For the case study described below, create a multi-axial diagnosis. List what yo
ID: 99302 • Letter: F
Question
For the case study described below, create a multi-axial diagnosis. List what you would diagnose for each of the 5 axes & briefly explain (with examples) your reasoning for each selection you make:
A 27-year-old married electrician complains of dizziness, sweating palms, heart palpitations, and ringing of the ears of more than 18 months’ duration. He has also experienced dry mouth and throat, periods of extreme muscle tension, and a constant “edgy” and watchful feeling that has often interfered with his ability to concentrate. These feelings have been present most of the time over the previous 2 years; they have not been limited to discrete periods. Although these symptoms sometimes make him feel “discouraged,” he denies feeling depressed and continues to enjoy activities with his family.
Because of these symptoms, the patient had seen a family doctor, a neurologist, a chiropractor, and an ear-nose-throat specialist. He had been placed on a nutritious diet including many small meals per day, received physical therapy for a pinched nerve, and was told that he might have “an inner ear problem.”
He also has many worries. He constantly worries about the health of his parents. His father, in fact, had a myocardial infarction (heart attack) 2 years previously, but is now feeling well. He also worries about whether he is “a good father,” whether his wife will ever leave him (there is no indication that she is unhappy with the marriage), and whether co-workers at his job like him. Although he recognizes that his worries are often unfounded (have no basis in truth), he can’t stop worrying.
For the past 2 years, he has had few social contacts because of his nervous symptoms. Although he has sometimes had to leave work when the symptoms became intolerable, he continues to work for the same company he joined for his apprenticeship following high-school graduation. He tends to hide his symptoms from his wife and children, to whom he wants to appear “perfect,” and reports few problems with them as a result of his nervousness.
Explanation / Answer
The electrician is likely to have generalized anxiety disorder (GAD). The symptoms for GAD according to DSM-IV-TR criteria includes restlessness, fatigue, difficulty in concentrating, irritability, muscle tension, sleep disturbances. GAD is diagnosed when a pattern of frequent, persistent worry and anxiety that is out of portion to the impact of the event becomes the focus of the worry. The clinical features for GAD include motor tension such as shakiness, restlessness and headaches, autonomic hyperactivity including shortness of breath, sweating too much and palpitations; and cognitive vigilance such as irritability and startling. The best diagnosis would be to check for:tensions, worries or fears everyday for at least six months with the symptoms of increased heart rate, tremor, chest pain, dizziness, fear of losing control, cold flashes and startled response. The patient is usually tormented with constant worries and they also worry about the fact that they are always worrying meaning meta-worrying.