Mr. M., a 29-year-old married electrician complains of dizziness, sweating palms, heart palpitations, and ringing of the ears of more than 18 months duration. He has also experienced dry mouth and throat, periods of extreme muscle tension, and a constant ‘edgy’ and watchful feeling that has often interfered with his ability to concentrate. These feelings have been present most of the time over the previous 2 years; they have not been limited to discrete periods. Although these symptoms sometimes make him feel ‘discouraged,’ he denies feeling depressed and continues to enjoy activities with his family.
Because of these symptoms, the patient had seen a family practitioner, a neurologist, a neurosurgeon, a chiropractor, and an ear-nose-throat specialist. He had been placed on a hypoglycemic diet, received physiotherapy for a pinched nerve, and told he might have “an inner ear problem.”
He also has many worries. He constantly worries about the health of his parents. His father, in fact, had a myocardial infarction 2 years previously, but is now feeling well. He also worries about whether he is “a good father,” whether his wife will ever leave him (there is no indication that she is dissatisfied with the marriage), and whether he is liked by co-workers on the job. Although he recognizes that his worries are often unfounded, he can’t stop worrying.
For the past 2 years the patient has had few social contacts because of his nervous symptoms. Although he has sometimes had to leave work when the symptoms became intolerable, he continues to work for the same company he joined for his apprenticeship following high-school graduation. He tends to hide his symptoms from his wife and children, to whom he wants to appear ‘perfect,’ and reports few problems with them as a result of his nervousness.
Questions:
1) What is/are Mr. M’s Axis I through III Diagnosis(es) (if any) according to the DSM IV TR?
2) What would substantiate the diagnosis? (Please refer to the diagnostic criteria and exclusionary criteria in the DSM to answer this question; please discuss other related conditions which may need to be ruled out or can be ruled out and why/how as outlined in the DSM).
3) What psychosocial and environmental problems (Axis IV) are affecting the diagnosis, treatment, and prognosis of mental disorders (Axes I and II)?
4) What medication(s) are appropriate considerations? Are there short term and long term considerations? Research what current medications or psychotherapeutic treatments are gaining advantage in managing this disorder. Please provide your psychopharmacologic plan with
specific drugs, dosages and any monitoring needs or patient educational needs relative to this
plan.
5) What would be the role of the advanced practice nurse as interdisciplinary team member in the
care of this client?
6) What is your judgment of Mr. M’s overall level of functioning (GAF score)?
Instructions: