Ward, Kaci CMN 552-802 Anxiety Disorder Assignment

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Anxiety Disorder Assignment 1. According to the DSM-5-TR, which of the following is considered a subtype of specific phobia? a. Blood-injection-injury b. Loud Sounds c. Social d. Agoraphobia Source: DSM, 5th edition text revision: Specific Phobia Diagnostic Criteria page 224-225 Rationale: The correct answer is A, Blood-injection-injury. The subtypes of specific phobias are animal, natural environment, blood-injection-injury, situational, and other. Agoraphobia and Social anxiety disorder is not a specific subtype. They are separate diagnoses. Loud sounds are not a subtype of a specific phobia but could be considered an “other” subtype. 2. A 30-year-old woman visits your clinic with increasing anxiety about using public transportation and standing in lines. She recalls sudden onset symptoms such as dizziness, fainting, sweating, and a sense of not being able to get out of places. These incidents have occurred in various settings, including crowded areas and enclosed locations. She avoids public transit and social events for fear of something terrible happening or that she may be unable to escape from such situations. Which is most likely the diagnosis based on the patient's presentation? a. Social Anxiety Disorder b. PTSD c. Agoraphobia d. Panic Disorder Source: DSM, 5th edition text revision: Agoraphobia Diagnostic Criteria, page 246-247 Rationale: The correct answer is C, Agoraphobia. According to the DSM-5-TR, the patient’s symptoms, including anxiety about public transportation and standing in line, are consistent with the criteria for Agoraphobia. The features of Agoraphobia also include feeling as if something terrible is going to happen or being unable to escape from situations. Social Anxiety Disorder, Panic Disorder, and PTSD may have some comparable symptoms. However, the presentation stated is most indicative of Agoraphobia. 3. A 9-year-old girl is brought to your clinic by her parents, concerned about her speech development. According to the parents, the child “overtalks” at home with family members but repeatedly refuses to speak in social situations such as school or extracurricular activities. Despite speaking and understanding the language, the child keeps silent when forced to communicate with classmates or adults outside the house. The parents observe that the child's behavior has persisted for over a year, causing concern for both the child and the family.

What is most likely the diagnosis based on the child’s presentation? a. Autism b. Selective Mutism c. Oppositional Defiant Disorder (ODD) d. Social Phobia Source: Sadock & Kaplan, 10 th edition: Selective Mutism, pages 3718-3721 Rationale: The answer is B, Selective Mutism. Sadock and Kaplan describe Selective Mutism (SM) as a consistent inability to talk in one or more specific social contexts despite talking in other situations. The diagnosis must not be based on a lack of understanding or comfort with language, and most often with children, the situation in which talking is avoided is school. SM can be misdiagnosed with Autism, but children with Autism do not have language deficits limited to certain situations. ODD criteria are not met because the child is not presenting with oppositional behaviors. Social phobia is ruled out in this presentation because no fear or avoidance of eating in public or using public restrooms was presented. 4. The PMHNP is interviewing a 29-year-old male patient with an overwhelming fear of snakes. They express having panic attacks when they see photos or hear references to snakes, and their phobia has started to interfere with their everyday functioning and social relationships. What is the first-line treatment recommended for this patient's condition? a. Atypical Antipsychotics b. SSRI’s c. Interpersonal Psychotherapy d. Exposure-based systematic desensitization Source: Sadock & Kaplan, 10 th edition: Differential Diagnosis, Etiology, Course, and Treatment, page 1727 Rationale: The correct answer is D, Exposure-based systematic desensitization. The treatment of choice for Specific Phobia is a behavioral therapy series that includes exposure-based, systematic desensitization. There is limited evidence on whether antidepressants or atypical antipsychotics are effective. Interpersonal Psychotherapy would not be the appropriate treatment for this diagnosis. 5. A 67-year-old patient comes into the clinic reporting excessive worry about various aspects of life, including health, family, and financial issues. He describes feeling irritable, fatigued, and having difficulty staying asleep over the last eight months. Based on these findings, what would be the recommended first-line treatment? a. Escitalopram 2.5mg daily b. Escitalopram 5mg daily c. Sertraline 50mg daily d. Sertraline 25mg daily

Source: Sadock & Kaplan, 10 th edition: Selective Serotonin Reuptake Inhibitors, Table 57.4c, page 4129-4130 Rationale: The correct answer is A, Escitalopram 2.5mg daily. The patient exhibits Generalized Anxiety Disorder (GAD). Escitalopram is the first-line treatment for GAD in the elderly. A lower starting dose is frequently recommended for older anxious individuals since SSRIs might increase anxiety symptoms if started too high. Therefore, starting Escitalopram at 5mg would be too high. Sertraline is a reasonable first-line treatment option for panic, social anxiety, PTSD, or OCD in elderly adults but is not a first-line treatment for GAD.

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References American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787 Sadock, B. J., Sadock, V. A., Ruiz, P., & Kaplan, H. I. (2017). Kaplan and Sadock’s comprehensive textbook of psychiatry (10th ed.). Wolters Kluwer.

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