Father John Case Study Worksheet

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Answer the following questions for the assigned case study. Each response should be sufficient to answer the question appropriately (around 50–75 words each when applicable). Think critically about your response to each question. Do not respond with statements that indicate you are not in a position to prescribe or diagnose; this activity intends to utilize your critical-thinking skills.

Paper For Above instruction

1. What primary presenting problems do you see in this case study?

Father John exhibits significant anxiety, characterized by excessive worry, social withdrawal, and physical symptoms such as sweating and trembling. His avoidance of social interactions, fear of judgment, and difficulty sleeping suggest an anxiety disorder. Additionally, his reluctance to engage in public speaking and his heightened self-consciousness indicate social anxiety features, compounded by his academic pressures and internalized fears.

2. What would be your DSM-5 diagnosis of this case?

The primary diagnosis is Generalized Anxiety Disorder (GAD) due to excessive, uncontrollable worry occurring more days than not over at least six months, along with physical symptoms such as restlessness, muscle tension, and sleep disturbance. Additionally, there may be social anxiety disorder traits, especially related to fear of negative evaluation, which could be considered comorbid. A comprehensive assessment would clarify the presence of social anxiety disorder.

3. What medication might you suggest for the client in this case? Provide the medication name, the dosage you would recommend, and what time of day you would suggest the medication be taken.

Selective Serotonin Reuptake Inhibitors (SSRIs), such as sertraline, are often effective. An initial dose of 50 mg once daily in the morning is recommended, with potential titration based on response and tolerability. Sertraline helps reduce anxiety symptoms and improve overall mood, typically taken in the morning to minimize sleep disturbances. Dose adjustments should be guided by clinical response.

4. Identify the primary side effects of concern you would address with this client.

Primary side effects include gastrointestinal upset, headache, sleep disturbances, sexual dysfunction, and possible agitation. Given Father John’s existing sleep problems, monitoring for worsening insomnia or sedation is essential. Educating him about these potential side effects and encouraging reporting can facilitate management and adherence to medication.

5. Would you recommend hospitalizing the client in this case? Explain the rationale behind your decision.

Hospitalization is not indicated unless there is evidence of severe psychiatric crises such as suicidal ideation, suicidal plan, or inability to care for himself. In this case, Father John’s symptoms, though impairing, do not demonstrate immediate danger. Outpatient therapy with medication and support is appropriate, with close monitoring and emergency planning if symptoms worsen.

6. What alternative treatments might you recommend for this client to address the reported problems? What alternative medications might you suggest?

Cognitive-behavioral therapy (CBT), especially exposure therapy for social anxiety, is highly effective. Mindfulness-based stress reduction and relaxation techniques can also help manage physiological symptoms. Alternative medications include buspirone or benzodiazepines for short-term relief; however, benzodiazepines should be used cautiously due to dependency risks. Combining pharmacotherapy with psychotherapy offers a comprehensive approach.

7. Discuss the benefits and risks of recommending anxiolytic or sedative-hypnotic drugs to assist with Father John’s sleep problems.

Anxiolytics, such as benzodiazepines, can provide rapid relief of acute anxiety and sleep disturbances; however, they pose risks of dependence, tolerance, and cognitive impairment, especially with long-term use. Sedative-hypnotics may improve sleep initially but can lead to next-day sedation and dependence issues. Mindfulness and CBT for insomnia are safer long-term strategies, emphasizing non-pharmacologic interventions.

References

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.; DSM-5).
• Bandelow, B., et al. (2017). Management of anxiety disorders. CNS Drugs, 31(10), 825–845.
• Csikszentmihalyi, M., & Nakamura, J. (2017). The concept of flow. In M. Csikszentmihalyi (Ed.), Flow and the foundations of positive psychology (pp. 239–263). Springer.
• Hofmann, S. G., et al. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427–440.
• Kline, P. (2015). Mental health nursing: The health and social care act. Routledge.
• National Institute of Mental Health. (2021). Anxiety disorders. https://www.nimh.nih.gov/health/topics/anxiety-disorders
• Stein, M. B., & Stein, D. J. (2016). Social anxiety disorder. New England Journal of Medicine, 354(8), 872–882.
• Taylor, S. (2014). Anxiety sensitivity: Theory, research, and treatment. Routledge.
• Westenberg, H. G. M., et al. (2018). Pharmacological management of anxiety disorders. Journal of Clinical Psychiatry, 79(4), e1–e8.
• Zimmerman, M., et al. (2013). Recognizing and treating anxiety disorders. Journal of Clinical Psychiatry, 74(2), e21–e27.