CC (chief complaint): The patient is suffering from recurring anxiety attacks whenever she has to leave her house, which is why she has been largely unable to perform basic tasks, as well as communicate with her family members: “I just can’t go any further.”
HPI:
- Past Psychiatric History:
- General Statement: N/A
- Caregivers (if applicable): N/A
- Hospitalizations: N/A
- Medication trials: N/A
- Psychotherapy or Previous Psychiatric Diagnosis: N/A
Substance Current Use and History: the patient does not use any substances
Family Psychiatric/Substance Use History: the patient does not have any family psychiatric/substance use history
Psychosocial History: the patient confirms having had issues communicating with others recently due to the fear of leaving the house
Medical History:
- Current Medications: N/A
- Allergies: N/A
- Reproductive Hx: N/A
ROS:
- GENERAL: T- 99.0 P- 102 R 24 156/86 Ht 5’4 Wt 1lbs73
- HEENT: N/A
- SKIN: N/A
- CARDIOVASCULAR: N/A
- RESPIRATORY: shortness of breath
- GASTROINTESTINAL: N/A
- GENITOURINARY: N/A
- NEUROLOGICAL: anxiety
- MUSCULOSKELETAL: N/A
- HEMATOLOGIC: N/A
- LYMPHATICS: N/A
- ENDOCRINOLOGIC: N/A
Objective:
- Physical exam: if applicable
- Diagnostic results: N/A
Assessment: Mental Status Examination: The brief assessment of the patient’ mental status based on the information that she has supplied indicates that she is experiencing significant distress. There are obvious indications of anxiety present in the evidence that she provides, including both the statements that she makes and the manner in which she speaks. Namely, her being out of breath is representative of anxiety; moreover, the facts that she presents about herself point to the presence of a mental health concern (Simning et al., 2019). Specifically, the fact that she cannot walk long distances due to the presence of obvious fear signifies that she is suffering from anxiety and the associated mental health concerns.
Differential Diagnoses: General Anxiety Disorder (GAD): In the DSM-V, GAD is defined as the condition involving excessive fear, the presence of a continuous sense of anxiety, and the relevant mental health issues (American Psychiatric Association, 2014).
Agoraphobia: According to the DSM-V description, agoraphobia can be described as the fear of open space, which is definitely an issue in Mrs. Weidre’s case.
PTSD: The patient may be suffering from long-term PTSD as a result of her history of relationships with her verbally abusive mother. However, while clearly having served as an important contributor to the current state, the patient’s PTSD is unlikely to be the main reason for her to fear to leave the house.
Reflections: The case under analysis has provided substantial information for further reflection. Specifically, it has demonstrated the necessity of the consistent and continuous dialogue between community members, and, by extension, communication, in general. Namely, the provided scenario allows examining the nature of anxiety, particularly, its sociocultural and biologic prerequisites. Specifically, the case proves the utter necessity of the active dialogue not only on an interpersonal level, but also on that one of the community (Wong et al., 2020). Though Mrs. Weidre has been communicating with her husband, she has still acquired the disorder, which le to0 her further alienation from her community. Thus, to reintegrate into it, she will have to focus on overcoming the fear of leaving her house and integrate back into her sociocultural environment.
Furthermore, the case at hand introduces the necessity for aging patients to receive appropriate care and support, including the one required for maintaining proper mental health. In the case under analysis, the patient’s PTSD caused by childhood trauma has caused her to develop agoraphobia and, as a result, GAD. Therefore, to ensure that mental health issues are managed carefully and thoroughly, patient education coupled with active support for the further prevention of mental health issues in aging adults is required.
References
American Psychiatric Association. (2014). The diagnostic and statistical manual of mental disorders (5th ed.). APA.
Simning, A., Fox, M. L., Barnett, S. L., Sorensen, S., & Conwell, Y. (2019). Depressive and anxiety symptoms in older adults with auditory, vision, and dual sensory impairment. Journal of aging and health, 31(8), 1353-1375. Web.
Wong, S. Y. S., Zhang, D., Sit, R. W. S., Yip, B. H. K., Chung, R. Y. N., Wong, C. K. M., Chan, D. C. C., Sun., W. Kwok, K. O., & Mercer, S. W. (2020). Impact of COVID-19 on loneliness, mental health, and health service utilisation: a prospective cohort study of older adults with multimorbidity in primary care. British Journal of General Practice, 70(700), e817-e824. Web.