Nursing Generalized Anxiety Disorder Discussion


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Clinical Case Summary

JN, who is a law student and married, has increasingly in the past year become more worried and stressed about everything which is interfering with her daily functioning and sleep. Her academics are causing stress as well as she gets anxious about the thoughts crossing her mind, i.e., her husband employment, potential accident, and financial issues. Her mental health is manifesting physically because she complains about recurring headaches, muscle spasms, and difficulty in falling asleep. She is having trouble concentrating on her school assignments and feels weak. Furthermore, she mentions that she has a history of anxiety but that in the past it motivated her but now it’s impairing her daily function.

Primary and Differential Diagnosis

           The case presented meets criteria for generalized anxiety disorder (GAD), F 41.1 according to the Diagnostic and Statistical Manual of Mental Disorders [DSM-5] (American Psychiatric Association [APA], 2013).  JN’s diagnostic criteria for this disorder are excessive anxiety and worry for at least 6 months (occurring more days than not), difficulty controlling the worry, and symptoms like fatigue, muscle tension, sleep disturbance, trouble in concentrating (APA, 2013). Obsessive-compulsive disorder (OCD) may be a differential diagnosis. Anxiety and getting worried are common symptoms of GAD and OCD. With the differential diagnosis of OCD, a patient may experience anxiety because of certain obsessional thoughts and concerns for the future (APA, 2013). These obsessions and thoughts are unwanted and urges a person to perform task tasks (compulsion). In JN’s current situation, the primary reason for her worry and anxiety are related to forthcoming and future events. Moreover, the recurrent worries present in GAD are mostly concerned with real life while the obsessions of OCD mostly do not entail real life concerns (Anna et al., 2020). Another differential diagnosis may be social anxiety disorder (APA, 2013). People with this disorder also have anticipatory anxiety but it is usually when they fear being evaluated in any kind of social interaction or performance. However, with a diagnosis of GAD, the worry occurs regardless of any social events or whether they are evaluated (APA, 2013; Karunakaran et al., 2021).

Patient Problems

The major problem which needs the most attention is JN’s constant worrying as it is causing significant stress and affecting her daily functioning (interpersonal, school, etc.).

The second priority is the sleep difficulty. The struggle to sleep can greatly affect mental and physical health because it is a basic need and sleep deprivation can lead to abnormality in everyday life (Richards et al., 2020).

The third priority is the difficulty with concentrating during exams and assignments. If JN’s anxiety is not controlled, it can negatively impact her academic progress and her future goals may be at stake.

The last priority are the physiological problems (headaches and muscle spasms) which are equally important; however, the physiological symptoms may be eliminated if the anxiety and sleep hygiene issues are dealt effectively (Cho et al., 2020).

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