- A 32-year-old white female is in the office today with a chief complaint â€œI have to force myself to go to work and other than that I donâ€™t want to leave my house.â€
- She reports that last week she tried to go to a Pampered Chef party one of her coworkers was having and she only got about three blocks from her house and had to turn around and go back home.
- She admits that being anxious is not new for her but feels as though lately those feelings are negatively impacting her life.
- Her medical history is inclusive for a diagnosis of psoriasis.
- She is married and has a 4-year-old son.
- She is presently on no routine medications. She takes an over-the-counter B-50 vitamin to help her manage stress associated with marital strife and childcare challenges secondary to her work schedule.
- Her last menstrual period was two weeks ago.
- BP 100/58, P 66, R 18
- Large raised silvery-white scaly patch noted posterior occipital region of scalp; no thyroid enlargement or tenderness with palpation; heart -regular rate and rhythm; lungs are clear to auscultation
The patient presented to the office complaining of having to force herself to go to work and other than that not wanting to leave the house. The patient voiced that she was invited to an event three blocks from home but turned around and went back home instead. Complains that being anxious is not new for her but lately it has been affecting her life negatively.
This is a married 32-year-old white female mother who came into the office with complaints of increased anxious feelings that negatively impact her life. Medical history is inclusive of psoriasis. No noted routine medications but takes over-the-counter B-50 vitamins to help manage her stress. Her last menstrual cycle was two weeks ago. A large raised silvery-white scaly patch is noted on the posterior occipital region of the scalp. Negative for thyroid enlargement or tenderness with palpation. Vitals BP 100/58, P 66, and R 18. Regular heart rate and rhythm and lungs clear to auscultation.
This patient is having anxious feelings that are impacting her life negatively. The majority of her anxious feelings are centered around social situations. This information leads me to diagnose this patient with Social Anxiety Disorder (SAD) which may be impacted a small amount by her medical diagnosis of psoriasis.
Social Anxiety Disorder (SAD) is characterized by excessive fear of embarrassment, humiliation, or rejection when exposed to possible negative evaluation by others when engaged in a public performance or social interaction (Rose & Prasanna, 2022). The avoidance of social situations can result in impairment in social, occupational, or other realms that are important to function in society (Rose & Prasanna, 2022). Another name given to SAD is social phobia. A medical evaluation is necessary to rule out medical disease, neurologic problems, current medications that may be anxiogenic, vitamin B12 deficiency, and any possible drug or alcohol abuse that could be an issue (Arcangelo, 2021, p. 811). Evaluation of patient history also includes family, environment, cognitive functioning, work or school situations, or exposure to chemical substances (Arcangelo, 2021, p. 811).
SAD has been shown to respond well to treatment with individual cognitive behavior therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) (Rose & Prasanna, 2022). I would start this patient on Paroxetine (Paxil) an SSRI at the recommended initial dose of 10mg daily and not to exceed 50mg daily (Arcangelo, 2021, p. 814). A significant reduction in “anxious mood” has been documented as early as one week with Paroxetine and remission rates as high as 73% (Arcangelo, 2021, p. 814). I would also recommend cognitive behavioral therapy for this patient, to specify, I would recommend a self-help program that is based on cognitive behavior treatment.
Educating this patient requires a thorough explanation at the beginning of drug therapy that includes what the patient should expect during treatment (Arcangelo, 2021, p. 813). The patient has to be taught about the duration of therapy, when to follow up, the expected length of time before results are seen, and how to respond to potential adverse drug effects (Arcangelo, 2021, p. 813). Potential side effects of SSRIs include weight gain, insomnia, GI sequelae, and agitation (Arcangelo, 2021, p. 815). Paroxetine may cause more weight gain and sexual inhibition than other drugs (Arcangelo, 2021, p. 815). Also, educate the patient on the possibility of interactions with other drugs.
Consulting with a mental health professional (therapist, psychologist, or psychiatrist) can provide a proper diagnosis and recommend a tailored treatment plan.