Question

ase Study Identifying Factors: Carmen Matthews is a 41-year-old separated Hispanic mother of two children, ages 10 and 12. She works full-time as a real estate agent. She is referred by her counselor. Chief Complaint: “I am so worried all the time. I feel like I’m caught in a nightmare.” History of Present Illness: The patient reports increased anxiety since her husband abruptly left town with his secretary about 8 months ago. She complains of constant worrying about paying her bills because of a downturn in the real estate market that reduced her income. Three months ago, she began to have more difficulty falling asleep, reporting that it can take her as much as 2 to 3 hours because she can’t stop worrying about how to provide for her children and how she will ever keep up with her mortgage and auto payments. She estimates her total sleep to be 4 hours a night. In addition to difficulty falling asleep, she complains of fatigue, impaired concentration, and muscle tension, which are having a detrimental effect on her performance at work She also complains of frequent headaches, which are not typical for her. She denies depressed mood or suicidal ideation, intent, and plan. She describes herself as a strong, positive person who has always been able to deal with her own problems, although she admits that she has always had a tendency to worry. She has no family in town and few close friends. Current Medications: None. Substance Abuse: Carmen denies use of alcohol, tobacco, and all other licit or illicit drugs. She drinks about 4 cups of tea a day. questions What additional information would have been helpful? What kind of medication(s) would you consider starting her on? Include rationale” “How would you write out one of the prescriptions?” “When would you want her to return for a follow-up visit?” “ “Choice and rationale for medication adjustment(s) for Carmen.” Rationale for if you would or would not start Carmen on Clonazepam

Answer 1

1 No information given about her nutritional history .Needed more information on her family history to take note whether any of her relatives suffered from anxiety or depressive episodes.

2 I would consider prescribing Anxiolytics,especially benzodiazepines.Since she is having trouble sleeping and is under financial stress.She must be in lot of stress and Clonazepam will be a good choice in the treatment of anxiety as well as for the treatment of insomnia.

3 I would advise her to use it for a week and return for a follow-up to check whether there is a need for changing the drug if her anxiety doesnt subsides.