Anxiety Case Study
Sample Case
Miss S is a 29 year old divorced mother whose two children attend a local nursery. She was divorced a year ago after her husband, who had had a string of extra-marital affairs, decided to leave her for another woman he had met at work. Soon after the divorce Miss S took a job in a call centre in order to make ends meet. She went to see her GP when she started having a lot of headaches. During the consultation she also told him that she had been having difficulty getting off to sleep for the last six months, was irritable, on edge, and found herself shouting at the children frequently. She had recently started experiencing palpitations and a tingling sensation in her hands.
When the GP asked if she felt “stressed”, she said that she spent most of the day worrying about various things, such as whether she was bringing up her children well, whether she would find another partner, and whether she would get “the sack”. She was unable to relax and had difficulty concentrating at work. She was seen by her supervisor at the call centre last week who told her that her performance was unacceptable and that if she did not “pull her socks up” she would be sacked.
Explain Miss S’s problem and how it should be managed.
Problem
Management
Common Questions
Describe the clinical features of generalised anxiety disorder
Generalised Anxiety Disorder usually presents with:
- Severe, long lasting anxiety
- Often without a precipitating cause
It may also show the following features:
- Sleeplessness
- Restlessness
- Concentrationlessness
- Nausea & Vomiting
- Muscle tension
Understand the difference between generalised anxiety disorder and panic disorder
Panic disorder is a condition where people have regular occurences of panic attacks, with periods of relatively normal mental state in between, whereas GAD tends to be present throughout a person's day.
However, many people with PD will have a continuing level of anxiety during the day, as well as their panic attacks. This can make it difficult to distinguish from GAD. They key difference is that for people with PD, the focus of their anxiety is on whether they will have another attack, leading to behaviour where they avoid places or situations where they have had previous episodes.
Describe the epidemiology of generalised anxiety disorder
It affects 2% of the population and women twice as much as men. In patients much more commonly have it.
Understand the aetiology of generalised anxiety disorder
There is no clear cut, or commonly accepted theory. It appears to run in families, so possibly has some genetic component. Often there will be a childhood event or early adulthood stressor that will have played some part in their condition.
Describe psychological theories of anxiety (eg. cognitive behavioural, psychodynamic)
There are two main theories. Its effort going into it in depth, and you don't need to know, so here is an incredibly brief summary:
- Psychodynamic - its all in the unconcious, which is set by your childhood. Freud
- Cognitive Behavioural - how a stimulus makes us feel is not based on the stimulus, but our processing of that event.
Know how to investigate a patient presenting with anxiety symptoms
- Rule out biological cause: eg. phaechromocytoma
- Depressive disease
- Hypothyroidism
- Alcohol/Drug withdrawal
- Hypoglycaemia
- Angina
- Supraventricular Tachicardia
Understand the principles of the management of anxiety disorders
Know how to screen for symptoms of anxiety
- Anxious or worried all/most of the time
- No control over the worry
- Duration of 6 months or more
- Irritability
- Concentration
- Restlessness
- Energy decreased
- Sleep impairment
- Tension in muscles