Homework answers / question archive / Demographic Information (Client One): Patient Initials: SS Age: 39 y/o Gender: Male Presenting problem: Chief Complaint (CC): "I constantly worry about everything

Demographic Information (Client One): Patient Initials: SS Age: 39 y/o Gender: Male Presenting problem: Chief Complaint (CC): "I constantly worry about everything

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Demographic Information (Client One):

Patient Initials: SS Age: 39 y/o Gender: Male

Presenting problem:

Chief Complaint (CC): "I constantly worry about everything."

History of Present Illness (HPI):

SS is a 39 y/o Caucasian male attending group therapy for substance abuse mandated by the court. The client is being treated in drug court for court charges related to methamphetamine manufacturing. SS reports that his addiction consisted of marijuana use and liquor or beer. Since his court charges, he has completed inpatient rehab treatment and has sustained sobriety for thirty days. SS complains of anxiety that doesn’t go away, which is interfering with his daily routine and preventing him from sleeping at night. The client sits at the group table biting his nails continuously. SS states “when I use to worry and get anxious before I would just smoke a joint, I can’t do that now, which makes it hard.” The client verbalized that he worries about the bills, his relationship, his sobriety, only to name a few. He denies that any of the things he becomes anxious about is not in any current jeopardy. SS explains that if he finds himself not worrying about something, he sees things to worry about which is hard to control. He states, “I always feel anxious and tense.” SS used marijuana and ETOH to cope with the anxiety before his sobriety, and without the substances he feels his anxiety is taking over.

Past Medical History (PMH):

Insomnia, Substance Abuse, ETOH Abuse

Medications:

Melatonin 6mg PO at HS, Campral 666mg PO TID

Personal/Social History:

Unemployed. Completing community service at HOMES Inc. in construction. Attends group therapy meetings twice a week and AA meetings twice a week for sobriety support. Lives at home with girlfriend of three years and her mother. Native language is English.

Past Psychiatric History:

Denies any previously diagnosed psychiatric history.

Substance Use History:

Smokes a pack of cigarettes a day for 20+ years, denies any current ETOH use, sober thirty days. History of marijuana use 15+ years. Denies any current use of illicit drugs.

Diagnosis: 300.02 (F41.1) Generalized Anxiety Disorder

Generalized Anxiety Disorder (GAD)- According to the DSM-5, SS meets GAD criteria is A.) Excessive anxiety and worry, occurring more days than not for at least six months, about a number of events or activities. B.) The individual finds it difficult to control the worry. C.) The anxiety and worry are associated with three (or more) of the following six symptoms: 1. Restlessness or feeling keyed up or on edge. 2. Muscle tension. 3. Irritability. 4. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep) (American Psychiatric Association, 2013, p. 222).

The client also scored 19 on the HAM-A, which indicates mild to moderate severity (Hamilton, 1959).

Plan:

The treatment plan for SS is to continue bi-weekly group therapy sessions using CBT to support his sobriety. SS will also be advised to continue AA meetings bi-weekly for additional sobriety support. The client will be referred to a licensed clinician for medication management for anxiety. The client will also be offered additional psychotherapy individually as needed to support him at this time.

Cognitive behavioral therapy (CBT): CBT is considered the treatment of choice for GAD. CBT changes the client’s way of thinking, behaving, reacting to situations to reduce anxiety (Cognitive Behavioral Therapy Los Angeles, n.d.). CBT has proven to increase the quality of life in clients with anxiety (Kaczkurkin & Foa, 2015).

Demographic Information (Client Two):

Patient Initials: MD Age: 42 y/o Gender: Male

Presenting problem:

Chief Complaint (CC): "Sometimes I can’t breathe."

