anxiety disorder
...t, the person feels there’s no way out of the vicious cycle of anxiety and worry, and then becomes depressed about life and the state of anxiety they find themselves in. Feelings of worry, dread, lack of energy, and a loss of interest in life are common. Many times there is no "trigger" or "cause" for these feelings and the person realizes these feelings are irrational. (http://www.mentalhealthchannel.net/gad/symptoms.shtml). The Psychiatric Mental Health Nursing textbook states, the primary symptom of GAD is, not surprisingly, excessive anxiety or dread. Clients with GAD typically realize that their symptoms are out of proportion to any real threat. According to DSM-IV-TR definitions, anxiety is considered excessive when it present more days than not for a period of six months or more. Anxiety is “generalized” if it focuses on a variety of life events or activities. The focus of anxiety cannot be solely on specific topics, such as gaining weight or fearing illness. To meet DSM-IV-TR criteria for a disorder, the anxiety must be both difficult to control and cause significant distress or impairment in functioning. Certain specific symptoms must be present and not be caused by medications, drugs, or illness. These six include three or more of the following: restlessness, easy fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance. When symptoms are due to another psychiatric illness such as depression, GAD is usually not diagnosed (Frisch & Frisch, 2005). Organic personality Disorder: The online Priory Group states, this disorder is characterized by a significant alteration in the expression of emotions, needs and impulses. Cognitive functions may be defective in the areas of planning and thinking and there may also be problems with emotional liability, irritability, anger, apathy and sexual disinhibition. (http://www.prioryhealthcare.co.uk/How-we-can-help/General-psychiatry/Organic-personality-disorder). Anthony Riser states (online), Organic Personality Disorder: Impaired judgment, childish behavior, aggressiveness, paranoia, impaired attention and memory and language difficulties are symptoms of organic personality disorder following TBI. Changes in an individual's character and personality are common after significant frontal lobe damage, and when present, a diagnosis of an Organic Personality Syndrome needs to be considered. Head-injured patients with OPS may be characterized by organically based persistent disturbances in self-control. OPS patients may show marked instability in their affect, some going from tears to laughter to anger in seconds. They may show recurrent belligerence and explosive outbursts of aggression or of rage that are grossly out of proportion to any psychosocial or environmental stressors. They may be markedly impaired in their social (interpersonal) judgment. They may show marked apathy called abulia. Abulia refers to a loss of drive and initiative. It has been described as a loss of purposeful striving. It can be interpreted as either apathy, indifference, and equanimity, depending upon the situational circumstances in which the patient is observed. Hypokinesia refers to the motor complement of the mental phenomenon; that is, patients with this disorder do not initiate motor behavior. Even the normal (unconscious) spontaneous levels of motor activity, such as minor postural adjustments, variations in position, gesturing, are absent or greatly reduced. In the acute phase (or in severe forms) of this disorder, the patient may fail to respond to commands. Mutism is present. In less acute (or less severe) presentations, long delays in initiating responses and slowness in response performance (once initiated) are seen. Upon the return of speech, it may be hypophonic (e.g., whispered) before resuming normal volume. Nevertheless, spontaneous speech is absent or limited. Speech tends to occur only in response to questions or other's speaking in the background. Counterintuitively, occasional and brief periods of excitement or agitation are often reported to occur in this disorder. In everyday situations the patient with this disorder may fail to initiate the retrieval of memories (sometimes referred to as "forgetting to remember"). (http://www.geocities.com/ahris2/npintro2.html) Neuropsychology an introduction by anthony riser. Client was referred by his outpatient psychiatrist, Dr. Go for admission for medication management. Dr. Go has been seeing client weekly with little improvement. Upon admittance to the inpatient unit, client was increasingly tense, anxious, and admitted to irritability leading to near behavioral discontrol over the weekend. Wife reported client made several threatening remarks. Client admitted to SI and HI, he stated more like ruminations with no plans of intent. Client has a history of psychosis NOS, cocaine and benzodiazepine abuse, and numerous blackouts. Client was polite and eager to answer any questioned asked. Client’s speech was at a normal rate, tone, and volume. Client seemed a little nervous as he was looking around at others when they passed by. Client paused in conversation and looked away when he was talking about his new wife and fifteen year old daughter. Client has been taking carbamaepine for approximately one and a half years. This menication is used for tonic-clonic seizures, complex-partial, mixed seizures, and trigeminal neuralgia. Investigational uses include diabetes insipidus, bipolar disorder, neugenic pain, schizophrenia, and psychotic behavior with dementia, rectal administration, diabetic neuropathy, and restless leg syndrome. This drug may cause thrombocytopenia, leukopenia, agranulocytis, leukocytosis, aplastic anemia, eosinophilia, drowsiness, dizziness, unsteadiness, confusion, fatigue, paralysis, headache, hallucinations, worsening of seizures, speech disturbance, nausea, constipation, diarrhea, anorexia, vomiting, abdominal pain, stomatitis, glossitis, increased liver enzymes, hepatitis, rash, Stevens-Johnson syndrome, hypertension, CHF, AV block, hypotension, pulmonary hypotension, albuminuria, increased BUN, and renal failure. Use caution with hypersensitivity to carbamazepine or tricyclics. Renal studies: urinalysis, BUN, and urine creatine every three months. Blood studies: RBC, Hct, Hgb, reticulocyte counts every week for four weeks then every month. Hepatic studies: ALT, AST, bilirubin. Check drug levels during initial treatment or when changing dose; should remain at 4-12 mcg/ml. Inform client to carry an emergency ID stating client’s name, drugs taken, condition, prescriber’s name and phone number. Avoid driving or other activities that require alertness (usually the first three days of treatment). Do not discontinue medications quickly after long-term use. Report immediately chills, rash, light-colored stools, dark urine, yellowing of the skin and eyes, abdominal pain, sore throat, mouth ulcers, bruising, blurred vision, and dizziness. Client has been taking quetiapine/Seroquel for approximately one and a half years. This medication is used for psychotic disorders. Medication may cause EPS, pseudoparkinsonism, akathisia, dystonia, tardive d...