioning. Worries tend to be pervasive, longer in duration, and more intense than typical concerns. GAD can significantly impair occupational, social, and family functioning, increasing healthcare utilization and morbidity risk (Munir & Takov, 2022).

Paper For Above instruction

Introduction

Generalized Anxiety Disorder (GAD) is a prevalent and impairing mental health condition characterized by pervasive and uncontrollable worry and anxiety about various aspects of life. It affects individuals across different ages, genders, and cultures, with significant socio-economic and health implications. This paper examines the clinical presentation, diagnosis, and treatment considerations for a representative case, J.R., a 45-year-old Hispanic male suffering from GAD, illustrating broader epidemiological and clinical features of the disorder.

Clinical Presentation of GAD

J.R. presents with classic symptoms of GAD, including persistent worry, muscular tension, irritability, fatigue, sleep disturbances, and difficulty concentrating. His physical symptoms—muscle tension and fatigue—are typical manifestations of heightened sympathetic nervous system activity associated with chronic anxiety (Boland, Verdiun, & Ruiz, 2021). Despite adherence to medication regimens, his symptoms have remained relatively unchanged, indicating the potential need for treatment modification or augmentation.

The mental status examination reveals an anxious but fully alert and oriented individual. His cooperative behavior and coherent speech suggest no psychosis or mood disorder predominance. Cognitive functions such as memory, abstractions, and calculations are preserved, supporting diagnosis based on classical criteria.

Diagnosis and Diagnostic Criteria

The diagnosis of GAD relies on criteria outlined in DSM-5, requiring excessive worry about multiple domains for at least six months, difficulty controlling worry, and physical symptoms like restlessness and sleep disturbance (American Psychiatric Association, 2022). J.R.'s presentation conforms to these criteria, with a score indicating moderate to severe anxiety on screening tools like GAD-7 (Munir & Takov, 2022). The diagnosis is further supported by the absence of other psychiatric or medical explanations.

Etiology and Risk Factors

Research identifies temperamental traits such as neuroticism, negative affectivity, and behavioral inhibition as predisposing factors for GAD. Environmental stressors, notably childhood adversities and parenting practices, contribute significantly to its development (Targum et al., 2018). Genetic predisposition, especially neuroticism attributable to one-third of genetic factors, also plays a critical role. Sociocultural factors influence symptom expression and perception, with women and adolescent girls more frequently diagnosed (APA, 2022). Likewise, higher prevalence in high-income countries may reflect differences in health-seeking behaviors and diagnostic practices.

Course and Prognosis

The natural course of GAD tends to be chronic, with symptoms fluctuating in intensity over a lifetime. Early onset is associated with higher comorbidity and functional impairment, impacting occupational and social domains significantly. Older adults often experience less intense symptoms but may have greater physical health comorbidities that complicate management. Full remission remains uncommon without targeted intervention (APA, 2022).

Associated Features and Comorbidities

GAD frequently coexists with other mental health conditions, particularly major depressive disorder, other anxiety disorders, and somatic symptom disorders. Physiological manifestations such as trembling, muscle soreness, and somatic complaints are common (Boland, Verdiun, & Ruiz, 2021). The presence of comorbidities increases the complexity of treatment and prognosis.

Assessment and Screening

Validated tools like the GAD-7 facilitate a quick assessment of anxiety severity and aid treatment planning. J.R.'s score of 14 indicates moderately severe anxiety, reinforcing the need for comprehensive intervention strategies. Routine screening in primary care settings is recommended given the high prevalence and impact of GAD (U.S. Department of Health and Human Services, 2019).

Treatment Approaches

Management of GAD involves an integrated approach combining pharmacotherapy and psychotherapy. Pharmacologically, selective serotonin reuptake inhibitors (SSRIs) such as escitalopram and paroxetine are first-line treatments, effectively reducing anxiety symptoms (Baldwin et al., 2016). Augmentation with benzodiazepines may be considered short-term but carries risks of dependency. Psychotherapeutic interventions, particularly cognitive-behavioral therapy (CBT), are regarded as evidence-based “gold standard” treatments, addressing maladaptive thought patterns and behavioral avoidance (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012).

The therapy aims to help patients develop better stress management skills, relaxation techniques, and cognitive restructuring of worry-focused thoughts. Mindfulness-based stress reduction (MBSR) and acceptance and commitment therapy (ACT) are emerging adjuncts with promising results (Hoge et al., 2018).

Pharmacological and psychological treatments should be tailored considering patient's preferences, comorbidities, and risk factors. Regular monitoring and adjustment of treatment plans are essential to achieve optimal outcomes.

Conclusion

GAD is a prevalent, impairing disorder with persistent worry, physical symptoms, and significant functional impact. Accurate diagnosis through detailed clinical assessment and validated screening tools is essential. Treatment requires an integrated approach using pharmacotherapy and evidence-based psychotherapy to enhance functioning and reduce distress. As exemplified by J.R., managing GAD demands ongoing evaluation and personalized interventions to improve quality of life and prevent chronicity.

References

  • American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: DSM-5-TR. APA Publishing.
  • Baldwin, D. S., et al. (2016). Evidence-based pharmacological treatment of generalized anxiety disorder. The International Journal of Neuropsychopharmacology, 19(2), pyv125.
  • Boland, R., Verdiun, M., & Ruiz, P. (2021). Kaplan and Sadock's synopsis of Psychiatry. Wolters Kluwer Health.
  • Hofmann, S. G., Asnaani, A., Vonk, J. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427-440.
  • Hoge, E. A., et al. (2018). Mindfulness meditation and anxiety: A meta-analytic review. Journal of Clinical Psychiatry, 79(3), 18r12107.
  • Munir, S., & Takov, V. (2022). Generalized anxiety disorder. Statpearls - NCBI bookshelf.
  • Targum, S. D., Murphy, C., Khan, J., Zumpano, L., Whitlock, M., Simen, A. A., & Binneman, B. (2018). Audio recording for independent confirmation of clinical assessments in generalized anxiety disorder. Innovative Clinical Neuroscience, 15(3-4), 37-42.
  • U.S. Department of Health and Human Services. (2019). Generalized anxiety disorder: When worry gets out of control. National Institute of Mental Health.

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