This write-up relates to NK who reports to the facility with a chief complaint of having difficulty sleeping. Upon further assessment, it came out that she has difficulty concentrating and is easily startled. She is worried uncontrollably and was fidgeting her fingers whilst being assessed. NK is a 28-year-old Caucasian woman who is two months pregnant with her first child. After the assessment, this writer playing the role of a provider diagnosed her with generalized anxiety disorder. This writes up in partial fulfillment for the award of a master’s degree in nursing by Walden University looks at the treatment options available to a patient in a specialized population diagnosed with a specific disorder from the DSM5. For the purpose of this write, a pregnant and her first trimester and a diagnosis of generalized anxiety disorder will be used.
According to Newman et al, 2021, Generalized anxiety disorder is a condition characterized by excessive worry, serious tension, and nervousness not caused by an extraordinary event but by daily life occurrences. These worrisome symptoms caused by GAD are much more severe than the common worries and anxieties that people go through. In addition, GAD presents physical symptoms like feelings of restlessness, insomnia, and muscle tension. The causes of GAD vary from biological factors to stressful life events, psychological and environmental factors (Newman et al, 2021).
The diagnostic and statistical manual of mental disorders 5th edition (DSM5) states the criteria for diagnosing GAD has an excessive worry and anxiety over day-to-day activities for a period of at least six months, the inability of the person to control the worry, and at least three of the following physical symptoms in the case of adults; tiring easily, restlessness, increased muscle aches or soreness, insomnia, and impaired concentration (American Psychiatric Association, 2013). Based on this criterion, NK admitted four of the physical symptoms being restlessness, fatigue, insomnia, and body aches. She also displayed anxiety and complained of excessive worry which she does not know how to manage. These led this writer to arrive at a diagnosis of GAD.
Generalized Anxiety disorder can be treated with either pharmacological, nonpharmacological, or a combination of both interventions. Pharmacological interventions are in the form of antidepressants to alleviate depression and anti-anxiety to inhibit anxiety. In some instances, benzodiazepines may be used to relieve anxiety. Those are the generalized treatment options for a regular population; however, these interventions may be schemed when dealing with a specialized population like a pregnant woman.
The treatment for GAD in a specialized population like NK would involve mainly therapy and psychoeducation. The medication would be considered in the severe cases. Nonpharmacological intervention that would be considered in the case of NK would be Cognitive Behavioral Therapy (CBT) because CBT as a treatment for GAD has been established as an excellent way to change pathological worries into normal worries (Borza, 2017).
In the event that NK’s symptoms become severe, escitalopram 10 mg QD will be prescribed. Prozac is a selective serotonin reuptake inhibitor that acts as an antidepressant. They are known to have the ability to cross the placenta but are generally safe for both mother and fetus. Benzodiazepines may not be considered because of the risk of fetal dependence and withdrawals. The FDA-approved list of SSRIs for the treatment of Gad includes paroxetine, escitalopram. Venlafaxine and duloxetine are approved selective serotonin and norepinephrine inhibitors (FDA, 2021).
Aside from the FDA-approved medical interventions, there are a few off-label medications that can be prescribed for GAD. This writer will recommend gabapentin 100 mg TID. Gabapentin is an anticonvulsant taken as an immediate release or extended-release. Gabapentin will be recommended as off-label for GAD for pregnancy with NK.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
Borza L. (2017). Cognitive-behavioral therapy for generalized anxiety. Dialogues in clinical neuroscience, 19(2), 203–208. https://doi.org/10.31887/DCNS.2017.19.2/lborza
FDA. (2021, September 23). First generic drug approvals. U.S. Food and Drug Administration. https://www.fda.gov/drugs/drug-and-biologic-approval-and-ind-activity-reports/first-generic-drug-approvals
Newman, M. G., Kanuri, N., Rackoff, G. N., Jacobson, N. C., Bell, M. J., & Taylor, C. B. (2021). A randomized controlled feasibility trial of internet-delivered guided self-help for generalized anxiety disorder (GAD) among university students in India. Psychotherapy, 58(4), 591–601. https://doi.org/10.1037/pst0000383.supp (Supplemental)
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