Use this scenario and make it original.
SCENARIO #1
The most interesting clientUse this scenario and make it original.
SCENARIO #1
The most interesting client that I encountered this week:
Background: The patient is a male, 42 years of age.
Reason for Visit: Diagnostic Interview.
CC: Recent feelings of significant anxiety.
The patient is a Caucasian, 42-year-old single male with a history of alcohol abuse that is ongoing. The patient presents after being recommended by a friend to see a therapist at this clinic for cognitive behavioral therapy and ongoing addiction treatment. Subsequently, this therapist recommended him to my preceptor for further management.
The patient is 6 2 and 279lbs. All vital signs are within normal limits apart from a blood pressure that maintains in the 150s/100s after multiple attempts. The patient has a positive cardiac history for hypertension, previously being on amlodipine however developing angioedema and subsequently changed to an ace inhibitor thereafter. It should be noted that the patients blood pressure may also be elevated at the time of his appointment due to his anxiety around it per his subjective response.
The patient presents well dressed, no evidence of personal malodor with a stable gait. MMSE WNL. However, when the patient begins discussing his psychiatric history, he often does not take deep breaths and appears to intermittently become tearful. The patient was previously diagnosed with major depressive disorder, single episode, moderate and alcohol dependence with intoxication, uncomplicated. During the interview, the patient describes a multitude of recent deaths within his circle of family and friends. He believes he has always had a history of anxiety; however, both his anxiety and drinking have become much worse after these deaths occurred. He describes having episodes of frequent panic and worry where he becomes diaphoretic and unable to
breath. Twice these episodes have sent him to the emergency room. He also describes that he feels a sense of impending doom when these episodes occur. When these episodes are not occurring, he rates his general anxiety and 8/10 most days. He believes he has suffered with some depression however denies feeling depressed on a regular basis and makes emphasis towards his anxiety.
The patient denies suicidal thoughts or ideations as well as any history of trauma or abuse. He does however mention recently finding out about abuse occurring with his siblings that is evidently hard for him to speak about in detail currently. The patient denies a history of manic symptoms, delusions, and/or hallucinations. He is sad because he does not have very many friends and has never been in a relationship. He believes this is because he lost a relationship with his parents for 10 years after coming out as homosexual 15 years ago but is hopeful because he is now rebuilding that relationship. He finds happiness in his job(s) and being surrounded by good people at work.
After this visit the patient is diagnosed with panic disorder [episodic paroxysmal anxiety] and generalized anxiety disorder. My preceptor decided to prescribe Effexor XR for him and recommended he follow up in 2 weeks. The patient is given information about medication side effects as well as when to seek non-emergent vs. emergent intervention including if he were to experience suicidal thoughts. It is recommended he continue cognitive behavioral therapy to help change his thought processes around drinking and was provided information of a local group for individuals diagnosed with anxiety and/or anxiety disorders.
Lab levels are requested prior to starting this medication and it is recommended that he follow up with his primary care provider concerning his blood pressure while being on this medication and/or to follow-up with a cardiologist.