Anxiety Case Study
Tom is a successful business and family man, with no health problems to speak of. From all outward appearances, Tom has no problems that could reasonably be assumed to be the root of the anxiety that has stubbornly plagued him during the past six months. Tom is experiencing generalized anxiety which is described as fearfulness, hopelessness, and worry that persevere even though there is no immediate threat or direct causation, and it is usually accompanied by physiological reactions such as headaches, nausea, fatigue, muscle tension, irritability, hot flashes, insomnia, and difficulty with concentration. Tom is consistently experiencing all the aforementioned symptoms. At times, Tom's anxiety is extreme enough that it interferes with his activities of daily living and his ability to function normally at work, home, and in society. (University of Phoenix, 2006)
Anxiety disorders have been strongly linked to genetic predisposition and can be shaped by experience; additionally, anxiety disorders can generally be traced to a specific stressor or traumatic event (Pinel, 2007). Trauma, as defined by the American Psychiatric Association, as "an event involving actual or threatened loss of life or personal integrity such that one experiences extreme fear, helplessness, or horror...studies have found that major depressive disorder and generalized anxiety disorder commonly develop in the aftermath of a trauma" (Grant, Beck, Marques, Palyo, & Clapp, 2008, p1).
Anxiety is generally treated with serotonin agonists and benzodiazepine. Benzodiazepines are thought to work as agonists, similar to serotonin agonists, because it binds to GABAA receptors. Benzodiazepines are highly addictive, so they are not recommended for long-term use; side effects include: problems with motor activities, nausea, tremors, sedation, and rebound anxiety. Serotonin agonists are most frequently used in the treatment of anxiety disorders, since they have less severe side effects than do benzodiazepines; however, serotonin agonists tout the following side effects: nausea, insomnia, headaches, and dizziness. Serotonin agonists exert their effect on the 5-HT1A serotonin receptor. Due to the medications used to treat anxiety disorders working as agonists on serotonin or GABAA receptors, the amygdale is believed to play a primary role in anxiety, because of its role in defensive behaviors and fear and due to the high concentration of GABAA receptors located in the amygdale. (Pinel, 2007)
Insomnia Case Study
Insomnia is a sleeping disorder in which a person has difficulty falling or staying asleep, waking too early, or a poor quality of sleep; Mary, a single mother, has been experiencing insomnia for the past month which is beginning to have bleed over into her waking hours, such as day time fatigue which is beginning to affect her professional life and cause serious problems in maintaining a social life. Mary states that she does not take any medications, drugs, or alcohol, and has no prior history of mental illness. After discussing the issue with her doctor, Mary is frustrated that he is reluctant to prescribe anything to help her sleep, fearing that she will become overly dependent. (University of Phoenix, 2006)
Hypnotic drugs, benzodiazepines, are the class used in the short-term to increase sleep. There are some major problems presented with long-term use of hypnotic drugs; these are the rapid development of tolerance to the medication causing the patient to take ever increasing dosages to continue the drug's effects, the drug is addictive, and stopping the medication after continued use causes rebound insomnia. Mary's doctor is wise to be hesitant in prescribing sleeping pills for her. Interestingly, melatonin is gathering support in the battle of sleeplessness. Melatonin is a serotonin synthesized hormone localized in the pineal gland which is primary in regulation of circadian sleep rhythms by releasing melatonin (Pinel, 2007).
There are four primary reasons for insomnia; they are: dependence on sleeping pills and rebound insomnia, cessation of breathing during sleep (sleep apnea), muscular twitching during sleep (nocturnal myoclonus), and discomfort and tension during the night that makes falling to sleep difficult (restless leg syndrome). These causes of insomnia, some of which can be life threatening, need to ruled out via an extensive sleep study, prior to Mary beginning a program of medication to alleviate her sleeping disorder. Prolonged cases of insomnia can lead to microsleeps, which are short periods of sleep during the day that last approximately two or three seconds which can pose a danger to Mary's health and safety and the health and safety of others. (Pinel, 2007)
References
Grant, D. M., Beck, J. G., Marques, L.,Palyo, S. A., & Clapp, J. D. (2008). The structure of distress following trauma: Posttraumatic stress disorder, major depressive disorder, and generalized anxiety disorder. Journal of Abnormal Psychology; 117:3; p662-672.
University of Phoenix. (2006). PSY 240: The brain, the body, and the mind: Appendix A. Axia College of University of Phoenix Course Materials; v2. Retrieved from https://axiaecampus.phoenix.edu/
Pinel, J. P. J. (2007). Basics of biopsychology. Boston, MA: Allyn and Bacon.
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