History of Present Illness (HPI):

MD is a 42 y/o Caucasian female attending group therapy for substance abuse mandated by the court. The client is being treated in drug court for court charges related to methamphetamine distribution. MD’s addiction consisted of ETOH and benzodiazepines. Since her court charges, she has completed inpatient rehab treatment and has sustained sobriety for ninety days. MD is complaining of shortness of air with palpations that are unannounced with no relation to triggers. She states “I can be at work, and it will just come on. First my heart starts beating fast, my hands become clammy, I break out in a shivering sweat, and I can’t breathe.” “It's scary because I can’t prepare for them.” MD reports using benzodiazepines and ETOH to cope with the anxiety before her sobriety. “These attacks are making it really hard to stay sober; it’s scary.” MD recognizes that the scariest part of the event is she feels like she is going to pass out and fears she will. Recently she has been asking her husband to drive her to work, and to her meetings because she is afraid, she will have an attack while driving. MD states “its scary, the first time I had one I thought I was having a heart attack.” MD cannot identify any triggers but does report she has had mild anxiety in the past, which she has been prescribed PRN Vistaril. The client scored a 9 on the HAM-A, which indicates mild severity (Hamilton, 1959).

Past Medical History (PMH):

ETOH Abuse, Substance Abuse, Insomnia

Medications:

Melatonin 6mg PO at HS, Vistaril 25mg PO every six hours as needed for anxiety

Personal/Social History:

Works full-time at Subway. Attends group therapy meetings twice a week and AA meetings twice a week for sobriety support. Lives at home with her husband and three children. Native language is English.

Past Psychiatric History:

Denies any previously diagnosed psychiatric history.

Substance Use History:

History of tobacco abuse two packs of cigarettes a day for 20+ years, currently using E-cigarette to “cut down on smoking,” denies any current ETOH use, sober three months, denies any use of illicit drugs.

Diagnosis:

300.01 (F41.0) Panic Disorder - According to the American Psychiatric Association (2013), MD meets criteria for panic disorder based on A.) Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur: 1. Palpitations, pounding heart, or accelerated heart rate. 2. Sweating. 3. Trembling or shaking. 4. Sensations of shortness of breath or smothering. 8. Feeling dizzy, unsteady, light-headed, or faint. 12. Fear of losing control or “going crazy.” B. At least one of the attacks has been followed by 1 month (or more) of one or both of the following: 1. Persistent concern or worry about additional panic attacks or their consequences 2. A significant maladaptive change in behavior related to the attacks C. The disturbance is not attributable to the physiological effects of a substance D. The disturbance is not better explained by another mental disorder (American Psychiatric Association, 2013, p. 208).

300.00 (F41.9) Unspecified Anxiety Disorder- According to DSM-5 unspecified anxiety disorder applies to MD since the anxiety symptoms she is experiencing does not meet an anxiety disorder criterion. The client is experiencing anxiety that causes clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the anxiety disorders diagnostic class, and do not meet criteria for adjustment disorder with anxiety or adjustment disorder with mixed anxiety and depressed mood (APA, 2013, p. 233).

Plan:

The treatment plan for MD is to continue bi-weekly group therapy sessions using CBT to support her panic/anxiety. MD will also be advised to continue AA meetings bi-weekly for sobriety support. The client will be referred to a licensed clinician for medication management for panic disorder. The client will also be offered additional psychotherapy individually as needed to teach her how to use breathing techniques and manage symptoms.

Cognitive behavioral therapy (CBT): BECK Institute for Cognitive Behavior Therapy (2019), acknowledges that panic disorders are characterized by un-triggered unexpected anxiety. CBT teaches "clients that panic attacks arise from an unexpected sensation and teaches clients to normalize, if not embrace, anxiety" (BECK Institute for Cognitive Behavior Therapy, 2019, para. 2).

Ethical Considerations:

Ethical considerations must be considered when treating clients in a group setting. As therapists, we must consider beneficence and non-maleficence related to client confidentiality. As the therapist, we are to do no harm and to work towards the benefit of others; this is done by building trusting relationships with individuals within the group. Ethically therapists are to protect the client’s confidentiality except when required to do so by law (Grand Canyon University, 2018). The same confidentiality rules apply to members within the group, as well. The therapist should make sure individuals within the group are aware of confidentiality and makes it clear to their clients before starting a group counseling session by having the individual sign a contract that promises confidentiality (Grand Canyon University, 2018).