Psychopharmacology

Possible etiologies

Generalized anxiety disorder (GAD)

GAD or as it is known in full generalized anxiety disorder is a widespread anxiety complication that is characterized by worrying chronically, tension and nervousness. This is different from a phobia; which is characterized by fear of something specific or situation. GAD diffuses a feeling of dread and unease spanning all aspects of one’s life. The anxiety is not as intensive as a panic attack but lasts much longer and consequently lowers the general quality of life over a longer time span of life. It does not matter whether you are conscious that your worrying is exaggerated or think that such worries protect you in some way, the consequence is the same. It is impossible for you to deliberately turn off your anxiety. They form an endless stream that flows on your mind (Segal, 2016). Our subject, Tom, is a case for GAD as his worrying is now affecting his quality of life on a large scale with anxiety and lack of sleep leading to mood swings and irritation.

Diagnosis

In order to assist Tom deal with generalized anxiety disorder, the health expert may

Conduct a physical examination to establish whether there is an underlying condition that may be connected to his anxiety condition.

Request for urine and blood tests if they suspect a medical condition

Ask Tom pointed questions regarding his medical history and symptoms

Employ psychological questions to determine diagnosis.

A lot of experts apply the criteria laid out in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) developed by the American Psychiatric to investigate mental complications. The manual is also used by insurance companies in their compensation analysis processes.

The DSM-5 criteria used for GAD includes

Exaggerated anxiety experiences on most days of the week about numerous events for a period spanning a month or longer.

Difficulty and dealing with the worry tendencies

There is to be at least three of the symptoms listed below in adults and children fatigue, restlessness, irritability, muscle tension, sleep problems and concentration problems. Tom already has anxiety, sleeping issues and irritability, hence the following will be examined in his case:

If he has anxiety that makes him get significant distress, and his daily life is interrupted negatively

If he manifests anxiety that does not have any link with any medical condition such as post traumatic stress Disorder, a medical condition or even substance abuse

Treatment and Management

There are two important treatment approaches for GAD, i.e. medications and psychotherapy. It has also been shown that a combination of the two treatments produces better results. Unfortunately, it may be a trial and error process to unravel the most effective treatment for Tom in this case.

Psychotherapy

This is also commonly referred to as talk therapy. The process requires that Tom is involved with the psychotherapist to tone down his symptoms of anxiety. It is often effective for GAD. CBT; also commonly referred in its full form as cognitive behavioral therapy is the most effective treatment for GAD. The therapy aims at guiding Tom back to the activities that have made Him anxious and consequently make him avoid them. The process is a gradual improvement that builds on earlier successes.

Medications

There are several medications that are used in their treatment of GAD. It is essential that Tom consults with his health care providers to settle on the most appropriate medications for his complications. This makes sure that due consideration is given to the side effects and effectiveness of the medications. Some of the first choice medications for the treatment of GAD include Antidepressants such as serotonin norepinephrine reuptake inhibitor and selective serotonin reuptake inhibitor. In particular antidepressants include venlafaxine (Effexor XR) and paroxetine (Paxil, Pexeva) duloxetine (Cymbalta), escitalopram (Lexapro). There is a chance that Tom’s health provider may propose alternative antidepressants.

He is advised to avoid all forms of sedatives including alcohol.

Cut back on coffee intake

Embrace various relaxation techniques. He could do yoga, meditation or similar activities.

Eat healthy. Have plenty of fruits, fish, whole grains and vegetable in his diet. These may be linked to stress and anxiety reduction; there is need for more research on them though (Mayo Clinic, 2014).

In summary, Tom has manifested possible symptoms of GAD. He feels anxious and has sleeping problems. He cannot live his life because of these disturbing behavioral and routine changes (including lack of sleep). Tom is a potential case for GAD and, thus, is suitable for GAD examination.

Case 2

Possible etiologies

Depression

Depression is a down mood condition that makes the life of a lot of children sad and painful. It interrupts their school life, family relationships, social activities and more. Although it is a normal occurrence for children to feel low; mood wise, depression is a condition that lasts for weeks and months or even years. Tim, in our case study, seems to be a victim of this. Some common symptoms of his condition include irritability, restlessness and guilt. Several life occurrences may have triggered depression in Tim and these need to be investigated further. Some common incidents include incidents of divorce and constant squabbles between spouses. Although depression tends to run in families, cases of children like Time without such family links but are depressed are common too. Depression is common and serious. It should be noted that depression does not subside without proper treatment.

Hypothyroidism

This condition occurs when a child’s thyroid has complications and consequently does not produce sufficient thyroid hormones. Hypothyroidism is tested in all babies at the point of birth. If a child is found with the condition, it must be attended immediately; lest it causes serious mental and physical retardation. Some of the conspicuous symptoms of hypothyroidism include a large tongue, puffy face, tiredness, delayed puberty, weight gain and tiredness. There are several problems that can cause hypothyroidism in children. These include some forms of medication, issues with the pituitary gland and immune disorders. Sometimes, a child is born without thyroid glands, or is born with a defective one. Tim.needs to be examined for this medical condition before its impact on his life can be determined, if at all.

