The client is a 46-year-old white male who works as a welder at a local steel fa

The client is a 46-year-old white male who works as a welder at a
local steel fabrication factory. He presents today after being referred by his
PCP after a trip to the emergency room in which he felt he was having a heart
attack. He stated that he felt chest tightness, shortness of breath, and
feeling of impending doom. He does have some mild hypertension (which is
treated with low sodium diet) and is about 15 lbs. overweight. He had his
tonsils removed when he was 8 years old, but his medical history since that
time has been unremarkable. Myocardial infarction was ruled out in the ER and
his EKG was normal. Remainder of physical exam was WNL.
He admits that he still has
problems with tightness in the chest and episodes of shortness of breath- he
now terms these “anxiety attacks.” He will also report occasional feelings of
impending doom, and the need to “run” or “escape” from wherever he is at.
In your office, he confesses to
occasional use of ETOH to combat worries about work. He admits to consuming
about 3-4 beers/night. Although he is single, he is attempting to care for
aging parents in his home. He reports that the management at his place of
employment is harsh, and he fears for his job. You administer the HAM-A, which
yields a score of 26.
Client has never been on any
type of psychotropic medication.
MENTAL STATUS EXAM
The client is alert, oriented
to person, place, time, and event. He is appropriately dressed. Speech is
clear, coherent, and goal-directed. Client’s self-reported mood is “bleh” and
he does endorse feeling “nervous”. Affect is somewhat blunted, but does brighten
several times throughout the clinical interview. Affect broad. Client denies
visual or auditory hallucinations, no overt delusional or paranoid thought
processes readily apparent. Judgment is grossly intact, as is insight. He
denies suicidal or homicidal ideation.
You administer the Hamilton
Anxiety Rating Scale (HAM-A) which yields a score of 26.
Diagnosis: Generalized anxiety
disorder
RESOURCES
§ Hamilton, M. (1959). Hamilton
Anxiety Rating Scale. Psyctests, doi:10.1037/t02824-0

Posted in Uncategorized

Place this order or similar order and get an amazing discount. USE Discount code “GET20” for 20% discount