Chapter 40: Anxiety Disorders
A 36-year-old nurse anesthetist states that he constantly wonders if he is capable of doing his job and feels as if he is not good enough. For the past year, he reports constant worry about making mortgage payments, paying telephone bills, making medication and billing code errors, and affording his children’s education. His coworkers and wife have commented on his irritability, and he reports increased muscle tension and difficulty sleeping. The anesthesiologist he works with has requested a meeting with him due to increased errors he has made at work. The patient most likely has which of the following disorders?
B. Obsessive-compulsive disorder (OCD)
C. Generalized anxiety disorder (GAD)
E. Substance-induced anxiety disorder
C. The patient’s symptoms are most consistent with generalized anxiety disorder. They have been ongoing for several years and include anxiety and worry associated with increased irritability (at home and work), difficulty concentrating, muscle tension, and difficulty sleeping. Substance-induced anxiety disorder would be a consideration given his access to drugs, but there is no mention of substance abuse or drug testing to confirm.
During his first day on the emergency medicine clerkship rotation, a medical student is asked to assist his attending physician with repairing a laceration on a 35-year-old man who presented to the emergency department after a bar fight. The student has done his best to avoid situations involving human blood throughout his training until now. As he is preparing the patient for laceration repair, he starts to examine the wound and faints. The student would most likely benefit from which of the following?
A. Eating a snack before starting his shift
B. Systematic desensitization
C. Dialectal behavioral therapy
D. Starting a selective serotonin reuptake inhibitor (SSRI)
B. This medical student most likely suffers from a specific phobia—fear of blood (hemophobia). Treatment of choice for phobia is systematic desensitization. There is no evidence to support that the student has diabetes or hypoglycemia. Dialectal behavioral therapy is the treatment of choice for borderline personality disorder. SSRI pharmacotherapy would not be indicated for these symptoms. Phobias are treatable with therapy, and it would be best to encourage the student to seek treatment before entertaining ideas of changing professions.
A 59-year-old veteran presents to your office with complaints of ongoing troubling nightmares related to experiences he endured while ...