Diagnosis

Diagnosis of mental health entails direct interviews with the parent or caregiver and Tim as well. There may be other relevant psychological tests. Getting information from school teachers, friends of Tim’s and his classmates is helpful in establishing the consistency of the symptoms. And that they are different from previous conduct. There are still no specific psychological tests that can clearly pinpoint the presence or absence of depression. However, questionnaires and interviews directed at both the parents and Tim; along with personal information can help experts to quickly diagnose depression in him. Often time, the questionnaires are helpful in unveiling other factors that contribute to the child’s depression. Such factors as ADHD and OCD are possibilities.

Management and Treatment

Depression treatment options are common for both children and adults. However, the family, environment and friends’ role in the process of treatment for Tim in particular differs from that of adults. The doctor handling Tim’s case may use psychotherapy as their first line of treatment and only resort to another option if there is no significant change. Studies show that a combination of both psychotherapy and medication produces the best results in the treatment of depression. Prozac, is the most effective medical treatment option for depression in teens and children like Tim. The drug has a nod from FDA in the treatment of depression in children between the ages of 8 and 18. There may be other mediations prescribed if there are other illnesses that contribute to the occurrence of depression in Tim (WebMD, 2016).

Tim is a classic case of GAD and depression. Tim falls within the range of 8 to 18 years. Tim is restless and seems to experience problems in school. Restlessness is a manifestation of fear and anxiety. It would be helpful to seek information from his parents and caregivers to investigate whether there are underling issues that lead to his anxiety.

Case 3

Possible etiologies

Depression

Depression can be triggered by a number of factors, including the loss of a loved one (which is true for our third case study – Doris), a stressful situation or a difficult relationship. Depression may also be triggered by changes in the body system and the brain in older adults, which be true for Doris as she is 48 years old. For instance, changes in the way blood flows in adults (ischemia) is one such possible turn of body workings. The condition sometimes leads to stiffening of vessels and consequently leading to limited or inhibited blood flow to several organs of the body including to the brain. This often triggers what is commonly referred to vascular depression. One does not need family history to develop this type of depression. Vascular depression patients may experience heart problems and stroke and other illnesses of the vascular system. This needs to be tested for Doris however. Depression may co occur with other problematic conditions such as diabetes, Parkinson’s disease, heart disease and cancer which so far Doris has not shown any signs of having. Such a scenario may lead to either or both to become worse. Indeed, even medications for managing some conditions may trigger depression. Depression in Doris’ case is a condition that interferes with her quality of life. It goes beyond just mood. It may affect her appetite, sleep patterns and more. However, it is not an inevitable ageing eventuality. She can actively take steps to forestall it (Robinson, Smith, & Segal, 2016).

Diagnosis

The following tests can help to pick rule out other possible conditions that cause depression symptoms in Doris. They will help her pinpoint the diagnostic results and check for related issues.

Doris’ health expert may inquire about her health. Sometimes depression is linked to other underlying health issues.

A complete blood count test may be conducted by her doctor so as to establish the functionality of the thyroid.

Anticipate the doctor to ask questions related to her thoughts, patterns of behavior and feelings. Doris may get a questionnaire to help respond to these questions.

Doris’ mental health expert is likely to use the criteria set out in the DSM-5 manual that is published by the American Psychological Association. The manual is used by insurance companies to compensate patients for treatment of mental condition and by providers of mental health to check and diagnose mental complications.

Management and Treatment

Alternative medicine practice and complementary medicine practice emphasize harmony between the body and the mind for Doris to sustain good health. Some commonly used techniques used to achieve relaxation of the body and mind and possibly help to assist depression in Doris’ case include

Music or art therapy

Acupuncture

Meditation

Massage therapy

Relaxation techniques such as yoga or tai chi

Spirituality

Guided imagery

Aerobic exercise

It should be noted that it is not enough to rely on these therapies to handle depression. They may add value when used alongside psychotherapy and medication and 48-year-old Doris is clearly lonely. Her husband died. Therefore, she is a likely candidate for depression because she lost her husband (a loved one). She may be experiencing changes in the way blood circulates around her body system; owing to her age.

References

Mayo Clinic. (2014, September 25). Lifestyle and Home remedies. Retrieved from Mayo Clinic: http://www.mayoclinic.org/diseases-conditions/generalized-anxiety-disorder/basics/lifestyle-home-remedies/con-20024562

Robinson, L., Smith, M., & Segal, J. (2016, April). Depression in Older Adults and the Elderly. Retrieved from Helpguide.org: http://www.helpguide.org/articles/depression/depression-in-older-adults-and-the-elderly.htm#causes

Segal, M. S. (2016, April). Generalized Anxiety Disorder (GAD). Retrieved from Helpguide: http://www.helpguide.org/articles/anxiety/generalized-anxiety-disorder-gad.htm

WebMD. (2016). Depression Health Center. Retrieved from WebMD: http://www.webmd.com/depression/guide/depression-children?page=3