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History
A 40-year-old schoolteacher attends his general practitioner surgery with his wife with complaints of feeling constantly fearful and stressed. These feelings have been present on most days over the past 3 years and are not limited to specific situations or discrete periods. He also experiences poor concentration, irritability, tremors, palpitations, dizziness and dry mouth. He has continued to work, but his symptoms are causing stress at work and at home. He denies any problems with his mood and reports that his energy levels are fine. He admits that he is experiencing problems with his sleep. He finds it difficult to fall asleep and states that he does not feel refreshed on waking up. He has been married for 15 years and lives with his wife and two sons aged 8 and 10. His parents live locally and he has no siblings. His father has been diagnosed with Alzheimer’s dementia. He remembers his mother being anxious for much of his childhood. He has no previous medical or psychiatric history and is not taking any medication. He smokes 20 cigarettes per day and drinks alcohol socially. He has never used any illicit drugs. He tends to hide his symptoms and said that he was seeing his general practitioner because his wife wanted him to seek help.

Mental state examination
He makes fleeting eye contact. He is a neatly dressed man with no evidence of self-neglect. He appears to be restless and tense but settles down as the interview progresses. He answers all the questions appropriately and there is no abnormality in his speech. His mood is euthymic and he does not have any thoughts of self-harm. There is no evidence of delusions or hallu- cinations. He is able to recognize the impact of his symptoms on his social and occupational functioning and is keen to seek help.

Physical examination
His blood pressure is 140/90 mm Hg and his pulse is regular and 110 beats per minute. The rest of the physical examination does not reveal any abnormality.

 

1. List three differential diagnoses with rationale for selections

 

2. Which diagnosis would you choose from the three listed?

 

3. Based on the case study interview, describe three (3) medication options for treatment you would consider for this patient.

Provide rationale for each medication.

4. From the three medication options in question one, which medication/s would you prescribe?

Explain reason for this choice (what made this medication stand out from the rest).

5. Based on the options listed in question one and two, which symptoms are you targeting with your choices? (List all of them) Validate reasons for each of your choices

6. From the three medications chosen in question 3 discuss the effect each has on the neurotransmitters?

   Be specific regarding which neurotransmitters you are targeting and how it will affect the disorder?

 

 

SCIENCE
HEALTH SCIENCE
NURSING

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